Objective To analyze the efficacy of vaginal disinfection with povidone-iodine before cesarean delivery in preventing postoperative infections. Methods Randomized controlled trials, identified from a systematic search of relevant databases including PubMed, EMBASE, CBM, CNKI, and CQVIP, were screened and evaluated according to standardized criteria. RevMan 5.2 software was used to do the meta-analysis. Results A total of 9 randomized controlled trials with 3 024 participants, with 1 508 in the vaginal cleansing group and 1 516 in the control group, were included in this meta-analysis. The analysis result showed that vaginal disinfection with povidone-iodine before cesarean delivery reduced the incidence of post-cesarean endometritis (RR=0.55, 95%CI 0.36-0.85, P=0.007). The incidence of post-cesarean endometritis was significantly reduced in women with ruptured membranes (RR=0.29, 95%CI: 0.16-0.52, P<0.000 1) and women in labor (RR=0.63, 95%CI 0.41-0.96, P=0.03), but not significantly reduced in the women with intact membranes (RR=0.73, 95%CI 0.50-1.08, P=0.11) or women not in labor (RR=0.79, 95%CI 0.53-1.17, P=0.24). Vaginal disinfection could not help to reduce the incidence of postoperative wound infection (RR=0.80, 95%CI 0.53-1.22, P=0.30) or postoperative fever (RR=0.92, 95%CI 0.76-1.11, P=0.37). Conclusion Vaginal disinfection with povidone-iodine before cesarean delivery can decrease the risk of post-cesarean endometritis, especially for women undergoing cesarean delivery with ruptured membranes or in labor, but vaginal disinfection do not reduce the risk of postoperative wound infection or fever.