治疗细菌性阴道病预防剖宫产后感染一项随机对照研究

J. Sadek, Mahmoud M A Soliman
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引用次数: 0

摘要

背景:缺乏临床资料确定妊娠晚期细菌性阴道病(BV)筛查和治疗的显著获益(即减少严重感染结局)。由于数据的缺乏,对于是否应该在妊娠后期对感染细菌性阴阳炎的妇女进行筛查和/或治疗以预防围产期感染存在争议。细菌性阴道炎是一种常见的下生殖道感染,全球流行率在23%至29%之间。目的:评估在剖宫产筛查中BV阳性妇女的治疗是否能显著降低感染率研究设计:该试验是一项随机双盲、单中心介入研究,在开罗大学医学院妇产科进行。研究人群包括150名符合条件的孕妇,她们在2019年12月至2021年2月期间入住分娩或产科病房,并接受了选择性或紧急CS。这些女性被随机分为两组。研究组“A组”参与者每天两次服用500克MTZ,持续一周,从CS后6小时开始,而对照组“B组”参与者每天两次服用一片安慰剂,持续一周,在CS后6小时。每组由75名孕妇组成。结果:150例患者中,8例因感染发病情况不明,因未随访而被排除在统计分析之外,留下142例女性进行分析。在接受细菌性阴道炎治疗的妇女中,66名妇女(91.7%)在一周内细菌性阴道炎检测呈阴性。本研究发现,BV治疗与剖宫产后子宫内膜炎的减少显著相关(P值= 0.0121)(cOR = 0.2834;95%CI =[0.2228 ~ 0.8627])。然而,在伤口感染发生率方面,情况有所不同。治疗组与对照组无显著差异(P值= 0.2048)。结论:我们的研究结果与产时绒毛膜羊膜炎和子宫内膜炎的证据一致,在妊娠后期(可能在35-37周)和B组链球菌培养,或妊娠后立即进行BV筛查,并对筛查阳性的患者进行治疗。由于没有专业协会的指导方针,术前筛查和治疗BV可能会减少手术部位感染。
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Treatment of bacterial vaginosis to prevent infection following caesarean delivery; a randomized control study
Background: There is shortage in clinical data determining significant benefit (i.e., decrease of severe infection outcomes) following screening and treatment of Bacterial vaginosis (BV) late in pregnancy. Due to this deficiency of data, there is controversy concerning whether ladies with BV should be screened and/or treated in late pregnancy to prevent peripartum infections. BV is a common lower genital tract infection with a global prevalence ranging between 23 and 29%. Aim: To asses if treatment of BV positive women screened at cesarean delivery significantly reduces infection rate Study Design: The trial was a randomized double-blinded, single center interventional study conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University. The study population consisted of 150 eligible pregnant women who were admitted in the labour or obstetric ward and underwent elective or emergency CS from December 2019 to February 2021. The women were randomized into either of the two arms. The study arm “Group A” participants received 500gm MTZ twice daily for one week, starting 6hrs following CS, whereas the control arm “Group B” participants received one placebo tablet twice daily for one week, 6hrs following CS. Each group comprised 75 pregnant women. Results: In total 150 patient, eight were excluded from statistical analysis for unknown infection morbidity status due to loss to follow up, leaving 142 women for analysis. Of those that were given treatment for BV, 66 women (91.7%) had a negative test for BV at one week. In this study, treatment of BV was found to be significantly associated with the reduction of post cesarean endometritis ( P value = 0.0121) (cOR = 0.2834; 95%CI = [0.2228 to 0.8627]). However, the situation was different regarding wound infection incidence. No significant difference was recognized between the treatment and control groups ( P value = 0.2048). Conclusion: Given the results of our study, which is in agreement to same evidence associating BV with intrapartum chorioamnionitis and endometritis post CS, BV screening late in pregnancy, possibly at the 35-37 week and group B streptococcus culture visit, or immediately following CS, and treatment of those positively screened could be made. With none existence of guidelines from professional societies, preoperative screening and treatment of BV could cause more reduction in surgical site infections.
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