Background
Surgical site infections (SSIs) occur in around 10% of women following a caesarean section. Efforts to reduce SSI include wound irrigation with povidone–iodine (PVI), but studies are nonconclusive, mostly old and few on women having caesarean section (CS).

Aims
To assess povidone–iodine (PVI) (Betadine) irrigation of wound prior to skin closure in reducing incidence of SSI after CS. Our hypothesis was that there would be no benefit with its use in reducing SSIs.

Materials and Methods
A randomised controlled trial with 3027 women. Women having CS were allocated to receive PVI irrigation or no irrigation after closure of fascia and before skin closure. Women were followed up to four weeks to assess for SSI. Main outcome measure was surgical site infection.

Results
The two groups (1520 in Betadine and 1507 on no Betadine group) were well balanced. The incidence of SSI was similar in the two groups (9.5% vs 9.8%, RR 0.97; 95% CI 0.78–1.21). There was no difference between groups (2.6% vs 2.0%, RR 1.29, 95% CI 0.81–2.06 Betadine vs no Betadine, respectively) in readmission for wound infection requiring intravenous antibiotics; this was so in both the elective CS group as well as CS in labour group.

Conclusion
PVI irrigation after the closure of fascia and before closure of skin is of no benefit in the prevention of SSI in women undergoing CS.