Screening for Bacterial Vaginosis in Pregnant Adolescents and Women to Prevent Preterm Delivery

Kahwati, Leila C.; Clark, Rachel; Berkman, Nancy D; Urrutia, Rachel Peragallo; Zeng, Jennifer; Viswanathan, Meera

doi:10.1001/jama.2020.0233

Cited by 22 publications

(44 citation statements)

References 77 publications

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“…A recent review concluded that BV treatment has no benefit in low-risk pregnancies for women with a previous PTB the data is inconclusive. [13] The guidelines of the four countries with the most respondents are consistent with this recent data. The Dutch guideline advises BV screening and treatment in women with previous PTB.…”

Section: Discussionsupporting

confidence: 82%

Differences in clinical practice regarding screening and treatment of infections associated with spontaneous preterm birth: An international survey

Werter

Dehaene

Gurney

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: An association between infections in pregnancy and increased risk of preterm birth (PTB) is described in the literature. We anticipated that differences may exist in screening and treatment approaches for infections associated with PTB, within and between European countries. The aim of this study was to examine and analyse these differences in clinical practice in greater detail. Study Design: We created a descriptive survey examining the screening and treatment of infections in pregnancy. The survey was sent to European representatives of the International Spontaneous Preterm Birth Young Investigators (I-SPY) group in Europe, who sent it to their network. Finally, we had 50 respondents from ten European countries. Results: We found substantial differences in screening for bacterial vaginosis and asymptomatic bacteriuria, administration of antibiotics to women with preterm prelabour rupture of membranes (PPROM), and timing of induction of labour after PPROM. These differences in clinical practice were present both within, and between countries. Conclusions: Approaches for screening and treatment of infections associated with PTB differ between European countries. There is a lack of robust evidence, which is reflected in a lack of uniformity in international guidelines. International collaboration is paramount to enlarge sample sizes in obstetric studies and to facilitate the process of developing, updating, and implementing consistent guidelines across Europe and beyond.

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Section: Discussionsupporting

confidence: 82%

Differences in clinical practice regarding screening and treatment of infections associated with spontaneous preterm birth: An international survey

Werter

Dehaene

Gurney

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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“…The US Preventative Task Force Services released updated recommendations in 2020 regarding screening and treatment of BV in pregnancy. After reviewing results from 13 randomized clinical trials, they recommend against treatment of asymptomatic BV in pregnancy, as treatment does not seem to decrease adverse obstetrical outcomes including PTB, low birth weight, or PPROM [170][171][172]. The benefits of treating high-risk individuals with a history of PTB is less clear [170].…”

Section: Addressing Infection: Trials Of Antibiotics To Prevent Ptbmentioning

confidence: 99%

Landscape of Preterm Birth Therapeutics and a Path Forward

Coler

Shynlova

Boros-Rausch

et al. 2021

JCM

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Preterm birth (PTB) remains the leading cause of infant morbidity and mortality. Despite 50 years of research, therapeutic options are limited and many lack clear efficacy. Tocolytic agents are drugs that briefly delay PTB, typically to allow antenatal corticosteroid administration for accelerating fetal lung maturity or to transfer patients to high-level care facilities. Globally, there is an unmet need for better tocolytic agents, particularly in low- and middle-income countries. Although most tocolytics, such as betamimetics and indomethacin, suppress downstream mediators of the parturition pathway, newer therapeutics are being designed to selectively target inflammatory checkpoints with the goal of providing broader and more effective tocolysis. However, the relatively small market for new PTB therapeutics and formidable regulatory hurdles have led to minimal pharmaceutical interest and a stagnant drug pipeline. In this review, we present the current landscape of PTB therapeutics, assessing the history of drug development, mechanisms of action, adverse effects, and the updated literature on drug efficacy. We also review the regulatory hurdles and other obstacles impairing novel tocolytic development. Ultimately, we present possible steps to expedite drug development and meet the growing need for effective preterm birth therapeutics.

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“…En cuanto al tamizaje de mujeres embarazadas, las guías estadounidenses mencionan que no hay beneficio global en realizarlo (recomendación clase D), ya que la evidencia es insuficiente y no se ha logrado determinar si realmente tratar los casos asintomáticos disminuye el riesgo de parto pretérmino (9,14). En caso de realizarse, el método más simple consiste en un hisopado de secreción vaginal que se observa al microscopio, pero puede llegar a ser tan complejo como realizar pruebas de detección molecular bacteriana.…”

Section: Tamizajeunclassified

Vaginosis bacteriana en el embarazo: últimos avances hasta la fecha

Martínez¹,

Miranda²

2022

Rev.méd.sinerg.

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La vaginosis bacteriana está causada por un desbalance en las poblaciones bacterianas de la microbiota vaginal normal. Ciertas condiciones en las que ocurren cambios hormonales considerables, como el embarazo, pueden precipitar esta disbiosis. En la mayoría de los casos es asintomática; pero de no serlo, se presenta con una secreción vaginal blanquecina, con mal olor, bastante característica. En cuanto a su fisiopatología, los factores de virulencia de las bacterias patógenas son los responsables de la disrupción del microambiente vaginal; y los factores de riesgo son en su mayoría los mismos que se vinculan con otras infecciones de transmisión sexual; sin embargo, también los niveles bajos de vitamina D se han asociado con esta. Su diagnóstico puede ser mediante hallazgos clínicos, histopatológicos o detección molecular; pero lo más reciente corresponde a pruebas rápidas de detección enzimática. Con respecto al tratamiento, en la mayoría de los casos, el consenso es a favor de tratar las pacientes sintomáticas; sin embargo, resulta incierto como se debe proceder con las pacientes asintomáticas.

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Screening for Bacterial Vaginosis in Pregnant Adolescents and Women to Prevent Preterm Delivery

Abstract: IMPORTANCE Preterm delivery results in adverse outcomes; identifying and treating bacterial vaginosis may reduce its occurrence. OBJECTIVE To update the evidence on screening and treatment of asymptomatic bacterial vaginosis in pregnancy for the US Preventive Services Task Force.

Cited by 22 publications

References 77 publications

Differences in clinical practice regarding screening and treatment of infections associated with spontaneous preterm birth: An international survey

Differences in clinical practice regarding screening and treatment of infections associated with spontaneous preterm birth: An international survey

Landscape of Preterm Birth Therapeutics and a Path Forward

Vaginosis bacteriana en el embarazo: últimos avances hasta la fecha

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