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Бактериальный вагиноз при беременности: современный взгляд на диагностику и терапию (обзор литературы)
Бактериальный вагиноз при беременности: современный взгляд на диагностику и терапию (обзор литературы)
Карапетян Т.Э., Ломова Н.А., Юсубова В.Р., Гвенетадзе Ш.Г. Бактериальный вагиноз при беременности: современный взгляд на диагностику и терапию (обзор литературы). Гинекология. 2019; 21 (5): 34–38.
DOI: 10.26442/20795696.2019.5.190667
DOI: 10.26442/20795696.2019.5.190667
DOI: 10.26442/20795696.2019.5.190667
________________________________________________
DOI: 10.26442/20795696.2019.5.190667
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Чтобы посмотреть материал полностью
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Аннотация
Бактериальный вагиноз (БВ) представляет собой самое распространенное заболевание нижнего отдела генитального тракта у женщин репродуктивного возраста (как беременных, так и небеременных) и служит наиболее частой причиной влагалищных выделений и неприятного запаха из половых путей. На сегодняшний день существует немало литературных данных, описывающих большое количество разных подходов к диагностике и лечению БВ во время беременности. БВ распространен, причем точная распространенность широко варьируется в зависимости от популяции пациенток. Исследования подтверждают, что распространенность БВ среди беременных женщин такая же, как и в популяции небеременных женщин, и составляет от 6 до 32%. Установлена зависимость между БВ и расовой принадлежностью, курением, сексуальным поведением и спринцеванием. БВ более распространен среди афроамериканских женщин, курящих женщин, сексуально активных женщин по сравнению с распространением среди девственниц и тех, кто применяет спринцевания. Диагноз БВ выставляется на основании клинической картины и результатов микробиологического исследования. Диагностические критерии одинаковы для беременных и небеременных женщин. В случае подтверждения БВ показано лечение. В большинстве международных рекомендаций по инфекциям, передаваемым половым путем, в качестве лечения для профилактики неблагоприятных акушерских исходов рекомендуется использовать либо метронидазол 500 мг перорально 2 раза в сутки в течение 7 дней, либо клиндамицин 300 мг перорально 2 раза в сутки в течение 7 дней. Наличие БВ рассматривается как фактор риска неблагоприятных акушерских исходов, таких как преждевременные роды, преждевременный разрыв плодных оболочек, спонтанный аборт, хориоамнионит и послеродовые инфекции, в частности эндометрит и инфекционные осложнения в области послеоперационной раны после кесарева сечения. Беременным женщинам с симптомами БВ рекомендуется проводить обследование и лечение для устранения симптомов. Лечение пероральными или местными антибиотиками приемлемо для достижения выздоровления (излечения) у беременных женщин с симптоматическим течением БВ и низким риском неблагоприятных акушерских исходов. Женщины без симптомов БВ и женщины без идентифицированных факторов риска преждевременных родов не должны подвергаться рутинному скринингу и лечению БВ, а пациентки с повышенным риском преждевременных родов могут извлечь пользу из рутинного скрининга и лечения БВ.
Ключевые слова: бактериальный вагиноз, беременность, акушерские осложнения, преждевременные роды.
Key words: bacterial vaginosis, pregnancy, obstetric complications, premature birth.
Ключевые слова: бактериальный вагиноз, беременность, акушерские осложнения, преждевременные роды.
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Key words: bacterial vaginosis, pregnancy, obstetric complications, premature birth.
Полный текст
Список литературы
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11. Wiesenfeld HC, Hillier SL, Krohn MA et al. Lower genital tract infection and endometritis: Insight in to subclinical pelvic inflammatory disease. Obstet Gynecol 2002; 100: 456e63.
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13. Eschenbach DA. Bacterial vaginosis: Emphasis on upper genital tract complications. Obstet Gynecol Clin North Am 1989;16:593e610
14. Spiegel CA, Amsel R, Eschenbach D et al. Anaerobic bacteria in nonspecific vaginitis. N Engl J Med 1980; 303: 601e7.
15. Hill GB, Eschenbach DA, Holmes KK. Bacteriology of the vagina. Scand J Urol Nephrol Suppl 1985; 86: 23e39.
16. Hillier SL. Diagnostic microbiology of bacterial vaginosis. Am J Obstet Gynecol 1993; 169: 455e9.
17. Bump RC, Zuspan FP, Buesching WJ 3rd et al. The prevalence, six-month persistence, and predictive values of laboratory indicators of bacterial vaginosis (nonspecific vaginitis) in asymptomatic women. Am J Obstet Gynecol 1984; 150: 917e24.
18. Hill LH, Ruperalia H, Embil JA. Nonspecific vaginitis and other genital infections in three clinic populations. Sex Transm Dis 1983; 10: 114e8.
19. Amsel R, Totten PA, Spiegel CA et al. Nonspecific vaginitis: Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74: 14e22.
