Pregnancy outcome in asymptomatic women with abnormal vaginal flora without any treatment and after treatment with vaginal clindamycin and clotrimazole: A randomised controlled trial

Abstract

Aims. To study the role of screening for and treatment of abnormal vaginal flora in early pregnancy, and its correlation with pregnancy outcome. Methods. Eight hundred asymptomatic women seen at the antenatal clinic of Lok Nayak Hospital, New Delhi, India, at 12 - 24 weeks’ gestation were screened for abnormal vaginal flora by means of examination of vaginal fluid smears on Gram-stained slides. Two hundred and forty-two women with abnormal vaginal flora were allocated randomly to receive either treatment (vaginal clindamycin and clotrimazole) or no treatment. The presence of abnormal vaginal flora was correlated with pregnancy outcomes in terms of preterm delivery or late miscarriage, premature rupture of the membranes (PROM) and puerperal sepsis. Results. A total of 242 patients with abnormal vaginal flora for whom outcome data were complete were analysed. Intervention in women with abnormal vaginal flora was associated with a decrease in the rate of preterm delivery (30.3% v. 18.6%; relative risk 1.65; 95% confidence interval 1.04 - 2.63; p<0.05). The advantage did not extend to late miscarriage, PROM or puerperal sepsis, as the decrease in these outcomes did not attain statistical significance. Conclusions. Screening for and treatment of asymptomatic abnormal vaginal flora in early pregnancy significantly reduces the rate of preterm delivery and consequent perinatal morbidity and mortality.