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1. Symptomatic women, screen for BV and treat to relieve symptoms and to subsequently reduce the risk of PTD. Research has shown a 50% reduction in risk of PTB following treatment with flagyl and erythromycin.

2. (some concern with the indication of Flagyl before 12 weeks and the completion of organogenesis based on concerns from animal studies and the lack of long-term data on cancer risks but a meta-analyses of published studies of children exposed in utero found no evidence of human teratogenicity).

3.The question of screening and treatment of asymptomatic women in reducing their risk for PTD is unclear and controversial. As there is no immediate therapeutic benefit to goal of screening and identifying BV in these women the goal would be to prevent adverse pregnancy events. Studies have suggested a different therapeutic approach for women who are at high risk vs. women at low risk for PTB (ie. those women with a prior PTB). Two placebo-controlled randomized clinical trails indicated a reduction in risk of PTB due to treatment with metrodinazole or metronidazanole and erythromycin among the high risk asymptomatic women. However, a recent clinical trial conducted by the NICHD network of MFM unit did not find a reduction in the occurrence of PTD following treatment with mtronidazinole and erthyromicin among asymptomatic normal risk pregnant women or high risk women.

4. Systemic treatment vs. vaginal creams.