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Treatment of bacterial vaginosis in pregnancy in order to reduce the risk of spontaneous preterm delivery - a clinical recommendation

Acta obstetricia et gynecologica Scandinavica, 2016-08, Vol.95 (8), p.850-860 [Peer Reviewed Journal]

2016 Nordic Federation of Societies of Obstetrics and Gynecology ;2016 Nordic Federation of Societies of Obstetrics and Gynecology. ;Acta Obstetricia et Gynecologica Scandinavica © 2016 Nordic Federation of Societies of Obstetrics and Gynecology ;ISSN: 0001-6349 ;EISSN: 1600-0412 ;DOI: 10.1111/aogs.12933 ;PMID: 27258798 ;CODEN: AOGSAE

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Title:
Treatment of bacterial vaginosis in pregnancy in order to reduce the risk of spontaneous preterm delivery - a clinical recommendation
Author: Haahr, Thor ; Ersbøll, Anne S. ; Karlsen, Mona A. ; Svare, Jens ; Sneider, Kirstine ; Hee, Lene ; Weile, Louise K. ; Ziobrowska-Bech, Agnes ; Østergaard, Claus ; Jensen, Jørgen S. ; Helmig, Rikke B. ; Uldbjerg, Niels
Subjects: Anti-Bacterial Agents - therapeutic use ; Bacterial vaginosis ; clindamycin ; Clindamycin - therapeutic use ; Female ; GRADE ; guideline ; Humans ; metronidazole ; Metronidazole - therapeutic use ; Pregnancy ; Pregnancy Complications, Infectious - drug therapy ; Pregnancy Complications, Infectious - therapy ; Premature Birth - etiology ; Premature Birth - prevention & control ; preterm birth ; preterm delivery ; probiotics ; Probiotics - therapeutic use ; Risk Factors ; Treatment Outcome ; Vaginosis, Bacterial - drug therapy ; Vaginosis, Bacterial - therapy
Is Part Of: Acta obstetricia et gynecologica Scandinavica, 2016-08, Vol.95 (8), p.850-860
Description: Introduction Bacterial vaginosis (BV) is characterized by a dysbiosis of the vaginal microbiota with a depletion of Lactobacillus spp. In pregnancy, prevalence's between 7 and 30% have been reported depending on the study population and the definition. BV may be associated with an increased risk of spontaneous preterm delivery (sPTD). However, it is controversial whether or not BV‐positive pregnant women will benefit from treatment to reduce the risk of sPTD. We could not identify any good‐quality guideline addressing this issue. Consequently we aimed to produce this clinical recommendation based on GRADE. Material and methods Systematic literature searches were conducted in the following databases: Guidelines International Network: G‐I‐N, Medline, Embase, The Cochrane Database of Systematic Reviews, Web of Science and http://www.clinicaltrials.gov from 1999 to 3 October 2014. Hence, nine guidelines, 34 reviews, 18 randomized controlled trials and 12 observational studies were included. Results The GRADE quality of evidence was consistently low or very low, primarily because none of the risk ratios (RR) for the risk of sPTD at <37 weeks were statistically significant. Concerning treatment with metronidazole, RR was 1.11 (95% CI 0.93–1.34) in low‐risk pregnancies and 0.96 (95% CI 0.78–1.18) in high risk pregnancies. Concerning treatment with clindamycin at any gestational age, the RR was 0.87 (95% CI 0.73–1.05). Conclusion This systematic review gives a strong recommendation against treatment with metronidazole and a weak recommendation against treatment with clindamycin to reduce the sPTD rate in both high‐risk and low‐risk pregnancies with BV.
Publisher: United States: Blackwell Publishing Ltd
Language: English;French;German
Identifier: ISSN: 0001-6349
EISSN: 1600-0412
DOI: 10.1111/aogs.12933
PMID: 27258798
CODEN: AOGSAE
Source: Journals@Ovid Open Access Journal Collection Rolling
MEDLINE
Alma/SFX Local Collection

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Treatment of bacterial vaginosis in pregnancy in order to reduce the risk of spontaneous preterm delivery - a clinical recommendation

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