Bacterial Vaginosis In Pregnancy Research Articles

Mycoplasma genitalium in pregnancy, including specific co-infections, is associated with lower birthweight: A prospective cohort study

Mycoplasma genitalium infection in pregnancy is increasingly reported at similar frequencies to other sexually transmitted infections (STIs). Knowledge on its contribution to adverse pregnancy outcomes is very limited, especially relative to other STIs or bacterial vaginosis (BV). Whether M.genitalium influences birthweight remains unanswered. Associations between birthweight and M.genitalium and other STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis) and BV in pregnancy were examined in 416 maternal-newborn pairs from a prospective cohort study in Papua New Guinea. Compared to uninfected women, M.genitalium (-166.9 g, 95% confidence interval [CI]: -324.2 to -9.7 g, p= 0.038) and N.gonorrhoeae (-274.7 g, 95% CI: -561.9 to 12.5 g, p= 0.061) infections were associated with lower birthweight in an adjusted analysis. The association for C.trachomatis was less clear, and T.vaginalis and BV were not associated with lower birthweight. STI prevalence was high for M.genitalium (13.9%), N.gonorrhoeae (5.0%), and C.trachomatis (20.0%); co-infections were frequent. Larger effect sizes on birthweight occurred with co-infections of M.genitalium, N.gonorrhoeae, and/or C.trachomatis. M.genitalium is a potential contributor to lower birthweight, and co-infections appear to have a greater negative impact on birthweight. Trials examining the impact of early diagnosis and treatment of M.genitalium and other STIs in pregnancy and preconception are urgently needed. Funding was received from philanthropic grants, the National Health and Medical Research Council, and the Burnet Institute. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Persistent Bacterial Vaginosis and Risk for Spontaneous Preterm Birth.

The aim of this study was to determine the association between persistent bacterial vaginosis (BV) in pregnancy and risk for spontaneous preterm birth (sPTB). Retrospective data from IBM MarketScan Commercial Database were analyzed. Women aged between 12 and 55 years with singleton gestations were included and linked to an outpatient medications database and medications prescribed during the pregnancy were analyzed. BV in pregnancy was determined based on both a diagnosis of BV and treatment with metronidazole and/or clindamycin, and persistent treatment of BV was defined as BV in more than one trimester or BV requiring more than one antibiotic prescription. Odds ratios were calculated comparing sPTB frequencies in those with BV, or persistent BV, to women without BV in pregnancy. Survival analysis using Kaplan-Meier curves for the gestational age at delivery was also performed. Among a cohort of 2,538,606 women, 216,611 had an associated International Classification of Diseases, 9th Revision or 10th Revision code for diagnosis of BV alone, and 63,817 had both a diagnosis of BV and were treated with metronidazole and/or clindamycin. Overall, the frequency of sPTB among women treated with BV was 7.5% compared with 5.7% for women without BV who did not receive antibiotics. Relative to those without BV in pregnancy, odds ratios for sPTB were highest in those treated for BV in both the first and second trimester (1.66 [95% confidence interval [CI]: 1.52, 1.81]) or those with three or more prescriptions in pregnancy (1.48 [95% CI: 1.35, 1.63]. Persistent BV may have a higher risk for sPTB than a single episode of BV in pregnancy. · Persistent BV beyond one trimester may increase the risk for sPTB.. · Persistent BV requiring more than one prescription may increase the risk for sPTB.. · Almost half of antibiotic prescriptions treating BV in pregnancy are filled after 20 weeks gestation..

Prevalence of Bacterial Vaginosis During Pregnancy in Tertiary Care Hospital, Lahore

Introduction: Pregnancy is a condition usually associated with increased vaginal discharge including vaginal infections like bacterial vaginosis, leading to adverse perinatal outcomes due to disturbance in vaginal ecosystem that warrants further evaluation and timely management.Aims & Objectives: The study was conducted to determine the prevalence of bacterial vaginosis in pregnancy and its contributing factors.Place and duration of study: Out Patient Department of Obstetrics & Gynecology, Shaikh Zayed Hospital, Lahore. Duration of the study was six months.Material & Methods: 120 pregnant females with age 20-40 years with singleton pregnancy of more than 12 weeks’ gestation were included. Women who were immunosuppressed and history of diabetes and hypertension and recent history of use of antibiotics were excluded. Vaginal swab specimen was taken & bacterial vaginosis was labelled after fulfilling Amsel criteria. Data was analyzed using SPSS version 21.Results: In this study, 120 cases were taken and mean age of participants was 27.55±3.97 years. The mean duration of gestation was 18.76±6.14 weeks. Bacterial vaginosis (BV) was seen in 24 (20%) of the cases. BV was seen in 19 (20.65%) cases with age 20-29 years’ vs 5 (17.86%) cases in age group 20-40 years with p= 1.0. Bacterial vaginosis was nearly significantly high in multiparous women where this was seen in 13 (27.65%) cases as compared to 11 (15.06%)cases in primiparous women with p= 0.11. Out of 20 cases of bacterial vaginosis, low education was seen in 12 (60%) of the cases.Conclusion: The prevalence of bacterial vaginosis in pregnancy at local setup is high and is seen nearly in 1 out of 5 cases. This demands health educational programs to enlighten women regarding screening and early detection & treatment to prevent complications during pregnancy.