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24. Platz-Christensen JJ, Pernevi P, Hagmar B et al. A longitudinal follow-up of bacterial vaginosis during pregnancy. Acta Obstet Gynecol Scand 1993; 72: 99e102.
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26. Wenman WM, Tataryn IV, Joffres MR et al. Demographic, clinical and microbiological characteristics of maternity patients: a Canadian clinical cohort study. Can J Infect Dis 2002; 13: 311e8.
27. Goldenberg R, Klebanoff M, Nugent R et al.; for the Vaginal Infections and Prematurity Study Group. Bacterial colonization of the vagina during pregnancy in four ethnic groups. Am J Obstet Gynecol 1996; 174: 1618e21.
28. Jonsson M, Karlsson R, Rylander E et al. The associations between risk behavior and reported history of sexually transmitted diseases, among young women: a population based study. Int J STD AIDS 1997; 8: 501e5.
29. Bump R, Buesching WB 3rd. Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am J Obstet Gynecol 1988; 158: 935e9.
30. Hawes SE, Hillier SL, Benedetti J et al. Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J Infect Dis 1996; 174: 1058e63.
31. Klebanoff MA, Hauth JC, MacPherson CA et al. Time course of the regression of asymptomatic bacterial vaginosis in pregnancy with and without treatment. Am J Obstet Gynecol 2004; 190: 363e70.
32. McDonald H, Brocklehurst P, Parsons J et al. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2007: CD000262.
33. Sarwal S. Vaginal discharge (bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis). In: Canadian guidelines on sexually transmitted infections. 2006 edition. Ottawa: Public Health Agency of Canada, 2006; p. 106e21.
34. Guise JM, Mahon SM, Aickin M et al. Screening for bacterial vaginosis in pregnancy. Am J Prev Med 2001; 20 (Suppl. 3): 62e72.
35. Burtin P, Taddio A, Ariburnu O et al. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol 1995; 172: 525e9.
36. Caro-Paton T, Carvajal A, Martin de Diego I et al. Is metronidazole teratogenic: a meta-analysis. Br J Clin Pharmacol 1997; 44: 179e82.
37. Van Schalkwyk J, Money DM. Pregnancy. In: Canadian guidelines on sexually transmitted infections. 2006 edition. Ottawa: Public Health Agency of Canada, 2006; p. 273e91.
38. McGregor JA, French JI, Jones W et al. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol 1994; 170: 1048e60.
39. McGregor JA, French JI, Parker R et al. Prevention of premature birth by screening and treatment for common genital tract infections: Results of a prospective controlled evaluation. Am J Obstet Gynecol 1995; 173: 157e67.
40. Hauth JC, Goldenberg RL, Andrews WW et al. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995; 333: 1732e6.
41. McDonald HM, O’Loughlin JA, Vigneswaran R et al. Bacterial vaginosis in pregnancy and efficacy of short-course oral metronidazole treatment: a randomized controlled trial. Obstet Gynecol 1994; 84: 343e8.
42. Carey JC, Klebanoff MA, Hauth JC et al. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 2000; 342: 534e40.
43. Ugwumadu A, Reid F, Hay P et al. Natural history of bacterial vaginosis and intermediate flora in pregnancy and effect of oral clindamycin. Obstet Gynecol 2004; 104: 114e9.
44. Joesef MR, Hillier SL, Wiknjosastro G et al. Intravaginal clindamycin treatment for bacterial vaginosis: Effects on preterm delivery and low birth weight. Am J Obstet Gynecol 1995; 173: 1527e31.
45. Kekki M, Kurki T, Pelkonen J et al. Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. Obstet Gynecol 2001; 97: 643e8.
46. Kurkinen-Räty M, Vuopala S, Koskela M et al. A randomised controlled trial of vaginal clindamycin for early pregnancy bacterial vaginosis. BJOG 2000; 107: 1427e32.
47. Lamont RF, Jones BM, Mandal D et al. The efficacy of vaginal clindamycin for the treatment of abnormal genital tract flora in pregnancy. Infect Dis Obstet Gynecol 2003; 11: 181e9.
48. Yudin MH, Landers DV, Meyn L et al. Clinical and cervical cytokine response to treatment with oral or vaginal metronidazole for bacterial vaginosis during pregnancy: a randomized trial. Obstet Gynecol 2003; 102: 527e34.
49. Guaschino S, Ricci E, Franchi M et al. Treatment of asymptomatic bacterial vaginosis to prevent preterm delivery: a randomized trial. Eur J Obstet Gynecol Reprod Biol 2003; 110: 149e52.
50. Morales WJ, Schorr S, Albritton J. Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebocontrolled, double-blind study. Am J Obstet Gynecol 1994; 171: 345e7.
51. Okun N, Gronau KA, Hannah ME. Antibiotics for bacterial vaginosis or trichomonas vaginalis in pregnancy: a systematic review. Obstet Gynecol 2005; 105: 857e68.
