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Cervicovaginal microflora and pregnancy outcome: results of a double-blind, placebo-controlled trial of erythromycin treatment.
Am J Obstet Gynecol. 1990 Nov; 163(5 Pt 1):1580-91.AJ

Abstract

Available information suggests that some instances of preterm birth or premature rupture of membranes are associated with clinically unrecognized infection and inflammation of the lower uterine segment, decidua, and fetal membranes. Various cervicovaginal microorganisms have been recovered from these sites. Many of these microorganisms produce factors that may lead to weakening of the fetal membranes, release of prostaglandins, or both. This study evaluated the presence of various lower genital tract microflora and bacterial conditions in 229 women enrolled in a double-blind, placebo-controlled trial of short-course erythromycin treatment at 26 to 30 weeks' gestation to prevent preterm birth. Demographic, obstetric, and microbiologic parameters were prospectively evaluated. Premature rupture of membranes occurred less frequently (p less than 0.01) among women who received erythromycin (6%) versus placebo (16%). Preterm premature rupture of membranes also occurred less frequently, although not significantly (p = 0.3) in patients who received erythromycin (2%) versus placebo (5%). Erythromycin treatment significantly decreased the occurrence of premature rupture of membranes among women who were initially positive for Chlamydia trachomatis infection. Logistic regression analysis demonstrated that C. trachomatis (p = 0.05; odds ratio, 9), vaginal wash phospholipase C (p = 0.08; odds ratio, 6) and prior preterm birth (p = 0.007; odds ratio 17) were associated with increased risk of preterm birth. Bacterial vaginosis, Mycoplasma hominis, Ureaplasma urealyticum were not significantly associated with increased risk of preterm birth or preterm rupture of membranes. These findings support a role for selected lower genital tract microflora in preterm birth and premature rupture. Large controlled treatment trials of specific infections or conditions associated with preterm birth and premature rupture of membranes are required to confirm the value of antimicrobial treatments in prevention of microbial-associated preterm birth.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

2240110

Citation

McGregor, J A., et al. "Cervicovaginal Microflora and Pregnancy Outcome: Results of a Double-blind, Placebo-controlled Trial of Erythromycin Treatment." American Journal of Obstetrics and Gynecology, vol. 163, no. 5 Pt 1, 1990, pp. 1580-91.
McGregor JA, French JI, Richter R, et al. Cervicovaginal microflora and pregnancy outcome: results of a double-blind, placebo-controlled trial of erythromycin treatment. Am J Obstet Gynecol. 1990;163(5 Pt 1):1580-91.
McGregor, J. A., French, J. I., Richter, R., Vuchetich, M., Bachus, V., Seo, K., Hillier, S., Judson, F. N., McFee, J., & Schoonmaker, J. (1990). Cervicovaginal microflora and pregnancy outcome: results of a double-blind, placebo-controlled trial of erythromycin treatment. American Journal of Obstetrics and Gynecology, 163(5 Pt 1), 1580-91.
McGregor JA, et al. Cervicovaginal Microflora and Pregnancy Outcome: Results of a Double-blind, Placebo-controlled Trial of Erythromycin Treatment. Am J Obstet Gynecol. 1990;163(5 Pt 1):1580-91. PubMed PMID: 2240110.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervicovaginal microflora and pregnancy outcome: results of a double-blind, placebo-controlled trial of erythromycin treatment. A1 - McGregor,J A, AU - French,J I, AU - Richter,R, AU - Vuchetich,M, AU - Bachus,V, AU - Seo,K, AU - Hillier,S, AU - Judson,F N, AU - McFee,J, AU - Schoonmaker,J, PY - 1990/11/1/pubmed PY - 1990/11/1/medline PY - 1990/11/1/entrez SP - 1580 EP - 91 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 163 IS - 5 Pt 1 N2 - Available information suggests that some instances of preterm birth or premature rupture of membranes are associated with clinically unrecognized infection and inflammation of the lower uterine segment, decidua, and fetal membranes. Various cervicovaginal microorganisms have been recovered from these sites. Many of these microorganisms produce factors that may lead to weakening of the fetal membranes, release of prostaglandins, or both. This study evaluated the presence of various lower genital tract microflora and bacterial conditions in 229 women enrolled in a double-blind, placebo-controlled trial of short-course erythromycin treatment at 26 to 30 weeks' gestation to prevent preterm birth. Demographic, obstetric, and microbiologic parameters were prospectively evaluated. Premature rupture of membranes occurred less frequently (p less than 0.01) among women who received erythromycin (6%) versus placebo (16%). Preterm premature rupture of membranes also occurred less frequently, although not significantly (p = 0.3) in patients who received erythromycin (2%) versus placebo (5%). Erythromycin treatment significantly decreased the occurrence of premature rupture of membranes among women who were initially positive for Chlamydia trachomatis infection. Logistic regression analysis demonstrated that C. trachomatis (p = 0.05; odds ratio, 9), vaginal wash phospholipase C (p = 0.08; odds ratio, 6) and prior preterm birth (p = 0.007; odds ratio 17) were associated with increased risk of preterm birth. Bacterial vaginosis, Mycoplasma hominis, Ureaplasma urealyticum were not significantly associated with increased risk of preterm birth or preterm rupture of membranes. These findings support a role for selected lower genital tract microflora in preterm birth and premature rupture. Large controlled treatment trials of specific infections or conditions associated with preterm birth and premature rupture of membranes are required to confirm the value of antimicrobial treatments in prevention of microbial-associated preterm birth. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/2240110/Cervicovaginal_microflora_and_pregnancy_outcome:_results_of_a_double_blind_placebo_controlled_trial_of_erythromycin_treatment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0002-9378(90)90632-H DB - PRIME DP - Unbound Medicine ER -