McDonald H, Brocklehurst P, Parsons J
Microbiology and Infectious Diseases, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, Australia, 5006.
Cochrane Database Syst Rev. 2005 Jan 25(1):CD000262. doi: 10.1002/14651858.CD000262.pub2.
Bacterial vaginosis is an imbalance of the normal vaginal flora with an overgrowth of anaerobic bacteria and a lack of the normal lactobacillary flora. Bacterial vaginosis during pregnancy has been associated with poor perinatal outcome and, in particular, preterm birth. Identification and treatment may reduce the risk of preterm birth and its consequences.
To assess the effects of antibiotic treatment of bacterial vaginosis in pregnancy.
We searched the Cochrane Pregnancy and Childbirth Group trials register (May 2004).
Randomized trials comparing antibiotic treatment with placebo or no treatment, or comparing two or more antibiotic regimens in pregnant women with bacterial vaginosis or intermediate vaginal flora.
Two reviewers assessed trials and extracted data independently. We contacted study authors for additional information.
Thirteen trials involving 5300 women were included; all were of good quality. Antibiotic therapy was effective at eradicating bacterial vaginosis during pregnancy (odds ratio (OR) 0.21, 95% confidence interval (CI) 0.19 to 0.24, nine trials of 3895 women). Treatment was not significant in reducing the risk of preterm birth before 37 weeks (OR 0.87, 95% CI 0.74 to 1.03, thirteen trials of 5300 women, and there was significant heterogeneity between trials, p-value 0.002), preterm birth before 34 weeks (OR 1.22, 95% CI 0.67 to 2.19, five trials of 851 women), preterm birth before 32 weeks (OR 1.14, 95% CI 0.76 to 1.70, four trials of 3565 women), or the risk of preterm prelabour rupture of membranes (OR 0.88, 95% CI 0.61 to 1.28, four trials of 2579 women). In women with a previous preterm birth, treatment did not affect the risk of subsequent preterm birth (OR 0.83, 95% CI 0.59 to 1.17, five trials of 622 women, with significant heterogeneity between these trials); however, it may decrease the risk of preterm prelabour rupture of membranes (OR 0.14, 95% CI 0.05 to 0.38, two trials of 114 women, and low birthweight (OR 0.31, 95% CI 0.13 to 0.75, two trials of 114 women).
AUTHORS' CONCLUSIONS: Antibiotic treatment can eradicate bacterial vaginosis in pregnancy. However, this review provides little evidence that screening and treating all pregnant women with asymptomatic bacterial vaginosis will prevent preterm birth and its consequences. For women with a previous preterm birth, there is some suggestion that treatment of bacterial vaginosis may reduce the risk of preterm prelabour rupture of membranes and low birthweight.
细菌性阴道病是正常阴道菌群失衡，厌氧菌过度生长且缺乏正常乳酸杆菌菌群。孕期细菌性阴道病与不良围产期结局相关，尤其是早产。识别和治疗可能降低早产风险及其后果。
评估孕期细菌性阴道病抗生素治疗的效果。
我们检索了Cochrane妊娠与分娩组试验注册库（2004年5月）。
比较抗生素治疗与安慰剂或不治疗，或比较两种或更多抗生素方案，用于患有细菌性阴道病或中间型阴道菌群的孕妇的随机试验。
两名评价员独立评估试验并提取数据。我们联系研究作者获取更多信息。
纳入了13项涉及5300名女性的试验；所有试验质量良好。抗生素治疗在孕期根除细菌性阴道病有效（比值比（OR）0.21，95%置信区间（CI）0.19至0.24，9项试验共3895名女性）。治疗在降低37周前早产风险方面无显著意义（OR 0.87，95% CI 0.74至1.03，13项试验共5300名女性，试验间存在显著异质性，p值0.002），34周前早产（OR 1.22，95% CI 0.67至2.19，5项试验共851名女性），32周前早产（OR 1.14，95% CI 0.76至1.70，4项试验共3565名女性），或胎膜早破风险（OR 0.88，95% CI 0.61至1.28，4项试验共2579名女性）。对于有早产史的女性，治疗不影响后续早产风险（OR 0.83，95% CI 0.59至1.17，5项试验共622名女性，这些试验间存在显著异质性）；然而，可能降低胎膜早破风险（OR 0.14，95% CI 0.05至0.38，2项试验共114名女性）以及低出生体重风险（OR 0.31，95% CI 0.13至0.75，2项试验共114名女性）。
抗生素治疗可根除孕期细菌性阴道病。然而，本综述几乎没有证据表明对所有无症状细菌性阴道病孕妇进行筛查和治疗可预防早产及其后果。对于有早产史的女性，有一些迹象表明治疗细菌性阴道病可能降低胎膜早破和低出生体重风险。
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