***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES : To determine whether intravaginal clindamycin cream reduces the incidence of abnormal pregnancy outcome in women with abnormal vaginal microbial flora grade d as intermediate or BV and to investigate the effect of the antibiotic on vaginal microbial flora . METHODS : A prospect i ve cohort study of pregnant women in an antenatal clinic of a district general hospital . The subjects were 268 women who had abnormal vaginal microbial flora at first clinic visit by examination of a Gram-stained vaginal smear and 34 women with a normal vaginal flora . Two hundred and thirty-seven women were evaluable . Women with abnormal Gram-stained smears ( grade d as II or III ) on clinic recall were r and omised to receive treatment ( intravaginal clindamycin cream ) or placebo and followed to assess outcome of pregnancy , vaginal flora , and detection of Mycoplasma hominis and Ureaplasma urealyticum after treatment . RESULTS : Abnormal outcomes of pregnancy were not significantly different in treated and placebo groups by Chi square ( P = 0.2 ) . However , women with grade III flora responded better to clindamycin than women with grade II flora by numbers of abnormal outcomes ( P = 0.03 ) and return to normal vaginal flora ( P = 0.01 ) ( logistic regression analysis model ) . This may be due to differences in vaginal bacterial species in these grade s. Women whose abnormal vaginal flora had spontaneously returned to normal on follow-up and were therefore not treated ( revertants ) had as many abnormal outcomes as placebos suggesting that damage by abnormal bacterial species occurred early in pregnancy . CONCLUSIONS : Gram-stain screening distinguishing grade II from grade III flora may be helpful in prescribing treatment other than clindamycin for women with grade II flora . Earlier diagnosis and treatment may be more effective in preventing an abnormal outcome , possibly as soon as pregnancy is diagnosed or even offered as a pre-conception screen Available information suggests that some instances of preterm birth or premature rupture of membranes are associated with clinical ly 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 prostagl and ins , 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 prospect ively 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 In a prospect i ve study of 202 women ( gestational age 24 + /- 4 weeks ) , we evaluated possible influences of lower genital tract infection or bacterial conditions on  obstetric outcomes  , including  preterm labor , preterm premature rupture of membranes , and preterm birth .  The presence of bacterial vaginosis ( 18.7 % ) was associated with an increased risk of preterm labor ( relative risk , 2.6 ; 95 % confidence interval , 1.08 to 6.46 ) . For women with bacterial vaginosis who also had Mobiluncus species morphotypes identified on Gram stain , the relative risk of preterm labor was 3.8 ( 95 % confidence interval , 1.32 to 11.5 ) . Presence of vaginal Mycoplasma hominis ( 10.8 % of patients ) was associated with both preterm labor ( relative risk , 1.8 ; 95 % confidence interval , 0.77 to 4.4 ) and preterm birth ( relative risk , 5.1 ; 95 % confidence interval , 1.45 to 17.9 ) . Recovery of Staphylococcus aureus ( 3.0 % ) was associated with preterm labor ( relative risk , 3.1 ; 95 % confidence interval 1.12 to 8.7 ) . Identification of two or more bacterial-linked abnormalities was also associated with preterm labor ( relative risk , 3.3 ; 95 % confidence interval , 1.44 to 7.58 ) . An increased level of vaginal wash protease ( greater than or equal to 10 trypsin units ) ( 16 % ) was associated with preterm labor and was noted in 50 % of women with preterm premature rupture of membranes . A history of prior preterm birth was the single best historical predictor of both preterm labor ( relative risk , 3.6 ; 95 % confidence interval , 1.92 to 6.83 ) and preterm birth ( relative risk , 6.7 ; 95 % confidence interval , 2.2 to 20.4 ) . History of three or more abortions , antenatal urinary tract infection , and occurrence of medical complications during pregnancy also correlated with increased risk of preterm labor . These findings affirm and refine associations of various maternal reproductive tract infections with preterm labor , premature rupture of membranes , and birth , allowing for controlled treatment trials aim ed at prevention of preterm birth OBJECTIVE To assess the ability of clindamycin vaginal cream to reduce the incidence of preterm birth in women with abnormal genital tract flora in the second trimester of pregnancy . METHODS This was a r and omized , double-blind , placebo-controlled , tricenter study . A total of 409 women with abnormal genital tract flora on Gram stain of vaginal secretions at 13–20 weeks ' gestation were r and omized to receive a 3-day course of clindamycin vaginal cream or placebo . Those women who still had abnormal vaginal flora 3 weeks later received a 7-day course of the original study drug ( ie , either clindamycin vaginal cream or placebo as per original r and omization ) . The primary outcome measure was the incidence of preterm birth . RESULTS There was a statistically significant reduction in the incidence of preterm birth in the clindamycin vaginal cream group ( 4 % ) compared with placebo ( 10 % ) ( P < .03 ) . Significantly more babies born preterm ( 63 % ) required admission to the neonatal intensive care unit compared with term infants ( 4 % ) ( P < .001 ) . CONCLUSION A 2 % clindamycin vaginal cream , when compared with placebo administered to women with abnormal genital tract flora before 20 weeks ' gestation , can reduce the incidence of preterm birth by 60 % and hence the need for neonatal intensive care