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Use of chlorhexidine during labor: How effective against neonatal group B streptococci colonization?

Dear Editor, Neonatal septicemia with group B streptococci (GBS) is associated with high morbidity and mortality rates. Intrapartum antibiotic administration to selected at-risk mothers is actually held as the sole treatment with proven efficacy in reducing transmission of GBS from mother to infant (1). Burman and the Swedish Chlorhexidine Study Group (2) reported that vaginal disinfection with chlorhexidine may provide an efficient prevention of neonatal infection with GBS without any significant adverse effects. Their regimen consisted in vaginal flushings with 60 ml chlorhexidine diacetate 0.2% repeated every 6 hours during labor. Since this procedure might be felt rather more constraining for mothers than common nursing care, we looked at the possible efficacy of chlorhexidine lubrified surgical gloves for routine vaginal examinations performed from admission in the labor ward to delivery. Consecutively, fifty-nine pregnant women antenatally screened as GBS carriers were prospectively and randomly allocated in two groups at the onset of labor: vaginal examinstions of the treated group were systematically performed with gloves lubrified with 5 ml chlorhexidine digluconate 1% cream; the control group was examined with uncoated gloves. Swabs for microbiological examination were sampled on different cutaneous areas of the newborn at delivery. We were unable to demonstrate any significant effect of this disinfection procedure on mother-infant GBS vertical transmission: 11 newborns out of 28 (390/,> were colonized in the treated groups versus 13 out of 31 (42%) in the control group (x2 = 0.003). From these results, we suggest that chlorhexidine lubrication of gloves used for vaginal examinations is ineffective in preventing GBS colonization of the newborn. One might consequently speculate about the real efficacy of chlorhexidine in preventing neonatal GBS transmission.