Impact of metronidazole therapy on preterm birth in women with bacterial vaginosis flora (Gardnerella vaginalis): a randomised, placebo controlled trial

McDonald, Helen; O’Loughlin, John; Vigneswaran, R.; Jolley, P. T.; Harvey, J. A.; Bof, A.; McDonald, Peter J.

doi:10.1111/j.1471-0528.1997.tb11009.x

Cited by 261 publications

(186 citation statements)

References 27 publications

Supporting

Mentioning

171

Contrasting

Unclassified

Order By: Relevance

“…These researchers recommended the longer course of therapy to eradicate upper genital tract organisms 11 . The results of this study supported those of McDonald et al 10 in that metronidazole did not reduce preterm delivery among the general population of pregnant women, nor did it reduce hospital admissions for preterm labor or preterm premature rupture of the membranes, postpartum endometritis, clinical intra-amniotic infections, vaginal infections serious enough to require treatment, and treatment with tocolytic drugs. The placebo and metronidazole groups did not differ with regard to incidence of admissions to the neonatal intensive-care unit, passage of meconium, or fetal death/neonatal death.…”

supporting

confidence: 80%

“…However, since the clinical diagnosis of BV need not be symptomatic, screening all pregnant women who have risk factors may be unnecessary and not cost-effective 21 , while the most advantageous time to screen and the optimum dosage of antibiotic is uncertain. 7 Morales et al 9 McGregor et al 1 McDonald et al 10 Cochrane database 3 Joesoef et al 12 Carey et al…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Treating Bacterial Vaginosis on Preterm Labor

Tebes

Lynch

Sinnott

2003

Infectious Diseases in Obstetrics and Gynecology

View full text Add to dashboard Cite

Objective: Multiple studies suggest that bacterial vaginosis (BV) causes preterm labor; yet its routine treatment remains controversial. In order to help to elucidate this controversy, we performed a thorough review of studies with levels of evidence ranging from I to II-II. Methods:We searched for all of the studies from the years 1994 to 2001 via Medline's database, including MD Consult and Ovid Mednet. Results: Several trials discovered a decrease in the incidence of preterm labor when BV was treated, but most of those trials were performed on women with a history of preterm labor. However, the majority of trials reviewed advise against treatment of a general low-risk obstetric population, as there was no significant decrease in preterm labor. Conclusions: Therefore, based on the above studies and the current guidelines of the Centers for Disease Control and Prevention (CDC), treating pregnant women in high-risk populations who are diagnosed with BV provides the clinician with an opportunity to possibly prevent preterm labor in this population. In nulliparous women without a history of preterm birth, treatment is recommended if other risk factors are present (e.g. gonorrhea or chlamydia). However, in the general low-risk populations, routine screening is not indicated.

show abstract

supporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

The Effect of Treating Bacterial Vaginosis on Preterm Labor

Tebes

Lynch

Sinnott

2003

Infectious Diseases in Obstetrics and Gynecology

View full text Add to dashboard Cite

show abstract

“…• Antibiotic treatment for women with a prior preterm birth and bacterial vaginosis has been suggested in secondary analyses to reduce the risk of recurrent preterm birth, 97,98 but evidence is inconsistent. [12][13][14]99,100 Antibiotic treatment of women with a prior preterm birth and a positive fetal fibronectin test 10 and interconceptional antibiotics given to women with a prior preterm birth 11 were both associated with an increased rate of recurrent preterm birth.…”

Section: Interventions Suggested To Reduce the Risk Of Recurrent Pretmentioning

confidence: 99%

Care for Women with Prior Preterm Birth

Iams

2010

Preterm Birth

View full text Add to dashboard Cite

Women who have delivered an infant between 16 and 36 weeks' gestation have an increased risk of preterm birth in subsequent pregnancies. The risk increases with more than 1 preterm birth and is inversely proportional to the gestational age of the previous preterm birth. African American women have rates of recurrent preterm birth that are nearly twice that of women of other backgrounds. An approximate risk of recurrent preterm birth can be estimated by a comprehensive reproductive history, with emphasis on maternal race, the number and gestational age of prior births, and the sequence of events preceding the index preterm birth. Interventions including smoking cessation, eradication of asymptomatic bacteriuria, progestational agents, and cervical cerclage can reduce the risk of recurrent preterm birth when employed appropriately. Keywordscerclage; prevention; progesterone; recurrent; preterm birth; risk estimation Efforts to reduce the incidence of preterm birth cannot yet be called successful but have produced sufficient information to justify management suggestions for clinicians, not only for strategies that do not work but also for those that do. The quality and number of clinical trials of interventions intended to reduce the incidence and/or morbidity of preterm birth has risen substantially in recent years, yielding data that can improve care for women at risk.An important advance has been the revision of the traditional model of preterm birth in which painful contractions or preterm membrane rupture were understood as the most common initial steps preceding cervical change. This concept has been challenged by observations from several clinical studies:• Drugs that arrest or inhibit uterine contractions can delay delivery but do not reliably reduce or prevent preterm birth. [1][2][3][4][5] • Assessment of contraction frequency is not a useful test to predict preterm birth, 6 and its use to detect and arrest initial or recurrent episodes of preterm labor does not affect the rate of preterm birth. [7][8][9] • Antibiotics that eradicate microorganisms associated with preterm birth also do not reliably reduce, and may sometimes increase, the incidence of preterm birth, especially in women with intact membranes. [10][11][12][13][14][15][16][17] • Progestational agents such as 17α-hydroxy-progesterone caproate reduce recurrent preterm birth in some women with a prior preterm birth, 18,19 especially those with early preterm birth 20 and short cervix, 21 but have no effect on preterm birth in multiple gestations. 22,23 NIH Public Access Author ManuscriptAm J Obstet Gynecol. Author manuscript; available in PMC 2013 May 09. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript• Cervical cerclage can reduce recurrent preterm birth in women with a prior preterm birth and short cervix 24,25 but increases the risk of preterm birth in women with multiple gestation who also have a short cervix. 24 These findings suggest the following 4 substantive changes in the "contractions change the cervi...

show abstract

“…There was no benefit from treatment in women who did not have BV. A large Australian study showed a small non-significant trend for a benefit of using short course metronidazole 400 mg bd for 2 days, repeated after 1 month if BV was still present [42]. Subgroup analysis showed a reduction in preterm birth in the treatment group, particularly those with a prior preterm birth who adhered to the medication.…”

Section: Treatment In Pregnancymentioning

confidence: 97%