OBJECTIVE The purpose of this study was to assess the association of presumptive Trichomonas vaginalis treatment during pregnancy and birth outcomes . STUDY DESIGN A community-r and omized trial of presumptive sexually transmitted disease treatment during pregnancy was conducted between 1994 and 1999 in Rakai district , Ug and a. A sub analysis of a trial of presumptive therapy with azithromycin , cefixime , and metronidazole assessed Trichomonas vaginalis treatment in pregnant women . RESULTS Children of 94 women with Trichomonas who were treated had increased low birth weight ( relative risk , 2.49 ; 95 % CI , 1.12 - 5.50 ) , preterm birth rate ( relative risk , 1.28 ; 95 % CI , 0.81 - 2.02 ) , and 2-year mortality rate ( relative risk , 1.58 ; 95 % CI , 0.99 - 2.52 ) , compared with children of 112 women with Trichomonas who were not treated . CONCLUSION Treatment of Trichomonas vaginalis during pregnancy may be deleterious , and we infer that this may be due to metronidazole . This is consistent with a National Institute for Child Health and Human Development trial that found an excess of preterm births in children of women with Trichomonas vaginalis infection who were treated with metronidazole OBJECTIVE Our purpose was to analyze ( 1 ) the effects of prevalent lower reproductive tract infections and ( 2 ) the effect of systematic diagnosis and treatment to reduce risks of early pregnancy loss ( < 22 weeks ) , preterm premature rupture of membrances  , and overall preterm birth . STUDY DESIGN A prospect i ve , controlled treatment trial was conducted on 1260 women . During the first 7 months of the program ( observation , phase I ) , women were examined at initiation of prenatal care for a panel of lower genital tract microorganisms and bacterial vaginosis . Women were followed up with reexaminations at 22 to 29 weeks and after 32 weeks ' gestation . The recommended treatments of the Centers for Disease Control ( i.e. , 300 mg of clindamycin orally twice daily for 7 days for bacterial vaginosis ) were used for infected women during the second 8 months of the study ( treatment , phase II ) . Data were analyzed according to intent to treat by means of univariate and multivariate methods . RESULTS Overall , presence of bacterial vaginosis ( 32.5 % ) at enrollment was associated with pregnancy loss at < 22 weeks ' gestation ( relative risk 3.1 , 95 % confidence interval 1.4 to 6.9 ) . Among women in the observation phase bacterial vaginosis was associated with increased risk of both preterm birth ( relative risk 1.9 , 95 % confidence interval 1.2 to 3.0 ) and preterm premature rupture of membranes ( relative risk 3.5 , 95 % confidence interval 1.4 to 8.9 ) . Within this population ( phase I ) 21.9 % of preterm birth overall ( 43.8 % premature rupture of membranes ) is estimated as attributable to bacterial vaginosis . Among women with bacterial vaginosis phase II ( treatment ) was associated with reduced preterm birth ( relative risk 0.5 , 95 % confidence interval 0.3 to 0.9 ) ; there was a similar reduction for women with preterm premature rupture of membranes ( relative risk 0.5 , 95 % confidence interval 0.2 to 1.4 ) . Women with both bacterial vaginosis and trichomoniasis were at highest risk of preterm birth ( 28 % ) ; treatment of both conditions ( phase II ) reduced preterm birth ( 17 % ) but did not eliminate this risk . Earlier patient enrollment and oral antibiotic treatment were associated with reduced preterm birth . CONCLUSIONS This prospect i ve , controlled trial confirms that the presence of bacterial vaginosis is associated with increased risks of pregnancy loss at < 22 weeks , preterm premature rupture of membranes , and preterm birth . Orally administered clindamycin treatment is associated with a 50 % reduction of bacterial vaginosis-linked preterm birth and preterm premature rupture of membranes .  Women at risk for preterm birth or preterm premature rupture of membranes because of bacterial vaginosis or common genital tract infections should be screened , treated , reevaluated for cure , and re-treated if necessary BACKGROUND Pregnant women with bacterial vaginosis may be at increased risk for preterm delivery . We investigated whether treatment with metronidazole and erythromycin during the second trimester would lower the incidence of delivery before 37 weeks ' gestation . METHODS In 624 pregnant women at risk for delivering prematurely , vaginal and cervical cultures and other laboratory tests for bacterial vaginosis were performed at a mean of 22.9 weeks ' gestation . We then performed a 2:1 double-blind r and omization to treatment with metronidazole and erythromycin  ( 433 women ) or placebo  ( 191 women ) . After treatment , the vaginal and cervical tests were repeated and a second course of treatment was given to women who had bacterial vaginosis at that time ( a mean of 27.6 weeks ' gestation ) . RESULTS A total of 178 women ( 29 percent ) delivered infants at less than 37 weeks ' gestation . Eight women were lost to follow-up . In the remaining population , 110 of the 
    Output:
    
For women with bacterial vaginosis , antibiotics reduced the risk of persistent infection but did not reduce the risk of preterm birth or the incidence of associated adverse outcomes for the general population or for any subgroup analyzed .
For women with Trichomonas vaginalis , metronidazole reduced the risk of persistent infection but increased the incidence of preterm birth .
CONCLUSION : Contrary to the conclusions of 3 recent systematic review s , we found no evidence to support the use of antibiotic treatment for bacterial vaginosis or Trichomonas vaginalis in pregnancy to reduce the risk of preterm birth or its associated morbidities in low- or high-risk women