52. Vermeulen G, Bruinse H. Prophylactic administration of clindamycin 2% vaginal cream to reduce the incidence of spontaneous preterm birth in women with an increased recurrence risk: A randomized placebo controlled double blind trial. Br J Obstet Gynaecol 1999; 106: 652e7.
53. Lamont RF, Duncan SLB, Mandal D et al. Intravaginal clindamycin to reduce preterm birth in women with abnormal genital tract flora. Obstet Gynecol 2003; 101: 516e22.
54. Leitich H, Brunbauer M, Bodner-Adler B et al. Antibiotic treatment of bacterial vaginosis in pregnancy: a meta-analysis. Am J Obstet Gynecol 2003; 188: 752e8.
2. Rein MF, Holmes KK. Non-specific vaginitis, vulvovaginal candidiasis, and trichomoniasis: clinical features, diagnosis and management. Curr Clin Top Infect Dis 1983; 4: 281e315.
3. Gravett MG, Hammel D, Eschenbach DA et al. Preterm labor associated with subclinical amniotic fluid infection and with bacterial vaginosis. Obstet Gynecol 1986; 67: 229e37.
4. Hillier SL, Martius J, Krohn MA et al. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 1988; 319: 972e8.
5. Hillier SL, Nugent RP, Eschenbach DA et al.; for the Vaginal Infections and Prematurity Study Group. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. N Engl J Med 1995; 333: 1737e42.
6. Korn AP, Bolan G, Padian N et al. Plasma cell endometritis in women with symptomatic bacterial vaginosis. Obstet Gynecol 1995; 85: 387e90.
7. Leitich H, Bodner-Adler B, Brunbauer M et al. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol 2003; 189: 139e47.
8. Minkoff H, Brunebaum AN, Schwartz RH et al. Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy. Am J Obstet Gynecol 1984; 150: 965e72.
9. Shennan A, Crawshaw S, Briley A et al. A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET trial. BJOG 2006; 113: 65e74.
10. Watts DH, Krohn MA, Hillier SL et al. Bacterial vaginosis as a risk factor for postcesarean endometritis. Obstet Gynecol 1990; 75: 52e8.
11. Wiesenfeld HC, Hillier SL, Krohn MA et al. Lower genital tract infection and endometritis: Insight in to subclinical pelvic inflammatory disease. Obstet Gynecol 2002; 100: 456e63.
12. Woolf SH, Battista RN, Angerson GM et al.; Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2003; 169: 207e8.
13. Eschenbach DA. Bacterial vaginosis: Emphasis on upper genital tract complications. Obstet Gynecol Clin North Am 1989;16:593e610
14. Spiegel CA, Amsel R, Eschenbach D et al. Anaerobic bacteria in nonspecific vaginitis. N Engl J Med 1980; 303: 601e7.
15. Hill GB, Eschenbach DA, Holmes KK. Bacteriology of the vagina. Scand J Urol Nephrol Suppl 1985; 86: 23e39.
16. Hillier SL. Diagnostic microbiology of bacterial vaginosis. Am J Obstet Gynecol 1993; 169: 455e9.
17. Bump RC, Zuspan FP, Buesching WJ 3rd et al. The prevalence, six-month persistence, and predictive values of laboratory indicators of bacterial vaginosis (nonspecific vaginitis) in asymptomatic women. Am J Obstet Gynecol 1984; 150: 917e24.
18. Hill LH, Ruperalia H, Embil JA. Nonspecific vaginitis and other genital infections in three clinic populations. Sex Transm Dis 1983; 10: 114e8.
19. Amsel R, Totten PA, Spiegel CA et al. Nonspecific vaginitis: Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74: 14e22.
20. Embrеe J, Caliando JJ, McCormack WM. Nonspecific vaginitis among women attending a sexually transmitted diseases clinic. Sex Transm Dis 1984; 11: 81e4.
21. Eschenbach DA, Hillier S, Critchlow C et al. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol 1988; 158: 819e28.
22. Paavonen J, Heinonen PK, Aine R et al. Prevalence of nonspecific vaginitis and other cervicovaginal infections during the third trimester of pregnancy. Sex Transm Dis 1986; 13: 5e8.
23. Kurki T, Sivonen A, Renkonen O-V et al. Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol 1992; 80: 173e7.
24. Platz-Christensen JJ, Pernevi P, Hagmar B et al. A longitudinal follow-up of bacterial vaginosis during pregnancy. Acta Obstet Gynecol Scand 1993; 72: 99e102.
25. Meis PJ, Goldenberg RL, Mercer B et al. The preterm prediction study: significance of vaginal infections. Am J Obstet Gynecol 1995; 173: 1231e5.
26. Wenman WM, Tataryn IV, Joffres MR et al. Demographic, clinical and microbiological characteristics of maternity patients: a Canadian clinical cohort study. Can J Infect Dis 2002; 13: 311e8.
