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Evidence-based Ways to Prevent Prematurity Caused by Infection Including Bacterial Vaginosis (BV) and Sexually Transmitted Infections (STIs)
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Preterm birth (short gestation, PTB, < 37weeks) and low birth (LBW, <1500grms) continue as the commonest cause of excess perinatal morbidity, mortality and excess birth related costs and medical malpractice liabilities worldwide. Reproductive tract infection and subsequent inflammation are now recognized as common and preventable causes of short gestation and biologic immaturity at birth. Bacterial vaginosis (BV) is the best studied of microbe-mediated infections or conditions causing preterm birth. Current evidence supports these "optimizing principles" for effectively reducing risks of infection induced adverse pregnancy effects:
Improved pregnancy outcomes are optimized when trichomoniasis, gonorrhea, and chlamydia as well as UTI/asymptomatic bacteruria are identified and treated with appropriate treatment of partners (TOPs)and tests of cure (TOC).
Conclusion: Bacterial vaginosis and other common reproductive tract microbial conditions should be 1) routinely identified, 2) treated with antimicrobials most likely to eliminate/suppress intrauterine microflora and 3) which have potentially important adjunctive advantages (antivirulence factor, anti-inflammatory, intracellular concentration and 4) which are established safe and effective in controlled trials. Selected populations appear to benefit from empiric antimicrobial therapy aimed at prevalent reproductive tract infections and at prevention or early treatment of intrauterine infection (chorioamnionitis, CAM or placentitis).
Both care providers and families can now improve pregnancy care with intelligent use of updated information about common genital tract infection. Future discussions will discuss optimized care of mothers to be who are actually having preterm labor.