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. 2015 Feb 1;2015(2):CD006178.
doi: 10.1002/14651858.CD006178.pub3.

Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery

Ussanee S Sangkomkamhang  1 , Pisake Lumbiganon, Witoon Prasertcharoensuk, Malinee Laopaiboon
Affiliations

Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery

Ussanee S Sangkomkamhang et al. Cochrane Database Syst Rev. .

Abstract

Background: Genital tract infection is associated with preterm birth (before 37 weeks' gestation). Screening for infections during pregnancy may therefore reduce the numbers of babies being born prematurely. However, screening for infections may have some adverse effects, such as increased antibiotic drug resistance and increased cost of treatment.

Objectives: To assess the effectiveness of antenatal lower genital tract infection screening and treatment programs for reducing preterm birth and subsequent morbidity.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 7) and reference lists of retrieved reports.

Selection criteria: We included all published and unpublished randomised controlled trials in any language that evaluated any described methods of antenatal lower genital tract infection screening compared with no screening.

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked for accuracy.

Main results: One study (4155 women at less than 20 weeks' gestation) met the inclusion criteria. The intervention group (2058 women) received infection screening and treatment for bacterial vaginosis, trichomonas vaginalis and candidiasis; the control group (2097 women) also received screening, but the results of the screening program were not revealed and women received routine antenatal care. The rate of preterm birth before 37 weeks' gestation was significantly lower in the intervention group (3% versus 5% in the control group) with a risk ratio (RR) of 0.55 (95% confidence interval (CI) 0.41 to 0.75; the evidence for this outcome was graded as of moderate quality). The incidence of preterm birth for infants with a weight equal to or below 2500 g (low birthweight) and infants with a weight equal to or below 1500 g (very low birthweight) were significantly lower in the intervention group than in the control group (RR 0.48, 95% CI 0.34 to 0.66 and RR 0.34; 95% CI 0.15 to 0.75, respectively; both graded as moderate quality evidence). Based on a subset of costs for preterm births of < 1900 g, the authors reported that for each of those preterm births averted, EUR 60,262 would be saved.

Authors' conclusions: There is evidence from one trial that infection screening and treatment programs for pregnant women before 20 weeks' gestation reduce preterm birth and preterm low birthweight. Infection screening and treatment programs are associated with cost savings when used for the prevention of preterm birth. Future trials should evaluate the effects of different types of infection screening programs.

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Conflict of interest statement

None known.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Lower genital tract infection screening versus no screening, Outcome 1 Preterm birth less than 37 weeks.
1.2
1.2. Analysis
Comparison 1 Lower genital tract infection screening versus no screening, Outcome 2 Preterm very low birthweight (below or equal 1500 g).
1.3
1.3. Analysis
Comparison 1 Lower genital tract infection screening versus no screening, Outcome 3 Preterm low birthweight (below or equal 2500 g).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Kiss 2004 {published data only}
    1. Kiss H, Petricevic L, Husslein P. Prospective randomised controlled trial of an infection screening programme to reduce the rate of preterm delivery. BMJ 2004;329:371. - PMC - PubMed
    1. Kiss H, Pichler E, Petricevic L, Husslein P. Cost effectiveness of a screen‐and‐treat program for asymptomatic vaginal infections in pregnancy: towards a significant reduction in the costs of prematurity. European Journal of Obstetrics & Gynecology and Reproductive Biology 2006;127(2):198‐203. - PubMed

References to studies excluded from this review

Gjerdingen 2000 {published data only}
    1. Gjerdinjen D, Fontaine P, Bixby M, Santilli J, Welsh J. The impact of regular vaginal pH screening on the diagnosis of bacterial vaginosis in pregnancy. Journal of Family Practice 2000;49:39‐43. - PubMed
Gupta 2013 {published data only}
    1. Gupta S, Tripathi R, Singh N, Bhalla P, Ramji S, Mala YM. Pregnancy outcome in asymptomatic women with abnormal vaginal flora without any treatment and after treatment with vaginal clindamycin and clotrimazole: a randomised controlled trial. South African Journal of Obstetrics and Gynaecology 2013;19(2):35‐8.
McGregor 1995 {published data only}
    1. McGregor JA, French JI, Parker R, Draper D, Patterson E, Jones W, et al. Prevention of premature birth by screening and treatment for common genital tract infections: results of a prospective controlled evaluation. American Journal of Obstetrics and Gynecology 1995;173(1):157‐67. [MEDLINE: ] - PubMed
Sungkar 2012 {published data only}
    1. Sungkar A. Early self‐diagnosis and treatment of bacterial vaginosis to prevent preterm premature rupture of membranes. Journal of Perinatal Medicine 2013;41(Suppl 1):171.
    1. Sungkar A, Purwosunu Y, Aziz MF, Pratomo H, Sutrisna B, Sekizawa A. Influence of early self‐diagnosis and treatment of bacterial vaginosis on preterm birth rate. International Journal of Gynecology and Obstetrics 2012;117(3):264‐7. - PubMed

