The effect of birth canal disinfection on HIV perinatal transmission and post-partum outcomes

Objective: To determine the effect of cleaning the birth canal at delivery with the antiseptic chlorhexidine (CL) on: a) perinatal transmission of HIV and other infections; b) neonatal and maternal morbidity and mortality. Methods: Women delivering in the main hospital of Blantyre, Malawi, were enrolled in the intervention (August through October 1994) and control (June, July and November. 1994) phases. Intervention consisted of manual cleaning of the birth canal with a cotton swab soaked in 0.25 CL before every vaginal exam. Babies in intervention phase were wiped with CL-soaked pads. HIV testing was by ELISA for women and PCR for babies. Results: Women who participated in the study were 3641 in the intervention and 3355 in the non-intervenuon.There were no complications to the mother or the child. The overall rate of HIV transmission from mother-to-infant was 27% and was not different in intervention (26.956) and non-intervention (27.9%) babies except when the membranes were ruptured for > 4 hours (24.4% among intervention vs 38.8% among control babies, p=0.02). There were several significant favorable outcomes. Admissions to the hospital due to neonatal problems were fewer among infants bom in the intervention than the non-intervention ( 175% vs 19.5% of deliveries: p=0.03). Neonatal sepsis was lower among infants bom during the intervention (4.7%) compared to the non-intervention (9.2%); OR=0.49, 95% O 0.30-0.80. Postpartum infections were lower in women who received the intervention than in women who did not (OR=0.36,95% CI 0.12-0.91 ), regardless of their HIV status. Postpartum duration of hospital stay was shorter among intervention compared to non-intervention women (Wilcoxon p=0.008). Neonatal mortality was lower in intervention than non-intervention infants (29.4 vs 37.6 per 1000 delr-cries, p=0.07). Infectious causes of infant death were significantly fewer during the intervention than the non-intervention phase (2.5 vs 75 per 1000 deliveries, p=O.OI). Conclusion: These results indicate that birth canal cleaning at delivery has public health benefits. Although the intervention did not reduce perinatal HiV transmission, it was associated with important desirable outcomes. We speculate that the reduced colonization of the birth canal with potential pathogens results in fewer infectious complications.The safety, simplicity and low cost of the intervention may result in lower morbidity and mortality.