Bacterial vaginosis in pregnancy: prevalence and outcomes in a tertiary care hospital.

Bacterial Vaginosis (BV) has recently emerged as a global health issue especially in pregnant women because of its adverse outcomes. Various studies have shown the impact of BV on both mother and baby as well as overall reproductive health of women. The study intended to assess the prevalence of BV in pregnant women visiting our hospital and estimate the risk of associated complications. A retrospective study was done on pregnant women who underwent vaginal swab for BV during the period January 2018- July 2019. BV was diagnosed by Nugent score and obstetric details until delivery were noted for pregnancy outcomes. Out of 217 women included in the study, 44 were diagnosed as positive for BV. Variables were compared between BV positive and negative groups by Chi square and t- test and risk ratios calculated for adverse pregnancy outcomes. Statistical analysis was done using SPSS 20.0 version. Prevalence of BV was found to be 20.3%. BV was significantly associated with preterm labour, premature rupture of membranes, preterm delivery, miscarriage, birth asphyxia, low birth weight, and neonatal intensive care unit admission. The study substantiated the evidence from previous studies that pregnant women with BV are at much higher risk for adverse maternal and fetal outcomes. Early Screening and awareness amongst women may help to prevent this.

Impact of treatment and the contribution of persistent posttreatment bacterial vaginosis infection on pregnancy outcome among asymptomatic women: A cohort study

Abstract Objective: The objective of this study was to evaluate the effect of antibiotic treatment and posttreatment persistent bacterial vaginosis (BV) infection on pregnancy outcome among asymptomatic women. Materials and Methods: A prospective cohort study was conducted among consenting, asymptomatic pregnant women without background medical disorders. All participants were recruited in the second trimester and had BV testing using Nugent score. BV-positive women were treated with a 7-day course of metronidazole with a repeat posttreatment laboratory testing after 4 weeks. The primary outcome was pregnancy outcome of BV-positive versus negative women; the secondary outcomes were posttreatment laboratory BV test result and pregnancy outcome among women with resolution versus persistent infection. Data analysis was performed using SPSS version 21.0 and P < 0.05 was significant. Results: The prevalence of BV in pregnancy was 24.1%; vulva itching and vaginal douching were more common among BV-positive women (P = 0.011 and P = 0.001), respectively. Adverse pregnancy outcomes such as premature rupture of membranes (PROM) (odds ratio [OR]: 8.185, 95% confidence interval [CI]: 3.196–20.962; P = 0.005), preterm delivery (OR: 24.517, 95% CI: 6.985–86.049; P = 0.001), and birth weight <2500 g (OR: 6.460, 95% CI: 2.893–14.429; P = 0.005) were more common among BV-positive women. Posttreatment persistent BV infection was 25.0% with significantly higher PROM (OR: 18.21, 95% CI: 4.654–71.317; P = 0.001), preterm delivery (OR: 14.571, 95% CI: 4.138–51.308; P = 0.001), birth weight <2500 g (OR: 14.57, 95% CI: 4.138–51.308; P = 0.001), and low 1st min Apgar scores (OR: 7.333, 95% CI: 1.223–43.960; P = 0.049). Conclusion: Symptom-based approach to BV in pregnancy excludes many asymptomatic women; we hereby recommend routine screening. Also, women with BV in pregnancy should undergo repeat testing posttreatment while those with persistent infection will benefit from repeat treatment pending further evidence to formulate a widely acceptable treatment guideline.

