Screening for bacterial vaginosis in pregnancy
CONTEXT: Bacterial vaginosis (BV) is a strong independent risk factor for adverse pregnancy outcomes. BV is found in 9% to 23% of pregnant women. Symptoms include vaginal discharge, pruritis, or malodor, but often women who have BV are asymptomatic. OBJECTIVE: To determine whether screening and trea...
| Main Authors: | , , , |
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| Corporate Authors: | , |
| Format: | eBook |
| Language: | English |
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Rockville (MD)
Agency for Healthcare Research and Quality (US)
2001, 2001
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| Series: | Systematic evidence reviews
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| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | CONTEXT: Bacterial vaginosis (BV) is a strong independent risk factor for adverse pregnancy outcomes. BV is found in 9% to 23% of pregnant women. Symptoms include vaginal discharge, pruritis, or malodor, but often women who have BV are asymptomatic. OBJECTIVE: To determine whether screening and treating pregnant women for BV reduces adverse pregnancy outcomes, as part of an assessment for the U.S. Preventive Services Task Force. DATA SOURCES: Randomized controlled trials (RCTs) of BV treatment in pregnancy that measured pregnancy outcomes were identified from multiple searches in MEDLINE from 1966 to 1999, the Cochrane Controlled Trials Register and Library, and national experts. STUDY SELECTION: All RCTs of BV treatment in pregnancy that specifically measured pregnancy outcomes. CONCLUSIONS: We found no benefit to routine BV screening and treatment. A subgroup of high-risk women may benefit from BV screening and treatment; however, there may be a subgroup for whom BV treatment could increase the occurrence of PTD. KEY WORDS: Bacterial vaginosis, vaginitis, pregnancy, screening, treatment, preterm delivery, antibiotics, adverse effects DATA EXTRACTION: The following information was extracted: study design and blinding, diagnostic methods, antibiotic interventions, timing of antibiotic treatment in pregnancy, criteria for treatment, comorbidities, demographic details, risk factors for preterm delivery (PTD) such as previous PTD, compliance, rates of spontaneous and total PTD less than 37 weeks and less than 34 weeks, preterm premature rupture of membranes, low birth weight less than 2,500 g, spontaneous abortion, postpartum endometritis, and neonatal sepsis. For each study, we measured the effect of treatment by calculating the difference in the rate of a given pregnancy outcome in the control group minus the treatment group (the absolute risk reduction [ARR]). A stepwise procedure based on the profile likelihood was applied to assess heterogeneity, to pool studies when appropriate, and to calculate the mean and 90% confidence intervals (CIs) for the effect of treatment. DATA SYNTHESIS: Seven RCTs met inclusion criteria for the meta-analysis. We found no benefit to BV treatment in average-risk women for any pregnancy outcome. Results of studies of high-risk populations (women who had previous PTD) were statistically heterogeneous. They clustered into 2 groups; 1 showed no benefit (ARR = 0.08, 90% CI = 0.19 to 0.04), whereas 3 homogeneous studies showed potential benefit of BV treatment (pooled ARR = 0.22; 90% CI = 0.13 to 0.31) for PTD before 37 weeks. Four high-risk studies reported results for PTD less than 34 weeks. The pooled estimate showed no benefit (ARR = 0.04, 90% CI = 0.2 to 0.09), but variation was noted among individual studies. Two trials of high-risk women found an increase in PTD less than 34 weeks in women who did not have BV but who received BV treatment. Comparisons of patient populations, treatment regimens, and study designs did not explain the heterogeneity among studies. |
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| Item Description: | Title from HTML header |
| Physical Description: | 1 PDF file |