Table of Contents Author Guidelines Submit a Manuscript
Infectious Diseases in Obstetrics and Gynecology
Volume 8, Issue 3-4, Pages 158-165
http://dx.doi.org/10.1155/S1064744900000211

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

1MRC Sexually Transmitted Diseases Research Group, Department of Medical Microbiology, Imperial College School of Medicine, Norfolk Place, Paddington, London, United Kingdom
2Department of Obstetrics and Gynaecology, Northwick Park and St. Mark's NHS Trust, Harrow, United Kingdom
3Department of Medical Statistics and Evaluation, Imperial College School of Medicine, The Hammersmith Hospital, London, United Kingdom
4Scientific Development Division, Public Health Laboratory Service, Headquarters Office, 61 Colindale Avenue, London NW9 5DF, United Kingdom

Received 16 November 1999; Accepted 26 April 2000

Copyright © 2000 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives: To determine whether intravaginal clindamycin cream reduces the incidence of abnormal pregnancy outcome in women with abnormal vaginal microbial flora graded as intermediate or BV 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 district general hospital. The subjects were 268 women who had abnormal vaginal microbial flora at first clinic visit by examination of a Gram-stained vaginal smear and 34 women with a normal vaginal flora. Two hundred and thirty-seven women were evaluable. Women with abnormal Gram-stained smears (graded as II or III) on clinic recall were randomised to receive treatment (intravaginal clindamycin cream) or placebo and followed to assess outcome of pregnancy, vaginal flora, and detection of Mycoplasma hominis and Ureaplasma urealyticum after treatment.

Results: Abnormal outcomes of pregnancy were not significantly different in treated and placebo groups by Chi square (P = 0.2). However, women with grade III flora responded better to clindamycin than women with grade II flora by numbers of abnormal outcomes (P = 0.03) and return to normal vaginal flora (P = 0.01) (logistic regression analysis model). This may be due to differences in vaginal bacterial species in these grades. Women whose abnormal vaginal flora had spontaneously returned to normal on follow-up and were therefore not treated (revertants) had as many abnormal outcomes as placebos suggesting that damage by abnormal bacterial species occurred early in pregnancy.

Conclusions: Gram-stain screening distinguishing grade II from grade III flora may be helpful in prescribing treatment other than clindamycin for women with grade II flora. Earlier diagnosis and treatment may be more effective in preventing an abnormal outcome, possibly as soon as pregnancy is diagnosed or even offered as a pre-conception screen. Infect. Dis. Obstet. Gynecol. 8:158–165, 2000.