Management of Labor
Management of Labor
Management of Labor
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Conclusion Grading Worksheet A – Annotation #20<br />
(Bacterial Vaginosis)<br />
Work Group's Conclusion: Treatment <strong>of</strong> bacterial vaginosis infection in pregnant women at high risk for preterm delivery by<br />
traditional seven-day courses <strong>of</strong> therapy early in pregnancy appears to reduce preterm delivery.<br />
Conclusion Grade: II<br />
Work Group's Conclusion: The evidence regarding treatment <strong>of</strong> low-risk, pregnant women with asymptomatic bacterial vaginosis<br />
is limited by use <strong>of</strong> inadequate therapy in the available studies.<br />
Conclusion Grade: Grade Not Assignable<br />
Authors' Conclusions/<br />
Work Group's Comments (italicized)<br />
Class Quality<br />
+,–,ø<br />
Author/Year Design<br />
Type<br />
-In a very high-risk group <strong>of</strong> patients with a<br />
premature delivery in the preceding pregnancy,<br />
the treatment <strong>of</strong> bacterial vaginosis<br />
and perhaps elevated vaginal pH in the second<br />
trimester would result in a substantial<br />
reduction <strong>of</strong> recurrent preterm births from<br />
either idiopathic preterm labor or PROM.<br />
Institute for Clinical Systems Improvement<br />
Population Studied/Sample Size Primary Outcome Measure(s)/Results (e.g., p-value,<br />
confidence interval, relative risk, odds ratio, likelihood<br />
ratio, number needed to treat)<br />
tion at 13-20 weeks; preterm delivery<br />
in preceding pregnancy;<br />
positive for BV; no evidence <strong>of</strong><br />
trichomona infection<br />
-Excluded: congenital anomalies;<br />
significant maternal complications;<br />
documented cocaine<br />
use; incompetent cervix likely;<br />
prior documented intra-amniotic<br />
or urinary tract infection resulting<br />
in preterm birth; 2 nd -94 enrolled: 14 subsequently excluded from analysis<br />
(5 lost to follow-up, 6 failed to complete treatment,<br />
3 required treatment for renal or pulmonary<br />
disease)<br />
-44 <strong>of</strong> the remaining 80 were treated with metronidazole,<br />
36 with placebo<br />
-Groups were similar at baseline in age, parity, race,<br />
smoking status, spontaneous abortions, preterm<br />
births, outcome <strong>of</strong> penultimate pregnancy, first trimester<br />
bleeding<br />
-Metronidazole group had fewer hospital admissions<br />
trimes- for preterm labor, fewer with >1 hospital admission,<br />
ter bleeding, asymptomatic bac- fewer with gestational age at delivery <strong>of</strong>
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