• Thor Haahr, Anne S Ersbøll, Mona A Karlsen, Jens Svare, Kirstine Sneider, Lene Hee, Louise K Weile, Agnes Ziobrowska-Bech, Claus Østergaard, Jørgen S Jensen, Rikke B Helmig, and Niels Uldbjerg.
• The Fertility Clinic, Skive Regional Hospital, Copenhagen, Denmark.
• Acta Obstet Gynecol Scand. 2016 Aug 1; 95 (8): 850-60.

IntroductionBacterial vaginosis (BV) is characterized by a dysbiosis of the vaginal microbiota with a depletion of Lactobacillus spp. In pregnancy, prevalence's between 7 and 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 to reduce the risk of sPTD. We could not identify any good-quality guideline addressing this issue. Consequently we aimed to produce this clinical recommendation based on GRADE.Material And MethodsSystematic 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 http://www.clinicaltrials.gov from 1999 to 3 October 2014. Hence, nine guidelines, 34 reviews, 18 randomized controlled trials and 12 observational studies were included.ResultsThe GRADE quality of evidence was consistently low or very low, primarily because none of the risk ratios (RR) for the risk of sPTD at <37 weeks were statistically significant. Concerning treatment with metronidazole, RR was 1.11 (95% CI 0.93-1.34) in low-risk pregnancies and 0.96 (95% CI 0.78-1.18) in high risk pregnancies. Concerning treatment with clindamycin at any gestational age, the RR was 0.87 (95% CI 0.73-1.05).ConclusionThis systematic review gives a strong recommendation against treatment with metronidazole and a weak recommendation against treatment with clindamycin to reduce the sPTD rate in both high-risk and low-risk pregnancies with BV.© 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

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