Classification and Regression Trees for Bacterial Vaginosis Diagnosis in Pregnant Women Based on High-Throughput Quantitative PCR

Bacterial vaginosis (BV) diagnosis in pregnancy is based on the Nugent score, which consists of semiquantitation of bacterial morphotypes. Limited data exist concerning molecular-based diagnosis in asymptomatic pregnant women. Using high-throughput quantitative PCR, 34 microorganisms were screened in asymptomatic pregnant women and compared with the Nugent score. Three-hundred and four vaginal samples had a Nugent score <7 (69.9%) and 131, a Nugent score ≥7 (30.1%), consistent with BV. More pregnant women with BV share Atopobiumvaginae, bacterial vaginosis associated bacteria-2, Gardnerella spp., Mobiluncus curtisii, Mo. mulieris, Mycoplasma hominis, Ureaplasma urealyticum, Prevotella bivia, Megasphaera 1, and Megasphaera 2 in their vaginal sample. Fewer pregnant women with BV share Lactobacillus crispatus, L. gasseri, L. jensenii, and Enterococcus faecalis in their vaginal sample (P<0.001). Classification and regression tree analysis was performed to determine which combinations of detected bacteria optimally diagnose BV in this population. A set of only four bacteria of 34 microorganisms (A. vaginae, Gardnerella spp., L. crispatus, and P. bivia) was the best combination to identify BV in a cohort of asymptomatic pregnant women, with a sensitivity of 77.1%, and specificity of 97.0% compared with the Nugent score. The quantitative PCR in the present study responds to the limits of the Nugent score by implementing an easily reproducible quantitative assay to assess the absence of BV in pregnancy.

Bacterial vaginosis in pregnancy – a storm in the cup of tea

Human vaginal microbiota is dominated by Lactobacillus spp both in the non-pregnant and pregnant state. Bacterial vaginosis (BV) is an imbalance of vaginal microbiota caused by a reduction in the normal lactobacillary bacteria, and a heavy over-growth of mixed anaerobic bacteria. Various clinical (Amsel’s Criteria), laboratory (Nugent’s score) and molecular diagnostic method (quantitative PCR) are used for diagnosis. BV in pregnancy is associated with increased risk of preterm birth, low birth weight, chorioamnionitis and postpartum endometritis, apart from bothersome vaginal discharge. Antibiotic treatment with metronidazole or clindamycin are effective in eradicating bacterial vaginosis and safe to use in pregnancy. Treatment of bacterial vaginosis has not been shown to improve obstetric outcomes in women at low risk of preterm birth, but may reduce the risk of preterm birth and low birth weight in women at increased risk of preterm birth. Routine screening and treatment is not recommended in low risk women. Test for cure should be performed after treatment. Further research is required on other treatment modalities such as probiotic therapy and microbiota transplantation.

Screening for Asymptomatic Bacterial Vaginosis in Pregnancy

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)BackgroundTo update its 2008 guideline, the USPSTF conducted a systematic review

USPSTF 2020 Recommendations on Screening for Asymptomatic Bacterial Vaginosis in Pregnancy

USPSTF 2020 Recommendations on Screening for Asymptomatic Bacterial Vaginosis in Pregnancy

Bacterial vaginosis in pregnancy: a current view on diagnosis and therapy (literature review)

Bacterial vaginosis (BV) is the most prevalent lower genital tract disease in women of reproductive age (both pregnant and non-pregnant) and the most common cause of vaginal discharge and foul odor from the genital tract. To date, there is a lot of literature describing many different approaches to the diagnosis and treatment of BV during pregnancy. BV is common, and its precise prevalence varies widely depending on the patient population. Studies confirm that the prevalence of BV among pregnant women is the same as in the population of non-pregnant women, and ranges from 6 to 32%. The link between BV and a patient’s ethnicity, smoking, sexual behavior and douching was established. BV is more prevalent among African American women, smokers, sexually active women compared to virgins and those who use douching. Diagnosis of BV is based on clinical symptoms and the results of microbiological examination. Diagnostic criteria are the same for pregnant and non-pregnant women. If BV is confirmed, treat-ment is indicated. In most international guidelines on sexually transmitted infections, the use of either metronidazole 500 mg orally 2 times a day for 7 days, or clindamycin 300 mg orally 2 times a day for 7 days are recommended for the prevention of adverse obstetric outcomes. BV is considered as the risk factor for adverse obstetric outcomes, such as premature birth, premature rupture of membranes, spontaneous abortion, chorioamnionitis and postpartum infections, such as endometritis and infectious compli-cations in the area of the postoperative wound after cesarean section. Pregnant women with symptoms of BV are advised to be screened and treated to eliminate the symptoms. Treatment with oral or local antibiotics is acceptable to achieve recovery (cure) in pregnant women with a symptomatic course of BV and a low risk of adverse obstetric outcomes. Women without symptoms of BV and women without identified risk factors for preterm birth should not be routinely screened and treated for BV, while patients with an increased risk for premature birth may benefit from routine screening and treatment for BV.

