{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T10:35:09Z","timestamp":1788690909545,"version":"build-2803163510"},"reference-count":71,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2018,2,21]],"date-time":"2018-02-21T00:00:00Z","timestamp":1519171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Centre of Research Excellence in Reducing Healthcare Associated Infections"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Surgical site infection (<jats:styled-content style=\"fixed-case\">SSI<\/jats:styled-content>) following caesarean section is a problem for women and health services. Caesarean section is a high volume procedure and the estimated incidence of <jats:styled-content style=\"fixed-case\">SSI<\/jats:styled-content> may be as high as 9%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The objective of this study was to identify a suite of perioperative strategies and surgical techniques that reduce the risk of <jats:styled-content style=\"fixed-case\">SSI<\/jats:styled-content> following caesarean section.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>Six electronic databases were searched to systematically review literature reviews, systematic reviews and meta\u2010analyses published from 2006 to 2016. Search terms included: <jats:italic>endometritis, <jats:styled-content style=\"fixed-case\">SSI<\/jats:styled-content>, caesarean section, meta\u2010analysis, review, systematic<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection criteria<\/jats:title><jats:p>Studies were sought in which competing perioperative strategies and surgical techniques relevant for caesarean section were identified and quantifiable infection outcomes were reported. General infection control strategies were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>Data on study characteristics and clinical effectiveness were extracted. Quality, including bias within individual studies, was examined using a modified A Measurement Tool to Assess Systematic Reviews (<jats:styled-content style=\"fixed-case\">AMSTAR<\/jats:styled-content>) checklist. Recommendations for <jats:styled-content style=\"fixed-case\">SSI<\/jats:styled-content> risk\u2010reducing strategies were developed using the Grading of Recommendations Assessment, Development and Evaluation (<jats:styled-content style=\"fixed-case\">GRADE<\/jats:styled-content>) approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>Of 466 records retrieved, 44 studies were selected for the evidence synthesis. Recommended strategies were: administer pre\u2010incision antibiotic prophylaxis, prepare the vagina with iodine\u2010povidone solution and spontaneous placenta removal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We recommend clinicians implement pre\u2010incision antibiotic prophylaxis, vaginal preparation and spontaneous placenta removal as an infection control bundle for caesarean section.<\/jats:p><\/jats:sec><jats:sec><jats:title>Funding<\/jats:title><jats:p>Queensland University of Technology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Infection control for caesarean: pre\u2010incision <jats:styled-content style=\"fixed-case\">AB<\/jats:styled-content> prophylaxis, vaginal prep, spontaneous placenta 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