Impact of treatment for bacterial vaginosis on prematurity among Brazilian pregnant women: a retrospective cohort study

Abstract

CONTEXT AND OBJECTIVE: Bacterial vaginosis has been associated with prematurity and other perinatal complications. However, the efficacy of the treatment for preventing such complications has not yet been well established. The objective of this study was to evaluate the impact of treatment for bacterial vaginosis on a low-risk population of Brazilian pregnant women, in order to prevent prematurity and other perinatal complications. DESIGN AND SETTING: Observational retrospective cohort study, at the Obstetric and Gynecology Department, Universidade Estadual de Campinas (Unicamp). METHODS: Vaginal bacterioscopy results from 785 low-risk pregnant women were studied. Three different groups of women were identified: 580 without bacterial vaginosis during pregnancy, 134 with bacterial vaginosis treated using imidazoles (metronidazole, tinidazole, or secnidazole) during pregnancy, and 71 with bacterial vaginosis not treated during pregnancy. The diagnosis of bacterial vaginosis was based on Nugent's criteria, from the vaginal bacterioscopy performed during the first prenatal care visit. RESULTS: The frequency of prematurity was 5.5% among the women without bacterial vaginosis, 22.5% among those with untreated bacterial vaginosis and 3.7% among those with treated bacterial vaginosis. The risk ratios for perinatal complications were significantly higher in the group with untreated bacterial vaginosis: premature rupture of membranes, 7.5 (95% CI: 1.9-34.9); preterm labor, 3.4 (95% CI: 1.4-8.1); preterm birth, 6.0 (95% CI: 1.9-19.7); and low birth weight, 4.2 (95% CI: 1.2-14.3). CONCLUSION: The treatment of bacterial vaginosis significantly reduced the rates of prematurity and other perinatal complications among these low-risk Brazilian pregnant women, regardless of the history of previous preterm delivery.

Genitourinary pathogens and preterm birth

“…failed to reduce the risk of preterm birth (P ¼ 0.84). Studies of bacterial vaginosis in pregnancy and preterm birth published since 2003 continue to emphasize an inconsistency of existing evidence(Table 3)[16,23,[61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78]. Two additional RCTs have been consequently published but failed to replicate the findings of the Cochrane review, though this may represent the use of different treatment approaches[61,62].…”

Frequência e etiologia de fluxos genitais na gravidez

“…A frequência de trabalho de parto prematuro foi de 9,7%, contra 3,2% no grupo sem VB -risco relativo (RR) 1,8; p=0,008. 3 Outro estudo, realizado na Universidade Estadual de Campinas, 4 verificou que o parto prematuro ocorreu em 5,5% (do grupo de mulheres sem VB) contra 22,5% no grupo com VB não tratada, o que conferiu uma razão de risco para as complicações perinatais neste grupo de 7,5 -com intervalo de confiança de 95% (IC95%) 1,9-34,9 -para rotura prematura de membranas no pré-termo; 3,4 (IC95% 1,4-8,1) para trabalho de parto prematuro; 6,0 (IC95% 1,9-19,7) para parto prematuro; e 4,2 (IC95% 1,2-14,3) para baixo peso ao nascer. 4 Acreditamos que essa diferença aparentemente contraditória possa estar associada ao tratamento realizado nas gestantes deste estudo.…”

“…O tratamento de eleição é o metronidazol e acredita-se que o tratamento precoce seja capaz de reduzir as complicações, como por exemplo, o trabalho de parto prematuro. [2][3][4][5] A candidíase vulvovaginal (CVV), também conhecida como monilíase vaginal, é um distúrbio devido ao crescimento anormal de fungos na mucosa do trato genital feminino. A CVV é considerada a segunda causa mais frequente de vulvovaginite, precedida apenas pela VB, não sendo considerada uma doença sexualmente transmissível (DST).…”

Use of a lactic acid plus lactoserum intimate liquid soap for external hygiene in the prevention of bacterial vaginosis recurrence after metronidazole oral treatment

“…Nevertheless, the high rate of remission is usually followed by high and unacceptable rates of recurrence 6,7,14,15 even when metronidazol was prescribed at higher doses 16 . Albeit the natural history of BV was almost totally elucidated, complications such as pelvic inflammatory disease (PID), premature membrane rupture, premature birth, endometritis, and increased susceptibility to reproductive tract infections (RTIs) including HIV are the main concerns with BV 17,18 . In addition, the quality of life of women with BV, mainly those with recurrent BV, is hampered in many domains and in severely affected women it can lead to depression and adversely impact relationships; however, literature regarding quality of life of women with BV is scarce 18 .…”