Asymptomatic Bacterial Vaginosis in Pregnancy and Missed Opportunities for Treatment: A Cross-Sectional Observational Study.

Background High rates of bacterial vaginosis (BV) have been described in nonpregnant South African women. Studies of BV in South African pregnant women are sparse. Diagnosis and prompt treatment of BV in pregnancy are expected to have a positive impact on pregnancy outcomes and HIV prevention. This study was undertaken to determine the prevalence of BV in pregnant women in a high HIV burden periurban setting in KwaZulu-Natal and explore how to enhance BV diagnosis in this setting where syndromic management of sexually transmitted diseases is the standard of care. Methods In this cross-sectional study, consenting HIV uninfected pregnant women were examined for abnormal vaginal discharge; nurses determined the vaginal pH and collected a vaginal swab for Gram-stain and Nugent scoring. Findings Among 750 HIV uninfected pregnant women, 280 (37.3%; 95%CI 33.9-40.9) tested positive for BV. Using a vaginal pH > 4.4, 65% of women with BV were correctly identified, while an abnormal vaginal discharge correctly identified a significantly lower proportion (52.9%) of women with BV (p=0.005). The sensitivity, specificity, and positive and negative predictive values of vaginal pH testing were 65.9% (95%CI 60.0 – 71.5%), 61.4% (95%CI 56.8 – 65.9%), and 50.1% and 75.4%, respectively. The 20-24 year-old pregnant women were twice more likely to test positive for BV than the adolescent pregnant women (43.6% vs 21.1%) (p = 0.037) and BV was not associated with the duration of a sexual relationship, frequency of unprotected sex during pregnancy, number of lifetime sex partners, or the partner's age. Conclusion There is a high burden of primarily asymptomatic BV in HIV uninfected pregnant women in this periurban setting. Both the sensitivity and specificity of vaginal pH testing are superior to the symptomatic diagnosis of BV but not good enough to be used as a screening tool.

Total and Free 25-Hydroxy-Vitamin D and Bacterial Vaginosis in Pregnant African American Women.

Objective This study sought to investigate associations between serum total and free 25(OH)D and bacterial vaginosis (BV) in early and later pregnancy among US black women to provide insight into the most clinically relevant measure of vitamin D status among pregnant black women with respect to risk for BV as well as insights into critical time points for measuring and/or addressing vitamin D status in pregnancy. Methods Data and biospecimens were derived from a subsample (N = 137) of women from the Emory University African American Vaginal, Oral, and Gut Microbiome in Pregnancy Cohort, for whom data related to vitamin D status (serum assays for total and free 25(OH)D) and Nugent score of Gram stained vaginal specimens in early (8-14 weeks) and later (24-30 weeks) were available. We compared total and free 25(OH)D concentrations for women according to Nugent score category (normal flora, intermediate flora, and BV) and assessed the odds of BV according to measures of vitamin D status. Results Thirty-seven (27%) women had adequate vitamin D status at baseline, whereas 70 (51%) had insufficient vitamin D and 30 (22%) were vitamin D deficient; there were not significant differences in the proportion of women with adequate, insufficient, or deficient vitamin D according to Nugent score category. However, the odds of BV later in pregnancy were significantly higher for women who experienced a smaller rise in total 25(OH)D and free 25(OH)D from 8-14 through 24-30 weeks gestation. Conclusion The change in measures of vitamin D status from early to later pregnancy is associated with the occurrence of BV in pregnancy. Further research is needed to examine the association between the change in vitamin D status over pregnancy and the occurrence of BV and other measures of vaginal microbial composition as well as to identify factors that influence change in vitamin D status over pregnancy.

Prevalence of bacterial vaginosis in pregnancy in a tertiary health institution, south western Nigeria.

