McDonald H M, Brocklehurst P, Gordon A
Women's and Children's Hospital, Microbiology and Infectious Diseases, 72 King William Road, North Adelaide, South Australia, Australia, 5006.
Cochrane Database Syst Rev. 2007 Jan 24(1):CD000262. doi: 10.1002/14651858.CD000262.pub3.
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 (PTB). Identification and treatment may reduce the risk of PTB and its consequences.
To assess the effects of antibiotic treatment of bacterial vaginosis in pregnancy.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2006).
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 review authors assessed trials and extracted data independently. We contacted study authors for additional information.
We included fifteen trials of good quality, involving 5888 women. Antibiotic therapy was effective at eradicating bacterial vaginosis during pregnancy (Peto odds ratio (OR) 0.17, 95% confidence interval (CI) 0.15 to 0.20; 10 trials, 4357 women). Treatment did not reduce the risk of PTB before 37 weeks (Peto OR 0.91, 95% CI 0.78 to 1.06; 15 trials, 5888 women), or the risk of preterm prelabour rupture of membranes (PPROM) (Peto OR 0.88, 95% CI 0.61 to 1.28; four trials, 2579 women). However, treatment before 20 weeks' gestation may reduce the risk of preterm birth less than 37 weeks (Peto OR 0.63, 95% CI 0.48 to 0.84; five trials, 2387 women). In women with a previous PTB, treatment did not affect the risk of subsequent PTB (Peto OR 0.83, 95% CI 0.59 to 1.17, five trials of 622); however, it may decrease the risk of PPROM (Peto OR 0.14, 95% CI 0.05 to 0.38) and low birthweight (Peto OR 0.31, 95% CI 0.13 to 0.75)(two trials, 114 women). In women with abnormal vaginal flora (intermediate flora or bacterial vaginosis) treatment may reduce the risk of PTB before 37 weeks (Peto OR 0.51, 95% CI 0.32 to 0.81; two trials, 894 women). Clindamycin did not reduce the risk of PTB before 37 weeks (Peto OR 0.80, 95% CI 0.60 to 1.05; six trials, 2406 women).
AUTHORS' CONCLUSIONS: Antibiotic treatment can eradicate bacterial vaginosis in pregnancy. This review provides little evidence that screening and treating all pregnant women with asymptomatic bacterial vaginosis will prevent PTB and its consequences. However, there is some suggestion that treatment before 20 weeks' gestation may reduce the risk of PTB. This needs to be further verified by future trials.
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（PTB）。识别并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（2006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治疗方案的随机试验，受试对象为患有细菌性阴道病或阴道菌群处于中间状态的孕妇。
两位综述作者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。
我们纳入了15项高质量试验，涉及5888名女性。抗生素治疗在孕期根除细菌性阴道病有效（Peto比值比（OR）0.17，95%置信区间（CI）0.15至0.20；10项试验，4357名女性）。治疗未降低37周前早产风险（Peto OR 0.91，95% CI 0.78至1.06；15项试验，5888名女性），也未降低胎膜早破（PPROM）风险（Peto OR 0.88，95% CI 0.61至1.28；4项试验，2579名女性）。然而，妊娠20周前治疗可能降低小于37周早产风险（Peto OR 0.63，95% CI 0.48至0.84；5项试验，2387名女性）。对于既往有早产史的女性，治疗不影响后续早产风险（Peto OR 0.83，95% CI 0.59至1.17，5项试验，622名）；然而，可能降低胎膜早破风险（Peto OR 0.14，95% CI 0.05至0.38）和低出生体重风险（Peto OR 0.31，95% CI 0.13至0.75）（2项试验，114名女性）。对于阴道菌群异常（中间菌群或细菌性阴道病）的女性，治疗可能降低37周前早产风险（Peto OR 0.51，95% CI 0.32至0.81；2项试验，894名女性）。克林霉素未降低37周前早产风险（Peto OR 0.80，95% CI 0.60至1.05；6项试验，2406名女性）。
抗生素治疗可根除孕期细菌性阴道病。本综述几乎没有证据表明筛查并治疗所有无症状细菌性阴道病孕妇可预防早产及其后果。然而，有一些迹象表明妊娠20周前治疗可能降低早产风险。这需要未来试验进一步验证。