Additional references

Amsel 1983
    1. Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. American Journal of Medicine 1983;74:14‐22. [MEDLINE: ] - PubMed
Bejar 1981
    1. Bejar R, Curbelo V, Davi SC, Gluck L. Premature labour bacterial sources of phospholipase. Obstetrics & Gynecology 1981;57(4):479‐82. [MEDLINE: ] - PubMed
Black 1997
    1. Black CM. Current methods of laboratory diagnosis of Chlamydia trachomatis infections. Clinical Microbiology Reviews 1997;10:160–84. [MEDLINE: ] - PMC - PubMed
Borchardt 1991
    1. Borchardt KA, Smith RF. An evaluation of an InPouchTMTV culture method for diagnosing Trichomonas vaginalis infection. Genitourinary Medicine 1991;67(2):149‐52. [MEDLINE: ] - PMC - PubMed
Brocklehurst 1998
    1. Brocklehurst P, Rooney G. Interventions for treating genital chlamydia trachomatis infection in pregnancy. Cochrane Database of Systematic Reviews 1998, Issue 4. [DOI: 10.1002/14651858.CD000054] - DOI - PMC - PubMed
Brocklehurst 2002
    1. Brocklehurst P. Antibiotics for gonorrhoea in pregnancy. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD000098] - DOI - PubMed
Brocklehurst 2013
    1. Brocklehurst P, Gordon A, Heatley E, Milan SJ. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database of Systematic Reviews 2013, Issue 1. [DOI: 10.1002/14651858.CD000262.pub4] - DOI - PMC - PubMed
Cotch 1997
    1. Cotch MF, Pastorek JG 2nd, Nugent RP, Hillier SL, Gibbs RS, Martin DH, et al. Trichomonas vaginalis associated with low birth weight and preterm delivery. The Vaginal Infections and Prematurity Study Group. Sexually Transmitted Diseases 1997;24(6):361‐2. [MEDLINE: ] - PubMed
Cox 1989
    1. Cox SM, MacDonald PC, Casey ML. Cytokines and prostaglandins in amniotic fluid of preterm labor pregnancies: decidual origin in response to bacterial toxins(lipopolysaccharide{LPS} and lipotechnoic acid {LTA}. 36th Annual Meeting of the Society for Gynecologic Investigation; 1989 March 16‐16; San Diego, CA. 1989.
Cunningham 1997
    1. Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC, Hankins GDV, et al. Williams obstetrics. 20th Edition. Connecticut: Appleton & Lange, 1997.
Cunningham 2001
    1. Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC, Hankins GDV, et al. Williams obstetrics. 21st Edition. Connecticut: Appleton & Lange, 2001.
Das 2003
    1. Das A, Ray P, Sharma M, Gopalan S. Rapid diagnosis of vaginal carriage of group B beta haemolytic streptococcus by an enrichment cum antigen detection test. Indian Journal of Medical Research 2003;117:247‐52. [MEDLINE: ] - PubMed
DeMeo 1996
    1. DeMeo LR, Draper DL, McGregor JA, Moore DF, Peter CR, Kapernick PS, et al. Evaluation of a deoxyribonucleic acid probe for the detection of Trichomonas vaginalis in vaginal secretions. American Journal of Obstetrics and Gynecology 1996;174(4):1339‐42. [MEDLINE: ] - PubMed
Domeika 1999
    1. Domeika M, Bassiri M, Butrimiene I, Venalis A, Ranceva J, Vasjanova V. Evaluation of vaginal introital sampling as an alternative approach for the detection of genital Chlamydia trachomatis infection in women. Acta Obstetricia et Gynecologica Scandinavica 1999;78(2):131‐6. [MEDLINE: ] - PubMed
Doyle 1996
    1. Doyle LW, Ford GW, Olinsky A, Knoches AM, Callanan C. Bronchopulmonary dysplasia and very low birth weight: lung function at 11 years of age. Journal of Pediatrics and Child Health 1996;32:339‐43. [MEDLINE: ] - PubMed
Elliott 1990
    1. Elliott B, Brunham RC, Laga M, Piot P, Ndinya‐Achola JO, Maitha G, et al. Maternal gonococcal infection as a preventable risk factor for low birth weight. Journal of Infectious Diseases 1990;161(3):531‐6. [MEDLINE: ] - PubMed
Goldenberg 1998
    1. Goldenberg RL, Rouse DJ. Prevention of premature birth. New England Journal of Medicine 1998;339(5):313‐20. [MEDLINE: ] - PubMed
GRADE 2014 [Computer program]
    1. McMaster University. GRADEpro. [Computer program on www.gradepro.org]. Version 2014. McMaster University, 2014.
Gravett 1986
    1. Gravett MG, Nelson HP, DeRouen T, Critchlow C, Eschenbach DA, Holmes KK. Independent associations of bacterial vaginosis and chlamydia trachomatis infection with adverse pregnancy outcome. JAMA 1986;256:1899‐905. [MEDLINE: ] - PubMed
Gülmezoglu 2002
    1. Gülmezoglu AM. Interventions for trichomoniasis in pregnancy. Cochrane Database of Systematic Reviews 2002, Issue 3. [DOI: 10.1002/14651858.CD000220] - DOI - PubMed
Gülmezoglu 2011
    1. Gülmezoglu AM, Azhar M. Interventions for trichomoniasis in pregnancy. Cochrane Database of Systematic Reviews 2011, Issue 5. [DOI: 10.1002/14651858.CD000220.pub2] - DOI - PMC - PubMed
Henriksen 1995
    1. Henriksen TB, Hedegaard M, Secher NS, Wilcox AJ. Standing at work and preterm delivery. British Journal of Obstetrics and Gynaecology 1995;102(3):198. [MEDLINE: ] - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hillier 1995
    1. Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, Martin DH. Association between bacterial vaginosis and preterm delivery of a low‐birth‐weight infant. New England Journal of Medicine 1995;333:1737‐42. [MEDLINE: ] - PubMed
Holzman 1995
    1. Holzman C, Paneth N, Little R, Pinto‐Martin J. Perinatal brain injury in premature infants born to mothers using alcohol in pregnancy. Pediatrics 1995;95(1):66. [MEDLINE: ] - PubMed
Jespersen 2005
    1. Jespersen DJ, Flatten KS, Jones MF, Smith TF. Prospective comparison of cell cultures and nucleic acid amplification tests for laboratory diagnosis of Chlamydia trachomatis infections. Journal of Clinical Microbiology 2005;43(10):5324‐6. [MEDLINE: ] - PMC - PubMed
Kleinman 1998
    1. Kleinman S, Busch MP, Hall L, Thomson R, Glynn S, Gallahan D, et al. False‐positive HIV‐1 test results in a low‐risk screening setting of voluntary blood donation. Retrovirus Epidemiology Donor Study. JAMA 1998;280(12):1080‐5. [MEDLINE: ] - PubMed
Lettieri 1993
    1. Lettieri L, Vintzileos AM, Rodis JF, Albini SM, Saladia CM. Does idiopathic preterm labor resulting in preterm birth exist?. American Journal of Obstetrics and Gynecology 1993;168(5):1480‐5. [MEDLINE: ] - PubMed
Lossick 1991
    1. Lossick JG, Kent HL. Trichomoniasis: trends in diagnosis and management. American Journal of Obstetrics and Gynecology 1991;165(4 Pt 2):1217‐22. [MEDLINE: ] - PubMed
Madico 1998
    1. Madico G, Quinn TC, Rompalo A, McKee KT Jr, Gaydos CA. Diagnosis of Trichomonas vaginalis infection by PCR using vaginal swab samples. Journal of Clinical Microbiology 1998;36(11):3205‐10. [MEDLINE: ] - PMC - PubMed
Mayta 2000
    1. Mayta H, Gilman RH, Calderon MM, Gottlieb A, Soto G, Tuero I, Sanchez S, et al. 18S ribosomal DNA‐based PCR for diagnosis of Trichomonas vaginalis. Journal of Clinical Microbiology 2000;38(7):2683‐7. [MEDLINE: ] - PMC - PubMed
McDonald 1994
    1. McDonald HM, O'Loughin JA, Jolley PT, Vigneswaran R, McDonald PJ. Changes in vaginal flora during pregnancy and association with preterm birth. Journal of Infectious Diseases 1994;170(3):724‐8. [MEDLINE: ] - PubMed
McFarlin 1995
