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Routine screening of abnormal vaginal flora during pregnancy reduces the odds of preterm birth: a systematic review
Eszter Hoffmann1,2, Szilárd Váncsa2,3,4, Alex Váradi3
1Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Üllői út, 78/A, 1082, Budapest, Hungary.
Insights
Routine screening for abnormal vaginal flora in pregnant women significantly reduces the risk of preterm birth and low birthweight. This proactive approach in prenatal care improves pregnancy outcomes by identifying and managing infections early.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Infectious Diseases in Pregnancy
Background:
- Prematurity is a leading cause of infant mortality and morbidity globally.
- Bacterial vaginosis is linked to ascending infections, increasing preterm birth risk.
- Current prenatal care lacks routine screening protocols for abnormal vaginal flora.
Approach:
- Systematic review and meta-analysis of 13 trials involving 143,534 pregnant women.
- Compared routine vaginal flora screening (Gram stain, pH) with standard prenatal care.
- Analyzed outcomes including preterm birth (<37 and <32 weeks) and low birthweight (<2500g and <1000g).
Key Points:
- Routine screening significantly reduced preterm birth before 37 weeks (OR 0.71) and before 32 weeks (OR 0.51).
- Screening also decreased low birthweight (<2500g) (OR 0.64) and very low birthweight (<1000g) (OR 0.33) deliveries.
- Effective screening methods included Gram stain, pH testing, and combined approaches.
Conclusions:
- Routine screening for abnormal vaginal flora in pregnancy is effective in preventing preterm birth and low birthweight.
- Implementing screening protocols can improve perinatal outcomes and reduce infant mortality.
- Further research is recommended to refine screening strategies and assess long-term impacts.
Abstract:
Prematurity is the leading cause of perinatal mortality and the morbidity among children under the age of 5. The prevalence of preterm birth is between 5 and 18% worldwide. Approximately 30% of preterm deliveries occur as a consequence of fetal or maternal infections. Bacterial vaginosis can increase the risk of ascending infections. However, there is no recommendation or protocol for screening of abnormal vaginal flora. The aim of this systematic review was to investigate the effectiveness of routine screening of abnormal vaginal flora during pregnancy care. We conducted our systematic search in the following databases: MEDLINE via PubMed, Embase, and Cochrane Library. Studies reporting on pregnant women with no symptoms of bacterial vaginosis were included in our analysis if they provided data on the outcome of their pregnancy. The intervention group went through screening of abnormal vaginal flora in addition to routine pregnancy care. Odds ratio (OR) with 95% confidence intervals (CIs) was used as effect size measure. From each study the total number of patients and number of events was extracted in both the intervention and control arm to calculate OR. Altogether we included 13 trials with 143,534 patients. The screening methods were Gram stain, pH screening, pH self-screening and pH screening combined with Gram stain. Regular screening of vaginal flora compared to no screening significantly reduces the odds of preterm birth before 37 weeks (8.98% vs 9.42%; OR 0.71, CI 0.57-0.87), birthweight under 2500 g (6.53% vs 7.24%; OR 0.64, CI 0.50-0.81), preterm birth before 32 weeks (1.35% vs 2.03%; OR 0.51, CI 0.31-0.85) and birthweight under 1000 g (0.86% vs 2.2%; OR 0.33, CI 0.19-0.57). In conclusion, the routine screening of abnormal vaginal flora might prevent preterm birth, extreme preterm birth, low birthweight deliveries and very low birthweight deliveries. Further research is needed to assess the problem more accurately.
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