Effect of Intravaginal Clindamycin Cream on Pregnancy Outcome and on Abnormal Vaginal Microbial Flora of Pregnant Women

摘要

Objectives:To determine whether intravaginal clindamycin cream reduces the incidence of abnormalpregnancy outcome in women with abnormal vaginal microbial flora graded as intermediate orBV and to investigate the effect of the antibiotic on vaginal microbial flora.Methods:A prospective cohort study of pregnant women in an antenatal clinic of a districtgeneral hospital. The subjects were 268 women who had abnormal vaginal microbial flora at firstclinic visit by examination of a Gram-stained vaginal smear and 34 women with a normal vaginalflora. Two hundred and thirty-seven women were evaluable. Women with abnormal Gram-stainedsmears (graded as II or III) on clinic recall were randomised to receive treatment (intravaginalclindamycin cream) or placebo and followed to assess outcome of pregnancy, vaginal flora, anddetection ofMycoplasma hominisandUreaplasma urealyticumafter treatment.Results:Abnormal outcomes of pregnancy were not significantly different in treated and placebogroups by Chi square (P= 0.2). However, women with grade III flora responded better to clindamycinthan women with grade II flora by numbers of abnormal outcomes (P= 0.03) and return tonormal vaginal flora (P= 0.01) (logistic regression analysis model). This may be due to differencesin vaginal bacterial species in these grades. Women whose abnormal vaginal flora had spontaneouslyreturned to normal on follow-up and were therefore not treated (revertants) had as manyabnormal outcomes as placebos suggesting that damage by abnormal bacterial species occurredearly in pregnancy.Conclusions:Gram-stain screening distinguishing grade II from grade III flora may be helpfulin prescribing treatment other than clindamycin for women with grade II flora. Earlier diagnosisand treatment may be more effective in preventing an abnormal outcome, possibly as soon aspregnancy is diagnosed or even offered as a pre-conception screen. Infect. Dis. Obstet. Gynecol.8:158–165, 2000.