27. Goldenberg R, Klebanoff M, Nugent R et al.; for the Vaginal Infections and Prematurity Study Group. Bacterial colonization of the vagina during pregnancy in four ethnic groups. Am J Obstet Gynecol 1996; 174: 1618e21.
28. Jonsson M, Karlsson R, Rylander E et al. The associations between risk behavior and reported history of sexually transmitted diseases, among young women: a population based study. Int J STD AIDS 1997; 8: 501e5.
29. Bump R, Buesching WB 3rd. Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am J Obstet Gynecol 1988; 158: 935e9.
30. Hawes SE, Hillier SL, Benedetti J et al. Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J Infect Dis 1996; 174: 1058e63.
31. Klebanoff MA, Hauth JC, MacPherson CA et al. Time course of the regression of asymptomatic bacterial vaginosis in pregnancy with and without treatment. Am J Obstet Gynecol 2004; 190: 363e70.
32. McDonald H, Brocklehurst P, Parsons J et al. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2007: CD000262.
33. Sarwal S. Vaginal discharge (bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis). In: Canadian guidelines on sexually transmitted infections. 2006 edition. Ottawa: Public Health Agency of Canada, 2006; p. 106e21.
34. Guise JM, Mahon SM, Aickin M et al. Screening for bacterial vaginosis in pregnancy. Am J Prev Med 2001; 20 (Suppl. 3): 62e72.
35. Burtin P, Taddio A, Ariburnu O et al. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol 1995; 172: 525e9.
36. Caro-Paton T, Carvajal A, Martin de Diego I et al. Is metronidazole teratogenic: a meta-analysis. Br J Clin Pharmacol 1997; 44: 179e82.
37. Van Schalkwyk J, Money DM. Pregnancy. In: Canadian guidelines on sexually transmitted infections. 2006 edition. Ottawa: Public Health Agency of Canada, 2006; p. 273e91.
38. McGregor JA, French JI, Jones W et al. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol 1994; 170: 1048e60.
39. McGregor JA, French JI, Parker R et al. Prevention of premature birth by screening and treatment for common genital tract infections: Results of a prospective controlled evaluation. Am J Obstet Gynecol 1995; 173: 157e67.
40. Hauth JC, Goldenberg RL, Andrews WW et al. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995; 333: 1732e6.
41. McDonald HM, O’Loughlin JA, Vigneswaran R et al. Bacterial vaginosis in pregnancy and efficacy of short-course oral metronidazole treatment: a randomized controlled trial. Obstet Gynecol 1994; 84: 343e8.
42. Carey JC, Klebanoff MA, Hauth JC et al. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 2000; 342: 534e40.
43. Ugwumadu A, Reid F, Hay P et al. Natural history of bacterial vaginosis and intermediate flora in pregnancy and effect of oral clindamycin. Obstet Gynecol 2004; 104: 114e9.
44. Joesef MR, Hillier SL, Wiknjosastro G et al. Intravaginal clindamycin treatment for bacterial vaginosis: Effects on preterm delivery and low birth weight. Am J Obstet Gynecol 1995; 173: 1527e31.
45. Kekki M, Kurki T, Pelkonen J et al. Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. Obstet Gynecol 2001; 97: 643e8.
46. Kurkinen-Räty M, Vuopala S, Koskela M et al. A randomised controlled trial of vaginal clindamycin for early pregnancy bacterial vaginosis. BJOG 2000; 107: 1427e32.
47. Lamont RF, Jones BM, Mandal D et al. The efficacy of vaginal clindamycin for the treatment of abnormal genital tract flora in pregnancy. Infect Dis Obstet Gynecol 2003; 11: 181e9.
48. Yudin MH, Landers DV, Meyn L et al. Clinical and cervical cytokine response to treatment with oral or vaginal metronidazole for bacterial vaginosis during pregnancy: a randomized trial. Obstet Gynecol 2003; 102: 527e34.
49. Guaschino S, Ricci E, Franchi M et al. Treatment of asymptomatic bacterial vaginosis to prevent preterm delivery: a randomized trial. Eur J Obstet Gynecol Reprod Biol 2003; 110: 149e52.
50. Morales WJ, Schorr S, Albritton J. Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebocontrolled, double-blind study. Am J Obstet Gynecol 1994; 171: 345e7.
51. Okun N, Gronau KA, Hannah ME. Antibiotics for bacterial vaginosis or trichomonas vaginalis in pregnancy: a systematic review. Obstet Gynecol 2005; 105: 857e68.
52. Vermeulen G, Bruinse H. Prophylactic administration of clindamycin 2% vaginal cream to reduce the incidence of spontaneous preterm birth in women with an increased recurrence risk: A randomized placebo controlled double blind trial. Br J Obstet Gynaecol 1999; 106: 652e7.
53. Lamont RF, Duncan SLB, Mandal D et al. Intravaginal clindamycin to reduce preterm birth in women with abnormal genital tract flora. Obstet Gynecol 2003; 101: 516e22.
54. Leitich H, Brunbauer M, Bodner-Adler B et al. Antibiotic treatment of bacterial vaginosis in pregnancy: a meta-analysis. Am J Obstet Gynecol 2003; 188: 752e8.
2. Rein MF, Holmes KK. Non-specific vaginitis, vulvovaginal candidiasis, and trichomoniasis: clinical features, diagnosis and management. Curr Clin Top Infect Dis 1983; 4: 281e315.
3. Gravett MG, Hammel D, Eschenbach DA et al. Preterm labor associated with subclinical amniotic fluid infection and with bacterial vaginosis. Obstet Gynecol 1986; 67: 229e37.
4. Hillier SL, Martius J, Krohn MA et al. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 1988; 319: 972e8.
5. Hillier SL, Nugent RP, Eschenbach DA et al.; for the Vaginal Infections and Prematurity Study Group. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. N Engl J Med 1995; 333: 1737e42.
6. Korn AP, Bolan G, Padian N et al. Plasma cell endometritis in women with symptomatic bacterial vaginosis. Obstet Gynecol 1995; 85: 387e90.
7. Leitich H, Bodner-Adler B, Brunbauer M et al. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol 2003; 189: 139e47.
8. Minkoff H, Brunebaum AN, Schwartz RH et al. Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy. Am J Obstet Gynecol 1984; 150: 965e72.
9. Shennan A, Crawshaw S, Briley A et al. A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET trial. BJOG 2006; 113: 65e74.
10. Watts DH, Krohn MA, Hillier SL et al. Bacterial vaginosis as a risk factor for postcesarean endometritis. Obstet Gynecol 1990; 75: 52e8.
11. Wiesenfeld HC, Hillier SL, Krohn MA et al. Lower genital tract infection and endometritis: Insight in to subclinical pelvic inflammatory disease. Obstet Gynecol 2002; 100: 456e63.
12. Woolf SH, Battista RN, Angerson GM et al.; Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2003; 169: 207e8.
13. Eschenbach DA. Bacterial vaginosis: Emphasis on upper genital tract complications. Obstet Gynecol Clin North Am 1989;16:593e610
14. Spiegel CA, Amsel R, Eschenbach D et al. Anaerobic bacteria in nonspecific vaginitis. N Engl J Med 1980; 303: 601e7.
15. Hill GB, Eschenbach DA, Holmes KK. Bacteriology of the vagina. Scand J Urol Nephrol Suppl 1985; 86: 23e39.
16. Hillier SL. Diagnostic microbiology of bacterial vaginosis. Am J Obstet Gynecol 1993; 169: 455e9.
17. Bump RC, Zuspan FP, Buesching WJ 3rd et al. The prevalence, six-month persistence, and predictive values of laboratory indicators of bacterial vaginosis (nonspecific vaginitis) in asymptomatic women. Am J Obstet Gynecol 1984; 150: 917e24.
18. Hill LH, Ruperalia H, Embil JA. Nonspecific vaginitis and other genital infections in three clinic populations. Sex Transm Dis 1983; 10: 114e8.
19. Amsel R, Totten PA, Spiegel CA et al. Nonspecific vaginitis: Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74: 14e22.
20. Embrеe J, Caliando JJ, McCormack WM. Nonspecific vaginitis among women attending a sexually transmitted diseases clinic. Sex Transm Dis 1984; 11: 81e4.
21. Eschenbach DA, Hillier S, Critchlow C et al. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol 1988; 158: 819e28.
22. Paavonen J, Heinonen PK, Aine R et al. Prevalence of nonspecific vaginitis and other cervicovaginal infections during the third trimester of pregnancy. Sex Transm Dis 1986; 13: 5e8.
23. Kurki T, Sivonen A, Renkonen O-V et al. Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol 1992; 80: 173e7.
24. Platz-Christensen JJ, Pernevi P, Hagmar B et al. A longitudinal follow-up of bacterial vaginosis during pregnancy. Acta Obstet Gynecol Scand 1993; 72: 99e102.
25. Meis PJ, Goldenberg RL, Mercer B et al. The preterm prediction study: significance of vaginal infections. Am J Obstet Gynecol 1995; 173: 1231e5.
26. Wenman WM, Tataryn IV, Joffres MR et al. Demographic, clinical and microbiological characteristics of maternity patients: a Canadian clinical cohort study. Can J Infect Dis 2002; 13: 311e8.
27. Goldenberg R, Klebanoff M, Nugent R et al.; for the Vaginal Infections and Prematurity Study Group. Bacterial colonization of the vagina during pregnancy in four ethnic groups. Am J Obstet Gynecol 1996; 174: 1618e21.
28. Jonsson M, Karlsson R, Rylander E et al. The associations between risk behavior and reported history of sexually transmitted diseases, among young women: a population based study. Int J STD AIDS 1997; 8: 501e5.
29. Bump R, Buesching WB 3rd. Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am J Obstet Gynecol 1988; 158: 935e9.
30. Hawes SE, Hillier SL, Benedetti J et al. Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J Infect Dis 1996; 174: 1058e63.
31. Klebanoff MA, Hauth JC, MacPherson CA et al. Time course of the regression of asymptomatic bacterial vaginosis in pregnancy with and without treatment. Am J Obstet Gynecol 2004; 190: 363e70.
32. McDonald H, Brocklehurst P, Parsons J et al. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2007: CD000262.
33. Sarwal S. Vaginal discharge (bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis). In: Canadian guidelines on sexually transmitted infections. 2006 edition. Ottawa: Public Health Agency of Canada, 2006; p. 106e21.
34. Guise JM, Mahon SM, Aickin M et al. Screening for bacterial vaginosis in pregnancy. Am J Prev Med 2001; 20 (Suppl. 3): 62e72.
35. Burtin P, Taddio A, Ariburnu O et al. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol 1995; 172: 525e9.
36. Caro-Paton T, Carvajal A, Martin de Diego I et al. Is metronidazole teratogenic: a meta-analysis. Br J Clin Pharmacol 1997; 44: 179e82.
37. Van Schalkwyk J, Money DM. Pregnancy. In: Canadian guidelines on sexually transmitted infections. 2006 edition. Ottawa: Public Health Agency of Canada, 2006; p. 273e91.
38. McGregor JA, French JI, Jones W et al. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol 1994; 170: 1048e60.
39. McGregor JA, French JI, Parker R et al. Prevention of premature birth by screening and treatment for common genital tract infections: Results of a prospective controlled evaluation. Am J Obstet Gynecol 1995; 173: 157e67.
40. Hauth JC, Goldenberg RL, Andrews WW et al. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995; 333: 1732e6.
41. McDonald HM, O’Loughlin JA, Vigneswaran R et al. Bacterial vaginosis in pregnancy and efficacy of short-course oral metronidazole treatment: a randomized controlled trial. Obstet Gynecol 1994; 84: 343e8.
42. Carey JC, Klebanoff MA, Hauth JC et al. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 2000; 342: 534e40.
43. Ugwumadu A, Reid F, Hay P et al. Natural history of bacterial vaginosis and intermediate flora in pregnancy and effect of oral clindamycin. Obstet Gynecol 2004; 104: 114e9.
44. Joesef MR, Hillier SL, Wiknjosastro G et al. Intravaginal clindamycin treatment for bacterial vaginosis: Effects on preterm delivery and low birth weight. Am J Obstet Gynecol 1995; 173: 1527e31.
45. Kekki M, Kurki T, Pelkonen J et al. Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. Obstet Gynecol 2001; 97: 643e8.
46. Kurkinen-Räty M, Vuopala S, Koskela M et al. A randomised controlled trial of vaginal clindamycin for early pregnancy bacterial vaginosis. BJOG 2000; 107: 1427e32.
47. Lamont RF, Jones BM, Mandal D et al. The efficacy of vaginal clindamycin for the treatment of abnormal genital tract flora in pregnancy. Infect Dis Obstet Gynecol 2003; 11: 181e9.
48. Yudin MH, Landers DV, Meyn L et al. Clinical and cervical cytokine response to treatment with oral or vaginal metronidazole for bacterial vaginosis during pregnancy: a randomized trial. Obstet Gynecol 2003; 102: 527e34.
49. Guaschino S, Ricci E, Franchi M et al. Treatment of asymptomatic bacterial vaginosis to prevent preterm delivery: a randomized trial. Eur J Obstet Gynecol Reprod Biol 2003; 110: 149e52.
50. Morales WJ, Schorr S, Albritton J. Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebocontrolled, double-blind study. Am J Obstet Gynecol 1994; 171: 345e7.
51. Okun N, Gronau KA, Hannah ME. Antibiotics for bacterial vaginosis or trichomonas vaginalis in pregnancy: a systematic review. Obstet Gynecol 2005; 105: 857e68.
52. Vermeulen G, Bruinse H. Prophylactic administration of clindamycin 2% vaginal cream to reduce the incidence of spontaneous preterm birth in women with an increased recurrence risk: A randomized placebo controlled double blind trial. Br J Obstet Gynaecol 1999; 106: 652e7.
53. Lamont RF, Duncan SLB, Mandal D et al. Intravaginal clindamycin to reduce preterm birth in women with abnormal genital tract flora. Obstet Gynecol 2003; 101: 516e22.
54. Leitich H, Brunbauer M, Bodner-Adler B et al. Antibiotic treatment of bacterial vaginosis in pregnancy: a meta-analysis. Am J Obstet Gynecol 2003; 188: 752e8.
