Treatment of bacterial vaginosis to prevent infection following caesarean delivery; a randomized control study

Background: There is shortage in clinical data determining significant benefit (i.e., decrease of severe infection outcomes) following screening and treatment of Bacterial vaginosis (BV) late in pregnancy. Due to this deficiency of data, there is controversy concerning whether ladies with BV should be screened and/or treated in late pregnancy to prevent peripartum infections. BV is a common lower genital tract infection with a global prevalence ranging between 23 and 29%. Aim: To asses if treatment of BV positive women screened at cesarean delivery significantly reduces infection rate Study Design: The trial was a randomized double-blinded, single center interventional study conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University. The study population consisted of 150 eligible pregnant women who were admitted in the labour or obstetric ward and underwent elective or emergency CS from December 2019 to February 2021. The women were randomized into either of the two arms. The study arm “Group A” participants received 500gm MTZ twice daily for one week, starting 6hrs following CS, whereas the control arm “Group B” participants received one placebo tablet twice daily for one week, 6hrs following CS. Each group comprised 75 pregnant women. Results: In total 150 patient, eight were excluded from statistical analysis for unknown infection morbidity status due to loss to follow up, leaving 142 women for analysis. Of those that were given treatment for BV, 66 women (91.7%) had a negative test for BV at one week. In this study, treatment of BV was found to be significantly associated with the reduction of post cesarean endometritis ( P value = 0.0121) (cOR = 0.2834; 95%CI = [0.2228 to 0.8627]). However, the situation was different regarding wound infection incidence. No significant difference was recognized between the treatment and control groups ( P value = 0.2048). Conclusion: Given the results of our study, which is in agreement to same evidence associating BV with intrapartum chorioamnionitis and endometritis post CS, BV screening late in pregnancy, possibly at the 35-37 week and group B streptococcus culture visit, or immediately following CS, and treatment of those positively screened could be made. With none existence of guidelines from professional societies, preoperative screening and treatment of BV could cause more reduction in surgical site infections.