Лечение вагиноза не снижает риск преждевременных родов

[Dr.Vad]

Treating Vaginosis Doesn't Prevent Preterm Birth

Obstet Gynecol. 2005 Apr;105(4):857-868.

Antibiotics for Bacterial Vaginosis or Trichomonas vaginalis in Pregnancy: A Systematic Review.

Okun N, Gronau KA, Hannah ME.

Departments of Obstetrics and Gynaecology, Mount Sinai Hospital, and Sunnybrook and Women's College Health Sciences Centre, Toronto; and Maternal Infant and Reproductive Health Research Unit at the Centre for Research in Women's Health, University of Toronto, Toronto, Ontario, Canada.

OBJECTIVE: To determine whether antibiotic treatment for bacterial vaginosis or Trichomonas vaginalis during pregnancy decreases the risk of preterm birth and associated adverse outcomes. DATA SOURCES: Pre-MEDLINE and MEDLINE (1966-2003), EMBASE (1980-2003), and the Cochrane Library were searched using the keywords "bacterial vaginosis," "Trichomonas," "Trichomonas vaginalis," "Trichomonas vaginitis," "Trichomonas infections," "pregnancy," "pregnant," "antibiotics," and "antibiotic prophylaxis."METHODS OF STUDY SELECTION: The search produced 1,888 titles, of which 1,256 abstracts were reviewed further. Of these, 1,217 were ineligible. Inclusion criteria were the following: randomized controlled trials in which antibiotics were compared with no antibiotic or placebo, for women in the second or third trimester of pregnancy with symptomatic or asymptomatic bacterial vaginosis or Trichomonas vaginalis, intact membranes, and not in labor. Exclusion criteria were as follows: published in a language other than English, dropout rate of more than 20% of women in either group, and lack of usable outcomes. Of the 39 papers reviewed in detail, 14 studies were included in the meta-analysis. TABULATION, INTEGRATION, AND RESULTS: One of the authors reviewed titles obtained from the searches, and 2 reviewers independently reviewed the abstracts, excluded those that were ineligible, identified eligible papers, and abstracted the data. For women with bacterial vaginosis, antibiotics reduced the risk of persistent infection but did not reduce the risk of preterm birth or the incidence of associated adverse outcomes for the general population or for any subgroup analyzed. For women with Trichomonas vaginalis, metronidazole reduced the risk of persistent infection but increased the incidence of preterm birth. CONCLUSION: Contrary to the conclusions of 3 recent systematic reviews, we found no evidence to support the use of antibiotic treatment for bacterial vaginosis or Trichomonas vaginalis in pregnancy to reduce the risk of preterm birth or its associated morbidities in low- or high-risk women.

[dr_medvedev]

Ну вот пишут, что у женщин с преждевр родами в анамнезе все же снижает.
Я лично не вижу ничего криминального в рутинной местной терапии бак вагиноза всем беременным без исключения, т.к. он ассоциирован не столько с риском преждевр родов, сколько с повышенной частотой гнойно-септических осложнений в послеродовом периоде.

Br J Obstet Gynaecol. 1997 Dec;104(12):1391-7. Related Articles, Links

Comment in:
BJOG. 2000 Feb;107(2):295-6.
Br J Obstet Gynaecol. 1997 Dec;104(12):1338-40.
Br J Obstet Gynaecol. 1998 Nov;105(11):1239-40.

Impact of metronidazole therapy on preterm birth in women with bacterial vaginosis flora (Gardnerella vaginalis): a randomised, placebo controlled trial.

McDonald HM, O'Loughlin JA, Vigneswaran R, Jolley PT, Harvey JA, Bof A, McDonald PJ.

Department of Microbiology and Infectious Disease, Women's and Children's Hospital, North Adelaide, SA, Australia.

OBJECTIVE: To ascertain whether metronidazole treatment of women with a heavy growth of Gardnerella vaginalis during mid-pregnancy would reduce the risk of spontaneous preterm birth. DESIGN: A multicentre, randomised, placebo-controlled trial. SETTING: Four metropolitan hospitals. PARTICIPANTS: Eight hundred and seventy-nine singleton women with a heavy growth of G. vaginalis or Gram stain indicative of bacterial vaginosis at 19 weeks of gestation. INTERVENTIONS: Oral metronidazole (400 mg) or placebo twice daily for two days at 24 weeks of gestation, and at 29 weeks if G. vaginalis found in test-of-cure swab four weeks after treatment. MAIN OUTCOME MEASURES: Spontaneous preterm birth less than 37 weeks. RESULTS: Intention-to-treat analysis showed no difference between metronidazole and placebo groups in overall preterm birth (31/429 [7.2%] vs 32/428 [7.5%]) or spontaneous preterm birth (20/429 [4.7%] vs 24/428 [5.6%]). Among the 480 women with bacterial vaginosis treatment had no effect on spontaneous preterm birth (11/242 [4.5%] vs 15/238 [6.3%]). In the subset of 46 women with a previous preterm birth, women in the metronidazole group showed a significant reduction in spontaneous preterm birth (2/22 [9.1%] vs 10/24 [41.7%], OR 0.14, 95% CI 0.01-0.84). A treatment effect was also found in compliant women with a previous preterm birth and bacterial vaginosis (0/14 [0%] vs 6/17 [35.3%], OR 0.0, 95% CI 0.0-0.94). CONCLUSION: Metronidazole treatment of women with a heavy growth of G. vaginalis or bacterial vaginosis did not reduce the preterm birth rate. Among women with a previous preterm birth, treatment reduced the risk of spontaneous preterm birth. Further studies are required to confirm these findings.

Искренне,
Медведев М.В.