title: Routine Use of an Antenatal Infection Screen-and-Treat Program to Prevent Preterm Birth: Long-Term Experience at a Tertiary Referral Center.
abstract: BACKGROUND
  Vaginal infection in early pregnancy is associated with preterm birth. This study evaluates long-term results after integrating an antenatal screen-and-treat program for asymptomatic vaginal infections into routine pregnancy care.
  
  
  METHODS
  We retrospectively analyzed data of all women with singleton high-risk pregnancies delivering at our tertiary referral center between 2005 and 2014. The intervention group included women who presented for a prenatal visit for a planned birth between 10 + 0 and 16 + 0 gestational weeks. Women were routinely screened for asymptomatic infections using Gram stain. In cases of bacterial vaginosis, candidiasis or trichomoniasis, women were treated according to our clinical protocol. The control group included women who did not undergo the program. Prenatal care was equal in both groups. Preterm birth served as the primary outcome variable.
  
  
  RESULTS
  Of the 20,052 women with singleton pregnancies, 8,490 (42.3%) participated in the antenatal prevention program. The mean gestational age at birth was 38.8 ± 2.6 weeks and 37.5 ± 4.3 weeks in the intervention and control groups, respectively (p < 0.001). The incidence of preterm birth was significantly lower in the intervention group than in the control group (9.7% vs 22.3%; p < 0.001). Low-birthweight neonates, stillbirths, and late miscarriages were less frequent in the intervention group (p < 0.001).
  
  
  CONCLUSIONS
  Long-term results support the use of an antenatal infection screen-and-treat program to prevent preterm birth. If integrated into routine pregnancy care at a high-risk obstetrical setting, this simple public health intervention could lead to a significant reduction in preterm birth, low infant birthweight, and adverse pregnancy outcomes.
authors: Department of Obstetrics and Gynecology, Division of Obstetrics and Fetomaternal Medicine, Medical University Vienna, Vienna, Austria.
authors: Alex
authors: A
authors: Farr
authors: Department of Obstetrics and Gynecology, Division of Obstetrics and Fetomaternal Medicine, Medical University Vienna, Vienna, Austria.
authors: Herbert
authors: H
authors: Kiss
authors: Section for Medical Statistics (IMS), Center of Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria.
authors: Michael
authors: M
authors: Hagmann
authors: Department of Obstetrics and Gynecology, Division of Obstetrics and Fetomaternal Medicine, Medical University Vienna, Vienna, Austria.
authors: Julian
authors: J
authors: Marschalek
authors: Department of Obstetrics and Gynecology, Division of Obstetrics and Fetomaternal Medicine, Medical University Vienna, Vienna, Austria.
authors: Peter
authors: P
authors: Husslein
authors: Department of Obstetrics and Gynecology, Division of Obstetrics and Fetomaternal Medicine, Medical University Vienna, Vienna, Austria.
authors: Ljubomir
authors: L
authors: Petricevic
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D058345:Asymptomatic Infections / Q000453:epidemiology / Q000628:therapy; D001317:Austria / Q000453:epidemiology; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D002985:Clinical Protocols; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011296:Prenatal Diagnosis / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014245:Trichomonas Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D016585:Vaginosis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
chemical_list: D000890:Anti-Infective Agents
keywords: preterm birth; prevention; screening; vaginal infection; vaginosis