    1. McFarlin BL, Bottoms SF. Maternal syphilis in Michigan: the challenge to prevent congenital syphilis. Midwifery 1995;11(2):55‐60. [MEDLINE: ] - PubMed
McGregor 1990
    1. McGregor JA, French JI, Richter R, Franco‐Buff A, Johnson A, Hillier S. Antenatal microbiological maternal risk factors associated with prematurity. American Journal of Obstetrics and Gynecology 1990;163(5 Pt 1):1465‐73. [MEDLINE: ] - PubMed
Meis 1995
    1. Meis PJ, Goldenberg RL, Mercer B, Moawad A, Das A, McNellis D, et al. The preterm prediction study: significance of vaginal infections. National Institute of Child Health and Human Development Maternal‐Fetal Medicine Units Network. American Journal of Obstetrics and Gynecology 1995;173(4):1231‐5. [MEDLINE: ] - PubMed
Muller 2006
    1. Muller I, Brade V, Hagedorn HJ, Straube E, Schorner C, Frosch M, et al. Is serological testing a reliable tool in laboratory diagnosis of syphilis? Meta‐analysis of eight external quality control surveys performed by the german infection serology proficiency testing program. Journal of Clinical Microbiology 2006;44(4):1335‐41. [MEDLINE: ] - PMC - PubMed
Muresu 1994
    1. Muresu R, Rubino S, Rizzu P, Baldini A, Colombo M, Cappuccinelli P. A new method for identification of Trichomonas vaginalis by fluorescent DNA in situ hybridization. Journal of Clinical Microbiology 1994;32(4):1018‐22. [MEDLINE: ] - PMC - PubMed
Nugent 1991
    1. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. Journal of Clinical Microbiology 1991;29(2):297‐301. [MEDLINE: ] - PMC - PubMed
Papiernik 1986
    1. Papiernik E, Bouyer J, Collin D, Winisdoerffer G, Dreyfus J. Precocious cervical ripening and preterm labor. Obstetrics & Gynecology 1986;67(2):238. [MEDLINE: ] - PubMed
Petrin 1998
    1. Petrin D, Delgaty K, Bhatt R, Garber G. Clinical and microbiological aspects of Trichomonas vaginalis. Clinical Microbiology Reviews 1998;11(2):300‐17. [MEDLINE: ] - PMC - PubMed
Quinlan 2000
    1. Quinlan JD, Hill DA, Maxwell BD, Boone S, Hoover F, Lense JJ. The necessity of both anorectal and vaginal cultures for group B streptococcus screening during pregnancy. Journal of Family Practice 2000;49(5):447‐8. [MEDLINE: ] - PubMed
Raynes‐Greenow 2004
    1. Raynes‐Greenow CH, Roberts CL, Bell JC, Peat B, Gilbert GL. Antibiotics for ureaplasma in the vagina in pregnancy. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD003767.pub2] - DOI - PubMed
Regan 1981
    1. Regan JA, Chao S, James SL. Premature rupture of membranes, preterm delivery, and group B streptococcal colonization of mothers. American Journal of Obstetrics and Gynecology 1981;141(2):184‐6. [MEDLINE: ] - PubMed
Rein 1990
    1. Rein MF, Muller M. Trichomonas vaginalis and trichomoniasis. In: Holmes KK, Mardh PA, Sparling PF, Wiesner PJ editor(s). Sexually Transmitted Diseases. McGraw‐Hill, 1990:481‐92.
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Roberts 2000
    1. Roberts JM. Recent advances: obstetrics. BMJ 2000;321(7252):33‐5. - PMC - PubMed
Roberts 2011
    1. Roberts CL, Rickard K, Kotsiou G, Morris JM. Treatment of asymptomatic vaginal candidiasis in pregnancy to prevent preterm birth: an open‐label pilot randomized controlled trial. BMC Pregnancy and Childbirth 2011;11:18. - PMC - PubMed
Romero 1992
    1. Romero R, Mazor M, Sepulveda W, Avila C, Copeland D, Williams J. Tumor necrosis factor in preterm and term labor. American Journal of Obstetrics and Gynecology 1992;166(5):1576‐87. [MEDLINE: ] - PubMed
Saigal 2000
