Ugwumadu Austin
Department of Obstetrics and Gynaecology, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
Best Pract Res Clin Obstet Gynaecol. 2007 Jun;21(3):391-402. doi: 10.1016/j.bpobgyn.2007.01.001. Epub 2007 May 18.
Bacterial vaginosis and intermediate flora are associated with late miscarriage and preterm delivery. The mechanisms involved are not yet fully understood. Clinical trials of antibiotic therapy to reduce these complications have yielded conflicting results. These trials, however, were conducted in mixed populations of pregnant women with variable risk profiles for preterm delivery. Furthermore, investigators used different criteria for diagnosis, treated with different antibiotics at different doses and via different routes, and initiated treatment at different gestational ages. Over 80% of pregnant women with abnormal vaginal flora have a good outcome, and in some populations the presence of bacterial vaginosis is not associated with preterm delivery, suggesting that other host factors may modify the risk. Recent studies have examined the roles of genetic regulation of host immune response, bacterial pathogenic factors, and enzymes in the vagina, and how these factors interact to drive a given outcome. These markers have the potential to better define the women at maximal risk and therefore guide future interventions. This chapter aims to appraise the current state of treatment of abnormal vaginal flora in pregnancy and suggest appropriate management based on the available evidence.
细菌性阴道病和中间型菌群与晚期流产及早产相关。其中涉及的机制尚未完全明确。旨在减少这些并发症的抗生素治疗临床试验结果相互矛盾。然而，这些试验是在早产风险各异的混合孕妇群体中进行的。此外，研究人员使用了不同的诊断标准，采用不同剂量、不同途径使用不同抗生素进行治疗，并在不同孕周开始治疗。超过80%阴道菌群异常的孕妇结局良好，在某些人群中，细菌性阴道病的存在与早产并无关联，这表明其他宿主因素可能会改变风险。近期研究探讨了宿主免疫反应的基因调控、细菌致病因素以及阴道内酶的作用，以及这些因素如何相互作用导致特定结局。这些标志物有可能更好地界定风险最高的女性，从而指导未来的干预措施。本章旨在评估孕期异常阴道菌群的当前治疗状况，并根据现有证据提出适当的管理建议。
