Vaginal Clindamycin in Preventing Preterm Birth and Peripartal Infections in Asymptomatic Women With Bacterial Vaginosis

Kekki, M; Kurki, Tapio; Pelkonen, J.; Kurkinen-Räty, Merja; Cacciatore, Bruno

doi:10.1097/00006250-200105000-00001

Cited by 8 publications

(26 citation statements)

References 24 publications

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“…Randomized clinical trials (RCTs) of antibiotic administration to reduce the rate of pre-term birth have yielded conflicting results (Morales et al 1994, Hauth et al 1995, McDonald et al 1997, Carey et al 2000, Paavonen et al 2000, Rosenstein et al 2000, Kekki et al 2001, Lamont 2003, Ugwumadu et al 2003) and there is no uniform proof that antibiotic use reduces risk of pre-term birth. The reader is referred to the original trials and systematic reviews for details (Brocklehurst et al 2000, Guise et al 2001, Klebanoff et al 2003, Leitich et al 2003b.…”

Section: Infection and Adverse Pregnancy Outcomementioning

confidence: 99%

A critical assessment of adverse pregnancy outcome and periodontal disease

Wimmer

Pihlstrom

2008

J Clinic Periodontology

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Variability among studies in definitions of periodontal disease and adverse pregnancy outcomes as well as widespread inadequate control for confounding factors and possible effect modification make it difficult to base meaningful conclusions on published data. However, while there are indications of an association between periodontal disease and increased risk of adverse pregnancy outcome in some populations, there is no conclusive evidence that treating periodontal disease improves birth outcome. Based on a critical qualitative review, available evidence from clinical trials indicates that, although non-surgical mechanical periodontal treatment in the second trimester of pregnancy is safe and effective in reducing signs of maternal periodontal disease, it does not reduce the rate of pre-term birth. Clinical trials currently underway will further clarify the potential role of periodontal therapy in preventing adverse birth outcomes. Regardless of the outcomes of these trials, it is recommended that large, prospective cohort studies be conducted to assess risk for adverse pregnancy outcome in populations with periodontal disease. It is critical that periodontal exposure and adverse birth outcomes be clearly defined and the many potential confounding factors and possible effect modifiers for adverse pregnancy outcome be controlled in these studies. If periodontal disease is associated with higher risk of adverse pregnancy outcome in these specific populations, large multicenter randomized-controlled trials will be needed to determine if prevention or treatment of periodontal disease, perhaps combined with other interventions, has an effect on adverse pregnancy outcome in these women.

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Section: Infection and Adverse Pregnancy Outcomementioning

confidence: 99%

A critical assessment of adverse pregnancy outcome and periodontal disease

Wimmer

Pihlstrom

2008

J Clinic Periodontology

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“…Antibacterial vaginosis treatment in asymptomatic women proved ineffective for the reduction in the rate of peripartum infection. On the other hand, recurrent bacterial vaginosis increased the risk for this complication as shown by a randomised, controlled trial that used vaginal clindamycin in bacterial vaginosis [48].…”

Section: Prophylaxismentioning

confidence: 99%

Postpartum infection treatments: a review

Chaim¹,

Burstein²

2003

Expert Opinion on Pharmacotherapy

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Upper genital tract infections are the most common complications of the puerperium. Less frequent complications are mastitis and septic pelvic thrombophlebitis. Several risk factors including obstetrical, gynaecological, demographic and surgical, are associated with an increased rate of postpartum endometritis and their influence is higher after a caesarean than vaginal delivery. Postpartum endometritis rate range from 15 to 35%. Their identification should be prioritized to prevent this complication. The vaginal flora plays a central role in the development of endometritis. Prophylactic antibiotic treatment at the time of caesarean delivery has helped reduce the rate of postpartum endometritis. When endometritis has been identified and cultures from the genital tract obtained. empirical therapy should be instituted until culture results are available and only then, if needed, therapy changed according to the microorganism's sensitivity. The use of penicillins, cephalosporins, aminoglycosides, metronidazole, macrolides, beta-lactamases inhibitors and quinolones has been reviewed. Various available therapies for endometritis and the experience and results of several authors were analysed. Cost-effectiveness is one of the most important aspects in the decision making process in searching for the best therapy. The monitoring of infection rates within each institution to determine the effectiveness of the prophylactic agent to be used is imperative; it would reduce costs and at the same time, provide the best adequate therapy. After reviewing all the aspects of the different therapies used in case of postpartum endometritis, it may be concluded that the combination of clindamycin and gentamicin is preferred as it can be administered once-daily, and is also the least expensive. Other issues to be taken into account are the number of daily doses and duration of therapy, factors that affect patients compliance and cost of hospitalisation.

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“…1,[3][4][5]15,17,18 Although many studies have suggested a link between periodontal disease and preterm delivery and bacterial vaginosis and preterm delivery, treatment studies of low-risk patients have not demonstrated any risk reduction in preterm birth with treatment of either. 14,17,19 These findings, in combination with our finding that the presence of both periodontal disease and BV is not synergistic, suggest that perhaps BV and periodontal disease are clinical markers for a genetic susceptibility or other environmental factors rather than causative agents. It is possible that the polymorphisms in the inflammatory pathway that make subjects more likely to have BV or periodontal disease also place them at higher risk for preterm delivery.…”

Section: Discussionmentioning

confidence: 79%

505: The interaction effect of bacterial vaginosis and periodontal disease on the risk of preterm delivery

Parry

Stamilio

Odibo

et al. 2011

American Journal of Obstetrics and Gynecology

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Objective-To determine if coexistence of periodontal disease (PD) and bacterial vaginosis (BV) is synergistic on the risk of spontaneous preterm delivery (sPTD). Study Design-Secondary analysis of a prospective cohort study. Women were screened 6-20 weeks gestation for PD and BV. Groups were defined by presence of BV and stratified on PD. The primary outcome was sPTD <37 weeks gestation. Univariable, stratified and multivariable analyses were performed to estimate the main and interaction effects of BV and PD on sPTD. Results-Of 1453 women screened, 792 (54.5%) were diagnosed with BV. Neither women with BV in the first trimester nor PD were at higher risk of sPTD (risk ratio (RR) for BV 1.1, 95% confidence interval (CI) 0.8-1.5, RR for PD 0.9, 95% CI 0.7-1.3). The interaction between BV and PD did not statistically significantly impact the odds of sPTD. Conclusions-Coexistence of PD and BV did not have a synergistic effect on sPTD.

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Vaginal Clindamycin in Preventing Preterm Birth and Peripartal Infections in Asymptomatic Women With Bacterial Vaginosis

Cited by 8 publications

References 24 publications

A critical assessment of adverse pregnancy outcome and periodontal disease

A critical assessment of adverse pregnancy outcome and periodontal disease

Postpartum infection treatments: a review

505: The interaction effect of bacterial vaginosis and periodontal disease on the risk of preterm delivery

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