Podcast Summary

Podcast: Dr. Chapa’s OBGYN Clinical Pearls
Episode: Change Gloves After Placenta at CS? Yes, and No.
Date: November 24, 2025
Host: Dr. Chapa

Episode Overview

This episode addresses a nuanced and timely clinical question in obstetrics: Should providers change surgical gloves after placental delivery and before uterine or abdominal wall closure during cesarean section (C-section) to reduce postoperative wound infections? Dr. Chapa explores the evidence, differing clinical guidelines, and practical implications, positioning the debate as a ‘trial’—presenting both sides and ultimately emphasizing clinical judgment.

Key Discussion Points & Insights

1. The Clinical Question & Its Relevance

• Prompted by a senior OB/GYN resident’s inquiry, Dr. Chapa revisits the longstanding debate on glove changes during C-sections.
• The question: “Is changing gloves after placental delivery evidence-based? Should it be a standard practice?” (03:00)

2. Recent Evidence and Guideline Updates

• International Literature:

  • Journal of Hospital Infection (UK, Nov 13, 2025) published a modeling study analyzing cost-effectiveness of glove changing post-placental delivery in cesarean births.
  • FIGO (International Federation of Gynecology and Obstetrics) issued guidance in September 2025 including:

    “Intraoperative change gloves prior to closure of the abdominal wall.” (12:10)

  • Points out that global recommendations, like FIGO’s, factor in broader international variance (e.g., higher infection rates in some settings).

• US vs. UK Practice Variability:

  • The UK and NHS have different baseline rates of surgical site infections (SSI) and unified care bundles compared to the US, anchoring their recommendations in a different healthcare context.

3. Putting the Issue ‘on Trial’

Dr. Chapa theatrically frames the question as a courtroom debate, switching between roles of “defending” and “prosecuting” glove changing:

• Defense Case:

  • Multiple randomized controlled trials (RCTs) and systematic reviews (notably, Neurice et al., 2021) show glove changing after placental delivery may reduce wound infection rates—but not endometritis or febrile morbidity. (23:30)
  • Relative risk reduction for wound infection estimated at 0.41 (CI 0.26–0.65).
  • Minimal to zero downside risk; low- or no-cost intervention.
  • FIGO and some newly published UK data support glove-changing, primarily for wound infection reduction.

  “Is there data to do this? Absolutely. Is it reasonable to do it? Yes. Is there a harm to do it? Zero. So why not?” —Dr. Chapa (20:16)

• Prosecution (Rebuttal) Case:

  • The cost-effectiveness model from the UK is based on estimates (e.g., 15% baseline SSI rate) much higher than typical US rates (~6% for C-section in general, up to ~12% for high-risk populations). (29:00)
  • US guidelines (ACOG, CDC, SMFM, ERAS) do not recommend routine glove changing, citing insufficient evidence and moderate to low quality data.
  • Even the 2021 systematic review authors concluded that “further adequately powered studies are needed…before routine adoption in clinical practice.” (26:38)
  • WHO echoes this, recognizing “the evidence is weak or moderate at best, and therefore is not currently recommended.” (35:30)

4. Why the Discrepancy?

• The US system relies on rigorous, high-certainty evidence and takes into account other SSI reduction strategies (e.g., skin prep with chlorhexidine, vaginal prep, addition of antibiotics) already widely adopted.
• Differences in baseline SSI rates and healthcare structure set divergent priorities for US vs. international (esp. UK/NHS/FIGO) practice.

5. Dr. Chapa’s Clinical Takeaway

• No harm in changing gloves; potentially some benefit, especially in higher-risk contexts.
• Guidelines may one day change with better evidence, but for now, it remains a personal or institutional practice decision.

  “If it’s low risk and possibly might could help, why not do it?” —Dr. Chapa (36:32)

Notable Quotes & Memorable Moments

• On Evidence Application:

  “Having data is sometimes different than having globally applicable data.” (06:23)

• Regarding Old School Techniques:

  “There was a physician back in Dallas county… after the placenta was out, we would wash our gloves in this little basin of sterile water, like Pontius Pilate. And then he’d say, ‘Proceed, Dr. Santos, God bless him.’” (08:15)

• On Study Quality:

  “…the quality of these data was meh. It really wasn’t great.” (27:50)

• Clinical Judgment:

  “So my answer to this resident was, hey, if they want to do it, why not? And you know what? Do this as a quality assessment…maybe something to consider.” (37:40)

• Practitioner Humor:

  “We’re going to put changing gloves in court…and we’re going to be both the attorney for the defendant, which is changing gloves, thank you very much. And…also the plaintiff, accusing that of not a good—not enough data.” (16:08)

Timestamps for Important Segments

• 03:00 — Listener question: Should gloves be changed after placental delivery?
• 06:23 — Difference between ‘having data’ and ‘having globally applicable data’.
• 08:15 — Historical anecdote: glove “washing” tradition.
• 12:10 — FIGO’s September 2025 recommendation.
• 20:16 — “Is there data to do this? Absolutely…” (summary of defense position)
• 23:30 — Evidence review: Systematic review findings (Neurice et al. 2021).
• 26:38 — Study caveats: “further adequately powered studies are needed...”
• 29:00 — Analysis of UK cost-effectiveness model vs. US SSI incidence.
• 35:30 — WHO perspective.
• 36:32 — Dr. Chapa’s show motto for low-risk interventions.
• 37:40 — Application to individual quality assessment/project.

Summary Table: Major Guidelines & Positions

| Society/Source | Position (as of Nov 2025) | Key Notes | |------------------------|-----------------------------------------------------------|------------------------------------------------| | ACOG (US) | Not recommended/routine; insufficient evidence | Awaiting stronger data | | CDC (US) | Not recommended/routine | Moderate/low-quality evidence | | SMFM (US) | Not included in guidance | | | ERAS Protocol | No recommendation on glove changing | Focus on other SSI reductions | | FIGO (International) | Recommends glove change prior to closure | Considers global settings & ease of implementation | | WHO | Acknowledges weak evidence, not formally recommended | Applicability considered variable | | UK/NHS (2025 model) | Potentially cost-effective (based on local high SSI rate) | Maths-based, local context (not US) |

Final Takeaway

Changing gloves after placental delivery during C-section may reduce wound infection rates, especially in higher-risk settings, and is supported by some international bodies (e.g., FIGO). However, leading US-based organizations do not recommend routine adoption due to the limited quality and moderate effect size of existing evidence. Dr. Chapa’s pragmatic view: feel free to incorporate glove changing if desired—it’s low risk and might help—but understand the current evidence limitations and guideline variability.