________________________________________________
2. Rein MF, Holmes KK. Non-specific vaginitis, vulvovaginal candidiasis, and trichomoniasis: clinical features, diagnosis and management. Curr Clin Top Infect Dis 1983; 4: 281e315.
3. Gravett MG, Hammel D, Eschenbach DA et al. Preterm labor associated with subclinical amniotic fluid infection and with bacterial vaginosis. Obstet Gynecol 1986; 67: 229e37.
4. Hillier SL, Martius J, Krohn MA et al. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 1988; 319: 972e8.
5. Hillier SL, Nugent RP, Eschenbach DA et al.; for the Vaginal Infections and Prematurity Study Group. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. N Engl J Med 1995; 333: 1737e42.
6. Korn AP, Bolan G, Padian N et al. Plasma cell endometritis in women with symptomatic bacterial vaginosis. Obstet Gynecol 1995; 85: 387e90.
7. Leitich H, Bodner-Adler B, Brunbauer M et al. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol 2003; 189: 139e47.
8. Minkoff H, Brunebaum AN, Schwartz RH et al. Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy. Am J Obstet Gynecol 1984; 150: 965e72.
9. Shennan A, Crawshaw S, Briley A et al. A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET trial. BJOG 2006; 113: 65e74.
10. Watts DH, Krohn MA, Hillier SL et al. Bacterial vaginosis as a risk factor for postcesarean endometritis. Obstet Gynecol 1990; 75: 52e8.
11. Wiesenfeld HC, Hillier SL, Krohn MA et al. Lower genital tract infection and endometritis: Insight in to subclinical pelvic inflammatory disease. Obstet Gynecol 2002; 100: 456e63.
12. Woolf SH, Battista RN, Angerson GM et al.; Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2003; 169: 207e8.
13. Eschenbach DA. Bacterial vaginosis: Emphasis on upper genital tract complications. Obstet Gynecol Clin North Am 1989;16:593e610
14. Spiegel CA, Amsel R, Eschenbach D et al. Anaerobic bacteria in nonspecific vaginitis. N Engl J Med 1980; 303: 601e7.
15. Hill GB, Eschenbach DA, Holmes KK. Bacteriology of the vagina. Scand J Urol Nephrol Suppl 1985; 86: 23e39.
16. Hillier SL. Diagnostic microbiology of bacterial vaginosis. Am J Obstet Gynecol 1993; 169: 455e9.
17. Bump RC, Zuspan FP, Buesching WJ 3rd et al. The prevalence, six-month persistence, and predictive values of laboratory indicators of bacterial vaginosis (nonspecific vaginitis) in asymptomatic women. Am J Obstet Gynecol 1984; 150: 917e24.
18. Hill LH, Ruperalia H, Embil JA. Nonspecific vaginitis and other genital infections in three clinic populations. Sex Transm Dis 1983; 10: 114e8.
19. Amsel R, Totten PA, Spiegel CA et al. Nonspecific vaginitis: Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74: 14e22.
20. Embrеe J, Caliando JJ, McCormack WM. Nonspecific vaginitis among women attending a sexually transmitted diseases clinic. Sex Transm Dis 1984; 11: 81e4.
21. Eschenbach DA, Hillier S, Critchlow C et al. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol 1988; 158: 819e28.
22. Paavonen J, Heinonen PK, Aine R et al. Prevalence of nonspecific vaginitis and other cervicovaginal infections during the third trimester of pregnancy. Sex Transm Dis 1986; 13: 5e8.
23. Kurki T, Sivonen A, Renkonen O-V et al. Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol 1992; 80: 173e7.
24. Platz-Christensen JJ, Pernevi P, Hagmar B et al. A longitudinal follow-up of bacterial vaginosis during pregnancy. Acta Obstet Gynecol Scand 1993; 72: 99e102.
25. Meis PJ, Goldenberg RL, Mercer B et al. The preterm prediction study: significance of vaginal infections. Am J Obstet Gynecol 1995; 173: 1231e5.
26. Wenman WM, Tataryn IV, Joffres MR et al. Demographic, clinical and microbiological characteristics of maternity patients: a Canadian clinical cohort study. Can J Infect Dis 2002; 13: 311e8.
27. Goldenberg R, Klebanoff M, Nugent R et al.; for the Vaginal Infections and Prematurity Study Group. Bacterial colonization of the vagina during pregnancy in four ethnic groups. Am J Obstet Gynecol 1996; 174: 1618e21.
28. Jonsson M, Karlsson R, Rylander E et al. The associations between risk behavior and reported history of sexually transmitted diseases, among young women: a population based study. Int J STD AIDS 1997; 8: 501e5.
29. Bump R, Buesching WB 3rd. Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am J Obstet Gynecol 1988; 158: 935e9.
30. Hawes SE, Hillier SL, Benedetti J et al. Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J Infect Dis 1996; 174: 1058e63.