IntroductionBacterial vaginosis (BV) is the most common cause of vaginal discharge in women of child bearing age. Bacterial vaginosis has emerged as a global health issue due to the adverse outcome in pregnancy and in the puerperium. The study determined the prevalence of BV and outcome of delivery among pregnant women.MethodsSocio-demographic data and vaginal swab samples were obtained from 362 consecutive pregnant women with abnormal vaginal discharge attending antenatal clinic in Ekiti State University Teaching Hospital, Ado-Ekiti. Data were analysed using SPSS statistical software 21 and association between variables was compared using Chi square.ResultsThe prevalence of BV among pregnant women with abnormal vaginal discharge in this study was 16.6%. Age group 25-34yrs, multiparity and higher education were significantly associated with BV, p < 0.05. Symptoms such as vulvar itching, dyspareunia, lower abdominal pains and characteristic of vaginal discharge such as colour and consistency were significantly associated with BV, p < 0.05. Women with bacterial vaginosis significantly had prelabour rupture of fetal membrane and their babies were born prematurely with low birth weight and Apgar score of less than 5 at one minute, p < 0.05. However, there was no difference statistically in rate of admission into special care baby unit among the women, p > 0.05.ConclusionThe findings of this study suggest that there should be screening for BV in pregnant women presenting with abnormal vaginal discharge so that they could be treated accordingly. This will mitigate the complications arising from bacterial vaginosis.

Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial

Preterm delivery during pregnancy (<37 weeks' gestation) is a leading cause of perinatal mortality and morbidity. Treating bacterial vaginosis during pregnancy can reduce poor outcomes, such as preterm birth. We aimed to investigate whether treatment of bacterial vaginosis decreases late miscarriages or spontaneous very preterm birth. PREMEVA was a double-blind randomised controlled trial done in 40 French centres. Women aged 18 years or older with bacterial vaginosis and low-risk pregnancy were eligible for inclusion and were randomly assigned (2:1) to three parallel groups: single-course or triple-course 300 mg clindamycin twice-daily for 4 days, or placebo. Women with high-risk pregnancy outcomes were eligible for inclusion in a high-risk subtrial and were randomly assigned (1:1) to either single-course or triple-course clindamycin. The primary outcome was a composite of late miscarriage (16-21 weeks) or spontaneous very preterm birth (22-32 weeks), which we assessed in all patients with delivery data (modified intention to treat). Adverse events were systematically reported. This study is registered with ClinicalTrials.gov, number NCT00642980. Between April 1, 2006, and June 30, 2011, we screened 84 530 pregnant women before 14 weeks' gestation. 5630 had bacterial vaginosis, of whom 3105 were randomly assigned to groups in the low-risk trial (n=943 to receive single-course clindamycin, n=968 to receive triple-course clindamycin, and n=958 to receive placebo) or high-risk subtrial (n=122 to receive single-course clindamycin and n=114 to receive triple-course clindamycin). In 2869 low-risk pregnancies, the primary outcome occurred in 22 (1·2%) of 1904 participants receiving clindamycin and 10 (1·0%) of 956 participants receiving placebo (relative risk [RR] 1·10, 95% CI 0·53-2·32; p=0·82). In 236 high-risk pregnancies, the primary outcome occurred in 5 (4·4%) participants in the triple-course clindamycin group and 8 (6·0%) participants in the single-course clindamycin group (RR 0·67, 95% CI 0·23-2·00; p=0·47). In the low-risk trial, adverse events were more common in the clindamycin groups than in the placebo group (58 [3·0%] of 1904 vs 12 [1·3%] of 956; p=0·0035). The most commonly reported adverse event was diarrhoea (30 [1·6%] in the clindamycin groups vs 4 [0·4%] in the placebo group; p=0·0071); abdominal pain was also observed in the clindamycin groups (9 [0·6%] participants) versus none in the placebo group (p=0·034). No severe adverse event was reported in any group. Adverse fetal and neonatal outcomes did not differ significantly between groups in the high-risk subtrial. Systematic screening and subsequent treatment for bacterial vaginosis in women with low-risk pregnancies shows no evidence of risk reduction of late miscarriage or spontaneous very preterm birth. Use of antibiotics to prevent preterm delivery in this patient population should be reconsidered. French Ministry of Health.

