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Table 12 Impact of antibiotics for high-risk pregnancies on stillbirth and perinatal mortality

From: Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy

Source Location and Type of Study Intervention Stillbirths/Perinatal Outcomes
Reviews and meta-analyses
King and Flenady 2002 [140] Chile, Denmark, USA, South Africa, UK. Meta-analysis (Cochrane). 9 RCTs included. Assessed the impact of any antibiotic (intervention) vs. no antibiotic (controls) in women in pre-term labour with intact membranes. PMR: RR = 1.22 (95% CI: 0.88–1.70) [NS]
Lumbiganon et al. 2004 [142] USA. Meta-analysis (Cochrane). 2 RCTs included. Assessed the impact of chlorhexidine vaginal wash (intervention) vs. placebo (controls) in preventing maternal and neonatal infections including chorioamnionitis and sepsis. PMR: RR = 1.00 (0.17–5.79) [NS]
Thinkhamrop et al. 2002 [146] Kenya, Belgium, USA, The Netherlands. Meta-analysis (Cochrane). 3 RCTs included. Assessed the impact of prophylactic antibiotic administration in the second and third trimester (intervention) vs. no antibiotic (controls), particularly in reference to women with prior pre-term birth and women with BV. PMR: OR = 0.5 (95% CI: 0.16–1.71) [NS] PROM: OR = 0.32 (95% CI: 0.14–0.73) LBW: OR = 0.48 (95% CI: 0.27–0.84) in women with a previous pre-term birth Pre-term: OR = 1.06 (95% CI: 0.68–1.64) [NS] Pre-term: OR = 0.48 (95% CI: 0.28–0.81) in women with confirmed BV.
Goldenberg et al. 2006 [143] Malawi, Egypt. Review. 2 non-randomised, non-blinded trials included. N = 11,380 women. Assessed the impact of chlorhexidine vaginal wash (intervention) vs. placebo (controls) in preventing maternal and neonatal infections and neonatal death. No pooled estimates given. ENND [Malawi]: RR = 0.78 [29/1000 vs 37/1000 in intervention vs. control groups, respectively], RR = 0.78) NM due to infections [Malawi]: OR = 0.5 (95% CI: 0.29–0.88, P < 0.005) [2.4 vs. 7.3 per 1000 in intervention vs. control groups, respectively]. Infant death [Egypt]: 2.8 vs. 4.2% in intervention vs. control groups, respectively (P = 0.01) Infant death due to infection: 0.22% vs. 0.84% in intervention vs. control groups, respectively (P = 0.004)
McDonald et al. 2007 [141] Australia, UK, USA, South Africa. Meta-analysis (Cochrane). 5 RCTs included. Assessed the impact of oral antibiotics (intervention) vs. placebo/no treatment (controls). PMR: OR = 0.94 (95% CI: 0.52–1.70) [NS]
Observational studies
Watson-Jones et al. 2007 [187] . Tanzania (Mwanza). Prospective cohort study. Women (N = 1688) attending ANC. As part of a study of the effectiveness of syphilis screening and treatment, assessed the impact of screening and treatment for reproductive tract infections (RTIs) during pregnancy on SB, IUGR, LBW, and pre-term birth. SBR: 27/1000. No statistical significance data. Pre-term: 12% LBW: 8% SB risk factors: past history of stillbirth, short maternal stature and anaemia. No association between treated RTIs and adverse pregnancy outcomes.
Tita et al. 2007 [200] USA (Alabama). RCT, subgroup analysis. Center for Women's Reproductive Health, University of Alabama at Birmingham. N = 241 nonpregnant women with reproductive tract infections; N = 124 conceived with birth outcome data (N = 59 intervention; N = 65 controls). Compared impact of 2 doses of azithromycin 1.0 g given 4 days apart plus sustained-release metronidazole 750 mg daily for 7 days (intervention) vs. placebo (controls). Treatment was repeated 3x/yr until conception or until study termination. Reevaluation after randomisation with cultures and histopathology. Followed up 5 years. Adverse pregnancy outcome (pre-term birth or fetal death): 66.1% (39/59) vs. 61.5% (40/65) [NS] in intervention vs. control groups, respectively. RR = 1.25 (99% CI: 0.42–3.7) [NS] in women colonised with any microbe at baseline vs. women without any colonisation. [62.7% vs 50%, respectively]. RR = 0.87 (0.50–1.5) [NS] in women with plasma cell endometritis vs. women without. [61.9% vs. 70.8%, respectively]. RR = 0.60 (95% CI = 0.3–1.2) [NS] in women without Gardnerella vaginalis colonisation vs. women with colonisation RR = 0.66 (95% CI = 0.4–1.2) [NS] in women without Gram-negative rod colonisation vs women with colonisation. RR = 1.5 (95% CI: 1.1–2.0) in intervention vs. control groups, respectively, in the presence of Gardnerella vaginalis (crossover interaction). RR = 1.5 (95% CI: 1.1–2.1) in intervention vs. control groups, respectively, in the presence of Gram-negative rod colonisation (crossover interaction).