31. Klebanoff MA, Hauth JC, MacPherson CA et al. Time course of the regression of asymptomatic bacterial vaginosis in pregnancy with and without treatment. Am J Obstet Gynecol 2004; 190: 363e70.
32. McDonald H, Brocklehurst P, Parsons J et al. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2007: CD000262.
33. Sarwal S. Vaginal discharge (bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis). In: Canadian guidelines on sexually transmitted infections. 2006 edition. Ottawa: Public Health Agency of Canada, 2006; p. 106e21.
34. Guise JM, Mahon SM, Aickin M et al. Screening for bacterial vaginosis in pregnancy. Am J Prev Med 2001; 20 (Suppl. 3): 62e72.
35. Burtin P, Taddio A, Ariburnu O et al. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol 1995; 172: 525e9.
36. Caro-Paton T, Carvajal A, Martin de Diego I et al. Is metronidazole teratogenic: a meta-analysis. Br J Clin Pharmacol 1997; 44: 179e82.
37. Van Schalkwyk J, Money DM. Pregnancy. In: Canadian guidelines on sexually transmitted infections. 2006 edition. Ottawa: Public Health Agency of Canada, 2006; p. 273e91.
38. McGregor JA, French JI, Jones W et al. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol 1994; 170: 1048e60.
39. McGregor JA, French JI, Parker R et al. Prevention of premature birth by screening and treatment for common genital tract infections: Results of a prospective controlled evaluation. Am J Obstet Gynecol 1995; 173: 157e67.
40. Hauth JC, Goldenberg RL, Andrews WW et al. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995; 333: 1732e6.
41. McDonald HM, O’Loughlin JA, Vigneswaran R et al. Bacterial vaginosis in pregnancy and efficacy of short-course oral metronidazole treatment: a randomized controlled trial. Obstet Gynecol 1994; 84: 343e8.
42. Carey JC, Klebanoff MA, Hauth JC et al. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 2000; 342: 534e40.
43. Ugwumadu A, Reid F, Hay P et al. Natural history of bacterial vaginosis and intermediate flora in pregnancy and effect of oral clindamycin. Obstet Gynecol 2004; 104: 114e9.
44. Joesef MR, Hillier SL, Wiknjosastro G et al. Intravaginal clindamycin treatment for bacterial vaginosis: Effects on preterm delivery and low birth weight. Am J Obstet Gynecol 1995; 173: 1527e31.
45. Kekki M, Kurki T, Pelkonen J et al. Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. Obstet Gynecol 2001; 97: 643e8.
46. Kurkinen-Räty M, Vuopala S, Koskela M et al. A randomised controlled trial of vaginal clindamycin for early pregnancy bacterial vaginosis. BJOG 2000; 107: 1427e32.
47. Lamont RF, Jones BM, Mandal D et al. The efficacy of vaginal clindamycin for the treatment of abnormal genital tract flora in pregnancy. Infect Dis Obstet Gynecol 2003; 11: 181e9.
48. Yudin MH, Landers DV, Meyn L et al. Clinical and cervical cytokine response to treatment with oral or vaginal metronidazole for bacterial vaginosis during pregnancy: a randomized trial. Obstet Gynecol 2003; 102: 527e34.
49. Guaschino S, Ricci E, Franchi M et al. Treatment of asymptomatic bacterial vaginosis to prevent preterm delivery: a randomized trial. Eur J Obstet Gynecol Reprod Biol 2003; 110: 149e52.
50. Morales WJ, Schorr S, Albritton J. Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebocontrolled, double-blind study. Am J Obstet Gynecol 1994; 171: 345e7.
51. Okun N, Gronau KA, Hannah ME. Antibiotics for bacterial vaginosis or trichomonas vaginalis in pregnancy: a systematic review. Obstet Gynecol 2005; 105: 857e68.
52. Vermeulen G, Bruinse H. Prophylactic administration of clindamycin 2% vaginal cream to reduce the incidence of spontaneous preterm birth in women with an increased recurrence risk: A randomized placebo controlled double blind trial. Br J Obstet Gynaecol 1999; 106: 652e7.
53. Lamont RF, Duncan SLB, Mandal D et al. Intravaginal clindamycin to reduce preterm birth in women with abnormal genital tract flora. Obstet Gynecol 2003; 101: 516e22.
54. Leitich H, Brunbauer M, Bodner-Adler B et al. Antibiotic treatment of bacterial vaginosis in pregnancy: a meta-analysis. Am J Obstet Gynecol 2003; 188: 752e8.
Авторы
Т.Э. Карапетян*, Н.А. Ломова, В.Р. Юсубова, Ш.Г. Гвенетадзе
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия
*t_karapetyan@oparina4.ru
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
*t_karapetyan@oparina4.ru
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия
*t_karapetyan@oparina4.ru
________________________________________________
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
*t_karapetyan@oparina4.ru
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