BackgroundBackgroundPreterm birth is birth before 37 weeks' gestation. Genital tract infection is one of the causes of preterm birth. Infection screening during pregnancy has been used to reduce preterm birth. However, infection screening may have some adverse effects, e.g. increased antibiotic drug resistance, increased costs of treatment.ObjectivesObjectivesTo assess the effectiveness and complications of antenatal lower genital tract infection screening and treatment programs in reducing preterm birth and subsequent morbidity.Search methodsSearch methodsWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2009) and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 3).Selection criteriaSelection criteriaWe included all published and unpublished randomised controlled trials in any language that evaluated any described methods of antenatal lower genital tract infection screening compared with no screening. Preterm births have been reported as an outcome.Data collection and analysisData collection and analysisTwo review authors independently assessed eligibility, trial quality and extracted data.Main resultsMain resultsOne study (4155 women) met the inclusion criteria. This trial is of high methodological quality. In the intervention group (2058 women), the results of infection screening and treatment for bacterial vaginosis, trichomonas vaginalis and candidiasis were reported; in the control group (2097 women), the results of the screening program for the women allocated to receive routine antenatal care were not reported. Preterm birth before 37 weeks was significantly lower in the intervention group (3% versus 5% in the control group) with a relative risk (RR) of 0.55 (95% confidence interval (CI) 0.41 to 0.75). The incidence of preterm birth for low birthweight preterm infants with a weight equal to or below 2500 g and very low birthweight infants with a weight equal to or below 1500 g were significantly lower in the intervention group than in the control group (RR 0.48, 95% CI 0.34 to 0.66 and RR 0.34; 95% CI 0.15 to 0.75, respectively).Authors' conclusionsAuthors' conclusionsThere is evidence that infection screening and treatment programs in pregnant women before 20 weeks gestation reduce preterm birth and preterm low birthweights. Future trials should evaluate the effects of types of infection screening program and the costs of introducing an infection screening program.
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