Clinical evaluation of the efficacy and safety of the use of vagilac to treat bacterial vaginosis in pregnancy

Objective: evaluation of the efficacy and safety of the use of probiotic Vagilac® in the prevention and treatment of vaginal dysbiosis in pregnancy.Material and methods: 140 pregnant women admitted to the Obstetric Probationary Ward of Moscow Regional Research Institute of Obstetrics and Gynecology of the Ministry of Health of Moscow at 36–39 weeks of gestation were examined and treated. All patients underwent complex clinical and laboratory examination. The patients were divided into 2 groups: I – 60 pregnant women with the established diagnosis of «bacterial vaginosis» (BV) and II – 80 pregnant women, who received antibacterial therapy due to exacerbation of infectious extragenital diseases. Of 140 pregnant women, 100 (60 from Group I and 40 from Group II) received oral probiotic Vagilac® for 10–14 days before delivery: 60 women to treat bacterial vaginosis, and 40 to prevent vaginal dysbiosis against the background of systemic antibiotic therapy. The remaining 40 pregnant women from Group II did not receive the probiotic, for which reason the second group was divided into two subgroups (IIa and IIb).Results: the drug has proved itself as a probiotic that is capable to restore vaginal microflora after various disorders, maintain and keep a healthy balance of bacteria that normally live in the vagina, prevent any disorders associated with antibiotic therapy. During vaginal delivery, traumatic injuries of the birth canal tissues were more common in patients who did not receive Vagilac®. The newborns who were born by the mothers who received Vagilac®, had no manifestations of severe forms of infectious and inflammatory diseases.The conclusion. The conducted studies showed that the treatment of bacterial vaginosis in pregnant women with probiotic Vagilak® was effective, did not adversely affect the fetus/child; in the group with and without BV no candidiasis vulvaginitis was detected.

Prevalence of Bacterial Vaginosis among Antenatal Patients at Federal Teaching Hospital Abakaliki, South East Nigeria

Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of child bearing age. About half of these women are asymptomatic. Adverse outcomes are consistently associated with bacterial vaginosis in pregnancy and in the puerperium. This study, which was done to look at the prevalence, involved recruiting 230 participants, and screening them for BV using the Amsel’s criteria. It is hoped that identification and treatment of these women will help prevent some of the sequela associated with BV. Restoration of the vaginal microflora by treating identified cases of BV will also help reduce the transmission of HIV and herpes simplex virus (HSV) as BV propagates their replication and vaginal shedding. Two hundred and thirty women in the age range 16 - 40 years were screened for BV. All the participants douched, soap and water being predominantly used. 55 women (23.9%) had BV based on Amsel’s criteria. Women with only one sexual consort had the highest incidence of BV (51.9%).

Impact of vitamin D supplementation on bacterial vaginosis in pregnancy

Impact of vitamin D supplementation on bacterial vaginosis in pregnancy

No. 211-Screening and Management of Bacterial Vaginosis in Pregnancy.

To review the evidence and provide recommendations on screening for and management of bacterial vaginosis in pregnancy. The clinical practice options considered in formulating the guideline. Outcomes evaluated include antibiotic treatment efficacy and cure rates, and the influence of the treatment of bacterial vaginosis on the rates of adverse pregnancy outcomes such as preterm labour and delivery and preterm premature rupture of membranes. Medline, EMBASE, CINAHL, and Cochrane databases were searched for articles, published in English before the end of June 2007 on the topic of bacterial vaginosis in pregnancy. The evidence obtained was rated using the criteria developed by the Canadian Task Force on Preventive Health Care. Guideline implementation will assist the practitioner in developing an approach to the diagnosis and treatment of bacterial vaginosis in pregnant women. Patients will benefit from appropriate management of this condition. These guidelines have been prepared by the Infectious Diseases Committee of the SOGC, and approved by the Executive and Council of the SOGC. The Society of Obstetricians and Gynaecologists of Canada. There is currently no consensus as to whether to screen for or treat bacterial vaginosis in the general pregnant population in order to prevent adverse outcomes, such as preterm birth.

The treatment of bacterial vaginosis in pregnancy with clindamycin to reduce the risk of infection-related preterm birth: a response to the Danish Society of Obstetrics and Gynecology guideline group's clinical recommendations.

Preterm birth is the major cause of perinatal mortality and morbidity worldwide. Infection/inflammation is responsible for a significant percentage of preterm birth, particularly at early gestations. A recent clinical recommendation by a guidelines group of the Danish Society of Obstetrics and Gynecology advised against the use of clindamycin for the treatment of bacterial vaginosis in pregnancy to reduce the risk of spontaneous preterm birth based on lack of evidence of efficacy. We believe that the evidence for the use of clindamycin for this indication is robust and that this recommendation was reached erroneously on the basis of flawed inclusion criteria: the inclusion of an unpublished study with poorly diagnosed bacterial vaginosis and the exclusion of an important pivotal study on the use of clindamycin in early pregnancy for the prevention of preterm birth. Had these errors been corrected, the conclusions would have been different.

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

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. 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. 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). 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.