Haahr Thor, Ersbøll Anne S, Karlsen Mona A, Svare Jens, Sneider Kirstine, Hee Lene, Weile Louise K, Ziobrowska-Bech Agnes, Østergaard Claus, Jensen Jørgen S, Helmig Rikke B, Uldbjerg Niels
The Fertility Clinic, Skive Regional Hospital, Copenhagen, Denmark.
Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Acta Obstet Gynecol Scand. 2016 Aug;95(8):850-60. doi: 10.1111/aogs.12933. Epub 2016 Jun 23.
Bacterial vaginosis (BV) is characterized by a dysbiosis of the vaginal microbiota with a depletion of Lactobacillus spp. In pregnancy, prevalence's between 7 and 30% have been reported depending on the study population and the definition. BV may be associated with an increased risk of spontaneous preterm delivery (sPTD). However, it is controversial whether or not BV-positive pregnant women will benefit from treatment to reduce the risk of sPTD. We could not identify any good-quality guideline addressing this issue. Consequently we aimed to produce this clinical recommendation based on GRADE.
Systematic literature searches were conducted in the following databases: Guidelines International Network: G-I-N, Medline, Embase, The Cochrane Database of Systematic Reviews, Web of Science and http://www.clinicaltrials.gov from 1999 to 3 October 2014. Hence, nine guidelines, 34 reviews, 18 randomized controlled trials and 12 observational studies were included.
The GRADE quality of evidence was consistently low or very low, primarily because none of the risk ratios (RR) for the risk of sPTD at <37 weeks were statistically significant. Concerning treatment with metronidazole, RR was 1.11 (95% CI 0.93-1.34) in low-risk pregnancies and 0.96 (95% CI 0.78-1.18) in high risk pregnancies. Concerning treatment with clindamycin at any gestational age, the RR was 0.87 (95% CI 0.73-1.05).
This systematic review gives a strong recommendation against treatment with metronidazole and a weak recommendation against treatment with clindamycin to reduce the sPTD rate in both high-risk and low-risk pregnancies with BV.
细菌性阴道病（BV）的特征是阴道微生物群失调，乳酸杆菌属减少。在孕期，根据研究人群和定义，报告的患病率在7%至30%之间。BV可能与自发性早产（sPTD）风险增加有关。然而，BV阳性的孕妇是否能从治疗中获益以降低sPTD风险存在争议。我们未能找到任何针对此问题的高质量指南。因此，我们旨在基于GRADE制定本临床建议。
在以下数据库进行系统文献检索：国际指南网络（G-I-N）、医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）、考克兰系统评价数据库、科学引文索引数据库以及http://www.clinicaltrials.gov，检索时间为1999年至2014年10月3日。共纳入9项指南、34篇综述、18项随机对照试验和12项观察性研究。
GRADE证据质量一直很低或极低，主要原因是孕周<37周时sPTD风险的风险比（RR）均无统计学意义。关于甲硝唑治疗，低风险妊娠的RR为1.11（95%可信区间0.93 - 1.34），高风险妊娠的RR为0.96（95%可信区间0.78 - 1.18）。关于任何孕周使用克林霉素治疗，RR为0.87（95%可信区间0.73 - 1.05）。
本系统评价强烈建议不使用甲硝唑治疗，弱建议不使用克林霉素治疗，以降低BV阳性的高风险和低风险妊娠的sPTD发生率。
