Preterm birth has been linked to ma...

Preterm birth has been linked to maternal bacterial vaginosis, possibly because of the hostile fetal environment created through related subclinical endometritis. Small studies of systemic and vaginal antibiotics have indicated that treatment of bacterial vaginosis improves pregnancy results but results are inconsistent. Ugwumadu and colleagues reasoned that systemic therapy would be necessary to address endometritis and that treatment early in pregnancy would be required to provide the best environment for the developing fetus.

The consideration group conducted a randomized clinical trial including more than 6000 pregnant women with bacterial vaginosis to assess the impact of systemic clindamycin treatment forward pregnancy outcomes. All women attending sum of two units English teaching hospitals for their first antenatal visit during a three-month period were showed screening for bacterial vaginosis and participation in the study

Patients included in the studious mood were at 12 to 16 weeks of gestation and had no contraindications, so as multiple pregnancy; uterine, cervical, fetal, or systemic disorders; or inability to take clindamycin. Ultrasonography was used to confirm gestational age and omit major fetal and uterine pathologies. The 494 eligible women with abnormal vaginal flora or glaring bacterial vaginosis on screening of vaginal secretions were allocated randomly to clindamycin (300 mg twice daily for five days) or identical placebo. Patients were monitored at clinic visits for pregnancy complications, miscarriage, preterm birth, and adverse meanings Data were collected on gestational age and condition of the infant at delivery.

The treatment and placebo assign places tos were similar at randomization. Five women were misspent to follow-up, and four women electively terminated their pregnancies. Eleven (5 percent) of the women treated with clindamycin had spontaneous preterm deliveries compared with 28 (12 percent) in the placebo form into groups The treated group also had fewer late miscarriages. Overall, 91 percent of women in the treatment cluster and 83 percent in the placebo cluster delivered at term. Mean gestational age and birth weight did not differ significantly between the clumps The effect of clindamycin therapy in reducing miscarriage and preterm delivery was greatest in women with the in the greatest degree severe bacterial vaginosis infection.

The authors close that oral clindamycin therapy used early in the other trimester of pregnancy significantly shapes preterm birth and late miscarriage, especially in women with more relentless infections.

ANNE D WALLING, MD

Ugwumadu A, et al. event of early oral clindamycin onward late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controll trial. Lancet March 22 2003;361:983-8

EDITOR'S NOTE: moment is building toward the aggressive identification and treatment of bacterial vaginosis in pregnancy. This subject of attention makes a persuasive argument for systemic therapy. Another new study reported that preterm deliveries decreased on 60 percent in women treated with intravaginal clindamycin for bacterial vaginosis (See Lamont RF et al. Intravaginal clindamycin to decrease preterm birth in women with abnormal genital tract flora. Obstet Gynecol March 2003;101:516-22) the two studies emphasized treatment as early as possible in pregnancy to improve the intrauterine environment for the developing fetus. the same wonders if the next grade will implicate bacterial vaginosis in early miscarriage or subfertility. Certainly, the condition is moving from being regarded as a "nuisance" to being seen as a serious indicator of an unhealthy genital tract, if not a "disease" in its be in possession of right.--a.d.w.

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group