Treatment of bacterial vaginosis in pregnancy in order to reduce the risk of spontaneous preterm delivery - A clinical guideline

INTRODUCTION: Bacterial vaginosis (BV) is characterized by a dysbiosis of the vaginal microbiota with a depletion of Lactobacillus spp. In pregnancy, prevalence's between 7-30% 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 in order to reduce the risk of sPTD. We could not identify any good quality guideline addressing this issue. Consequently we aimed to produce this clinical guideline based on GRADE.

MATERIAL AND METHODS: 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 www . clinicaltrials. gov from 1999 to 3 October 2014. Thus, nine guidelines, 34 reviews, 18 randomized controlled trials and 12 observational studies were included.

RESULTS: The GRADE quality of evidence was consistently low or very low, primarily because none of the risk ratios (RR) for the risk of sPTD<37 weeks were statistically significant: Concerning treatment with metronidazole, RR was 1.11 (95% CI 0.92-1.34) in low risk pregnancies and 0.92 (0.75-1.14) in high risk pregnancies. Concerning treatment with clindamycin at any gestational age, the RR was 0.87 (0.73-1.05).

CONCLUSION: This guideline gives a strong recommendation against treatment with metronidazole and a weak recommendation against treatment with clindamycin in order to reduce the sPTD rate in both high and low risk pregnancies with BV. This article is protected by copyright. All rights reserved.