    1. Saigal S, Hoult LA, Streiner DL, Stoskopf BL, Rosenbaum PL. School difficulties at adolescence in a regional cohort of children who were extremely low birth weight. Pediatrics 2000;105(2):325‐31. [MEDLINE: ] - PubMed
Satin 1994
    1. Satin AJ, Leveno KJ, Sherman ML, Reedy NJ, Lowe TW. Maternal youth and pregnancy outcomes: middle school versus high school age groups compared to women beyond the teen years. American Journal of Obstetrics and Gynecology 1994;171(1):184. [MEDLINE: ] - PubMed
Schunemann 2009
    1. Schunemann HJ. GRADE: from grading the evidence to developing recommendations. A description of the system and a proposal regarding the transferability of the results of clinical research to clinical practice [GRADE: Von der Evidenz zur Empfehlung. Beschreibung des Systems und Losungsbeitrag zur Ubertragbarkeit von Studienergebnissen]. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen 2009;103(6):391‐400. - PubMed
Shrier 2004
    1. Shrier LA, Dean D, Klein E, Harter K, Rice PA. Limitations of screening tests for the detection of Chlamydia trachomatis in asymptomatic adolescent and young adult women. American Journal of Obstetrics and Gynecology 2004;190(3):654‐62. [MEDLINE: ] - PubMed
Temmerman 1994
    1. Temmerman M, Chomba EN, Ndinya‐Achola J, Plummer FA, Coppens M, Piot P. Maternal human immunodeficiency virus‐1 infection and pregnancy outcome. Obstetrics & Gynecology 1994;83(4):495‐501. [MEDLINE: ] - PubMed
Thies 1994
    1. Thies K, Anders C, Baldus M, Schleiffer T, Weber B, Rabenau H, et al. Detection of primary HIV infection by a second‐generation HIV(p24) antigen test. Infusionstherapie und Transfusionsmedizin 1994;21(5):333‐6. [MEDLINE: ] - PubMed
Thinkhamrop 2002
    1. Thinkhamrop J, Hofmeyr GJ, Adetoro O, Lumbiganon P. Prophylactic antibiotic administration in pregnancy to prevent infectious morbidity and mortality. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858.CD002250] - DOI - PubMed
Volmink 2007
    1. Volmink J, Siegfried NL, Merwe L, Brocklehurst P. Antiretrovirals for reducing the risk of mother‐to‐child transmission of HIV infection. Cochrane Database of Systematic Reviews 2007, Issue 1. [DOI: 10.1002/14651858.CD003510.pub2] - DOI - PubMed
Walker 2001
    1. Walker GJA. Antibiotics for syphilis diagnosed during pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 3. [DOI: 10.1002/14651858.CD001143] - DOI - PMC - PubMed
Watson 2002
    1. Watson EJ, Templeton A, Russell I, Paavonen J, Mardh PA, Stary A, et al. The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review. Journal of Medical Microbiology 2002;51(12):1021‐31. [MEDLINE: ] - PubMed
Wolner‐Hanssen 1989
    1. Wolner‐Hanssen P, Krieger JN, Stevens CE, Kiviat NB, Koutsky L, Critchlow C, et al. Clinical manifestations of vaginal trichomoniasis. JAMA 1989;261(4):571‐6. [MEDLINE: ] - PubMed
Wood 2000
    1. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. New England Journal of Medicine 2000;343(6):378‐84. [MEDLINE: ] - PubMed
Yoon 2000
    1. Yoon BH, Romero R, Park JS, Kim M, Oh SY, Kin CJ. The relationship among inflammatory lesions of the umbilical cord (funisitis), umbilical cord plasma interleukin 6 concentration, amniotic fluid infection, and neonatal sepsis. American Journal of Obstetrics and Gynecology 2000;183(5):1124‐9. [MEDLINE: ] - PubMed

References to other published versions of this review

Sangkomkamhang 2008
    1. Sangkomkamhang US, Lumbiganon P, Prasertcharoensook W, Laopaiboon M. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD006178.pub2] - DOI - PubMed

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