Raynes Greenow Camille H, Roberts Christine L, Bell Jane C, Peat Brian, Gilbert Gwendolyn L, Parker Sharon
School of Public Health, University of Sydney, Rm 125, Edward Ford Building A27, Sydney, New South Wales, Australia, 2006.
Cochrane Database Syst Rev. 2011 Sep 7;2011(9):CD003767. doi: 10.1002/14651858.CD003767.pub3.
Preterm birth is a significant perinatal problem contributing to perinatal morbidity and mortality. Heavy vaginal ureaplasma colonisation is suspected of playing a role in preterm birth and preterm rupture of the membranes. Antibiotics are used to treat infections and have been used to treat pregnant women with preterm prelabour rupture of the membranes, resulting in some short-term improvements. However, the benefit of using antibiotics in early pregnancy to treat heavy vaginal colonisation is unclear.
To assess whether antibiotic treatment of pregnant women with heavy vaginal ureaplasma colonisation reduces the incidence of preterm birth and other adverse pregnancy outcomes.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2011).
Randomised controlled trials comparing any antibiotic regimen with placebo or no treatment in pregnant women with ureaplasma detected in the vagina.
Three review authors independently assessed eligibility and trial quality and extracted data.
We included one trial, involving 1071 women. Of these, 644 women between 22 weeks and 32 weeks' gestation were randomly assigned to one of three groups of antibiotic treatment (n = 174 erythromycin estolate, n = 224 erythromycin stearate, and n = 246 clindamycin hydrochloride) or a placebo (n = 427). Preterm birth data was not reported in this trial. Incidence of low birthweight less than 2500 grams was only evaluated for erythromycin (combined, n = 398) compared to placebo (n = 427) and there was no statistically significant difference between the two groups (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.46 to 1.07). There were no statistically significant differences in side effects sufficient to stop treatment between either group (RR 1.25, 95% CI 0.85 to 1.85).
AUTHORS' CONCLUSIONS: There is insufficient evidence to assess whether pregnant women who have vaginal colonisation with ureaplasma should be treated with antibiotics to prevent preterm birth.Preterm birth is a significant perinatal problem. Upper genital tract infections, including ureaplasmas, are suspected of playing a role in preterm birth and preterm rupture of the membranes. Antibiotics are used to treat women with preterm prelabour rupture of the membranes; this may result in prolongation of pregnancy and lowers the risks of maternal and neonatal infection. However, antibiotics may be beneficial earlier in pregnancy to eradicate potentially causative agents.
早产是一个严重的围产期问题，会导致围产期发病率和死亡率上升。重度阴道解脲脲原体定植被怀疑在早产和胎膜早破中起作用。抗生素用于治疗感染，也被用于治疗胎膜早破的孕妇，能带来一些短期改善。然而，在孕早期使用抗生素治疗重度阴道定植的益处尚不清楚。
评估对阴道重度解脲脲原体定植的孕妇进行抗生素治疗是否能降低早产及其他不良妊娠结局的发生率。
我们检索了Cochrane妊娠与分娩组试验注册库（2011年5月31日）。
比较在阴道检测到解脲脲原体的孕妇中，任何抗生素治疗方案与安慰剂或不治疗的随机对照试验。
三位综述作者独立评估纳入标准和试验质量并提取数据。
我们纳入了一项试验，涉及1071名女性。其中，644名妊娠22至32周的女性被随机分为三组抗生素治疗组之一（174名服用无味红霉素，224名服用硬脂酸红霉素，246名服用盐酸克林霉素）或安慰剂组（427名）。该试验未报告早产数据。仅对服用红霉素的女性（共398名）与服用安慰剂的女性（427名）评估了出生体重低于2500克的发生率，两组之间无统计学显著差异（风险比（RR）0.70，95%置信区间（CI）0.46至1.07）。两组之间因副作用严重到足以停药的情况无统计学显著差异（RR 1.25，95%CI 0.85至1.85）。
尚无足够证据评估阴道解脲脲原体定植的孕妇是否应使用抗生素治疗以预防早产。早产是一个严重的围产期问题。包括解脲脲原体在内的上生殖道感染被怀疑在早产和胎膜早破中起作用。抗生素用于治疗胎膜早破的女性；这可能会延长孕周并降低母婴感染风险。然而，抗生素在孕早期可能有助于根除潜在病原体。
