Prospective randomised controlled trial of an infection screening programme to reduce the rate of preterm delivery

Abstract

Objective To evaluate whether a screening strategy in pregnancy lowers the rate of preterm delivery in a general population of pregnant women. Design Multicentre, prospective, randomised controlled trial. Setting Non-hospital based antenatal clinics. Participants 4429 pregnant women presenting for their routine prenatal visits early in the second trimester were screened by Gram stain for asymptomatic vaginal infection. In the intervention group, the women's obstetricians received the test results and women received standard treatment and follow up for any detected infection. In the control group, the results of the vaginal smears were not revealed to the caregivers. Main outcome measures The primary outcome variable was preterm delivery at less than 37 weeks. Secondary outcome variables were preterm delivery at less than 37 weeks combined with different birth weight categories equal to or below 2500 g and the rate of late miscarriage. Results Outcome data were available for 2058 women in the intervention group and 2097 women in the control group. In the intervention group, the number of preterm births was significantly lower than in the control group (3.0% v 5.3%, 95% confidence interval 1.2 to 3.6; P = 0.0001). Preterm births were also significantly reduced in lower weight categories at less than 37 weeks and ≤ 2500 g. Eight late miscarriages occurred in the intervention group and 15 in the control group. Conclusion Integrating a simple infection screening programme into routine antenatal care leads to a significant reduction in preterm births and reduces the rate of late miscarriage in a general population of pregnant women.

Antibiotics for treating bacterial vaginosis in pregnancy

“…The results of the five trials (Kekki 1999;Kiss 2004;Lamont 2003;Morales 1994;NICHD MFMU 2000) in which women were treated before 20 weeks' gestation are encouraging, showing a significant association between treatment and preterm birth less than 37 weeks. However this finding needs to be further verified by future trials as there have been no head to head comparisons of early versus late treatment.…”

“…This may be too late to prevent ascending infection and may be one of the main reasons for the observed lack of a statistically significant effect on the preterm birth rates. The five studies in which women were treated before 20 weeks (Kekki 1999;Kiss 2004;Lamont 2003;Morales 1994; NICHD MFMU 2000 subgroup) showed a decrease in risk of preterm birth. Secondly, the efficacy of antibiotic treatment in long-term eradication of bacterial vaginosis is at best 80%.…”

“…Two trials did not report an intention-to-treat analysis (Kiss 2004;Morales 1994). The Morales trial (Morales 1994) excluded women who were not compliant with the treatment allocated (6% of the total trial cohort).…”

Re: Short cervix: is a follow‐up measurement useful?

“…Bacterial vaginosis is an independent risk factor for preterm delivery, affecting 6-32% of pregnant women 2 . So screening for bacterial vaginosis in pregnant women and subsequent antibiotic treatment can effectively prevent preterm labor 3 . Would it be possible for Fox et al to comment on the incidence of bacterial vaginosis in their population?…”

Prevalence of antenatal vulvovaginal candidiasis: our experience

“…Several factors indicate an association between vaginal candidiasis and preterm births. 1,2 Candida can be isolated from the amniotic fluid of the pregnant women with preterm deliveries. 3,4 Candida species colonises the vagina in 20% of all women, which rises to 30% in pregnancy.…”