Clinical criteria require three of the following symptoms or signs:

 

All pregnant women who have symptomatic disease require treatment.  BV has been associated with adverse pregnancy outcomes (e.g., premature rupture of the membranes, chorioamnionitis, preterm labor, preterm birth, intraamniotic infection, postpartum endometritis, and postcesarean wound infection). 

 

 

Metronidazole 500 mg orally twice a day for 7 days

          OR

Metronidazole 250 mg orally three times a day for 7 days

          OR

Clindamycin 300 mg orally twice a day for 7 days (Intravaginal clindamycin cream 2%, intravaginally at bedtime for 7 days should only be used during the first half of pregnancy)

 

1.       Alcohol should not be used at any time during pregnancy.  Alcohol may cause serious side effects if used prior to 24 hrs after completing a course of metronidazole

2.       Advise patient to return if symptoms persist or recur.

 

NOTE:  Metronidazole has been used safely in the first trimester and is appropriate for the symptomatic patient.

 

Prepared in conjunction with the

Division of Maternal-Fetal Medicine

Duke University Medical Center

 

                                                            ______________________          _____

1/16/07                                                                        Director                                                            Date       

                                                                

 

1.             McCoy MC, Katz VL, Kuller JA, Killam AP, Livengood CH.  "Bacterial Vaginosis in Pregnancy:  An Approach for the 19909's"  Obstet Gynecol.  50:482-8, 1995

 

2.               Czeizel AE, Rockenbauer M.  A population based case-control teratologic study of oral metronidazole treatment during pregnancy.  Br J Obstet Gynaecol. 1998.  March 105(3):322-7.

 

3.               Diav-Citrin O, Shechtman S, Gotteiner T, Arnon J, Ornoy A.  Pregnancy outcome after gestational exposure to metronidazole:  a prospective controlled cohort study.  Teratology 2001, May 63(5):186-92.

 

The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.

 

These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.

The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.

 

These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols