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Preterm labour--is bacterial vaginosis involved?
H J Odendaal1, I Popov, J Schoeman
1Department of Obstetrics and Gynaecology, University of Stellenbosch, Tygerberg Hospital, Medical Research Council Perinatal Mortality Research Unit, Tygerberg, W Cape.
Summary
Metronidazole treatment for bacterial vaginosis (BV) did not reduce preterm labor in pregnant women. This study found no significant benefits, and in high-risk multigravidae, metronidazole was associated with lower birth weight and increased preterm delivery.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases in Pregnancy
- Clinical Trial Research
Background:
- Bacterial vaginosis (BV) is a common vaginal condition in pregnancy.
- BV has been linked to adverse pregnancy outcomes, including preterm labor.
- Effective treatment strategies for BV to prevent preterm labor are crucial.
Purpose of the Study:
- To evaluate the efficacy of metronidazole in treating bacterial vaginosis (BV).
- To determine if metronidazole treatment reduces the incidence of preterm labor in primigravidae and high-risk multigravidae.
- To assess the impact of metronidazole on birth weight and perinatal outcomes.
Main Methods:
- A randomized controlled trial was conducted in a tertiary academic hospital.
- Participants included primigravidae and high-risk multigravidae screened for BV.
- BV was treated with either metronidazole or vitamin C; outcomes included preterm delivery, birth weight, and perinatal deaths.
Main Results:
- In primigravidae, metronidazole or vitamin C showed no significant difference compared to no BV, except for the 5-minute Apgar score.
- High-risk multigravidae treated with metronidazole had significantly lower birth weights and a higher incidence of delivery before 37 weeks compared to BV-negative or vitamin C groups.
- Delivery before 28 weeks was also significantly higher in the metronidazole group for high-risk multigravidae.
Conclusions:
- Metronidazole treatment for bacterial vaginosis before 26 weeks' gestation does not appear to reduce the prevalence of preterm labor.
- Metronidazole use in high-risk pregnant women with BV was associated with adverse perinatal outcomes, including lower birth weight and increased preterm delivery.
- Previous preterm labor or midtrimester abortion were identified as the primary risk factors for preterm labor.