Authors’ comments

Abstract

My co-authors and I appreciate the interest in and thoughtful comments regarding our ultrasonographic cervical length measurement in the first and second trimester and the risk of preterm delivery. There is considerable evidence to show an association between genital tract infections such as bacterial vaginosis (BV) and preterm delivery (PTD). However there is no agreement regarding the significance of BV colonization and PTD and it is not quite clear whether BV is a cause of preterm birth or just an association. Meta-analyses to date have shown screening and treating BV in pregnancy does not prevent PTD. Only one randomised controlled trial managed to show that treatment of abnormal vaginal flora and BV with oral clindamycin early in the second trimester reduces the rate of late miscarriage and PTD in asymptomatic pregnant women. Several organizations (Centers for Disease Control and Prevention 2002 1564/id) and NICE do not recommend routine screening and treating BV in a general pregnant population. Additionally the American College of Obstetrics and Gynecology (ACOGs) current recommendation is antibiotics do not appear to prolong gestation and should be reserved for group B streptococcal prophylaxis in patients in whom delivery is imminent. The most recent systematic review has concluded that there is no benefit to the use of antibiotic treatment for BV in pregnancy to reduce the risk of pretermbirth or its associated morbidities in low- or high-risk women. Three metaanalyses have been recently published concluded that there is no benefit to screening and treatment of BV among the general obstetric population. Pregnant women who note an abnormal vaginal discharge pruritus or malodor should be tested for BV trichomonas gonorrhea and chlamydia. Those who test positive we treat appropriately. However our study population consisted of asymptomatic and low-risk pregnant women; therefore we do not screen BV routinely in asymptomatic pregnant women. I think that more studies are needed to confirm the effectiveness of the screening and treatment of pregnant women for bacterial vaginosis both in high- or low-risk patients without preterm labour and in patients with preterm labour. (full text)