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Two-drug BV regimen urged in pregnancy.(Obstetrics)(Bacterial vaginosis)
HOUSTON -- Bacterial vaginosis in pregnant women requires a two-drug regimen to reduce the incidence of low-birth-weight and preterm babies, Dale Brown Jr., M.D., said at a conference on vulvo-vaginal diseases sponsored by Baylor College of Medicine.
Dr. Brown, chair of clinical affairs in the obstetrics and gynecology department at Baylor, said clinical studies involving single-drug therapy have failed to show a reduction in the incidence of low-birth-weight and preterm babies, because such therapy is not aggressive enough to prevent recurrence of bacterial vaginosis (BV).
"I just don't think that the single-drug treatment ... is eradicating the organisms appropriately, because we know this vaginosis itself is a coterie of several types of organisms," he said. "If we allow any options for gram-negative organisms to take hold, that's why we continue to see" low-birth-weight babies and preterm deliveries.
Dr. Brown estimated that 15%-20% of pregnant women are diagnosed with BV. They face a fivefold increased risk of late miscarriage in the second trimester, he said. While more than 30% of infections will spontaneously resolve, there is a high recurrence rate. Recurrence can be up to 30% in 3 months and 80% in 9-12 months in non-pregnant patients.
The American College of Obstetricians and Gynecologists has taken the position (in a practice bulletin) that "there are insufficient data to suggest screening and treating women at either low or high risk will reduce the overall rate of preterm birth" (Obstet. Gynecol. 2001;98:709-16).
For its part, the Centers for Disease Control and Prevention recommends BV screening in symptomatic pregnant women and asymptomatic pregnant women who are at high risk because they have previously delivered a premature infant. Treatment can be given to pregnant women who test positive for BV, the CDC says.
In contrast with the ACOG and CDC positions, Dr. Brown called for aggressive screening for BV in pregnant women regardless of their risk. All ...
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Source: HighBeam Research, Two-drug BV regimen urged in pregnancy.(Obstetrics)(Bacterial...