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The accuracy of various tests for bacterial vaginosis in predicting preterm birth: a systematic review
Author(s) -
Honest Honest,
Bachmann Lucas M.,
Knox Ellen M.,
Gupta Janesh K.,
Kleijnen Jos,
Khan Khalid S.
Publication year - 2004
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2004.00124.x
Subject(s) - bacterial vaginosis , medicine , gram staining , confidence interval , asymptomatic , obstetrics , meta analysis , gynecology , biology , microbiology and biotechnology , antibiotics
Objective To determine the accuracy with which various types of tests for bacterial vaginosis predict spontaneous preterm birth in pregnant women. Data sources Studies were identified without language restrictions through nine different databases, and manual searching of bibliographies of known primary and review articles. Study selection and data extraction There are four different bacterial vaginosis testing methods: Gram staining tests using either Nugent's or Spiegel's criteria, and gas liquid chromatography are laboratory based, and the fourth method uses clinical (Amsel's) criteria to diagnose bacterial vaginosis. Two reviewers independently selected studies and extracted data on their characteristics, quality and accuracy. Accuracy data were used to form 2 × 2 contingency tables of the bacterial vaginosis test results with spontaneous preterm birth as the reference standard. Data synthesis Data on asymptomatic women and women with symptoms of threatened preterm labour were analysed separately. Data were pooled to produce summary estimates of likelihood ratios for positive (LR+) and negative (LR−) test results for the various types of tests. Results There were 18 primary articles, involving altogether 17,868 women. There was unexplained heterogeneity in the meta‐analyses of the accuracy results, which requires caution in their interpretation. Meta‐analyses of studies testing asymptomatic women in the second trimester showed that clinical criteria had a LR+ of 0.98 (95% confidence interval 0.59 to 1.6) and a LR− of 1.00 (0.93 to 1.1), Gram staining (Nugent's criteria) had a LR+ of 1.6 (1.4 to 1.9) and a LR− of 0.9 (0.8 to 0.9), and Gram staining (Spiegel's criteria) had a LR+ of 2.4 (1.4 to 4.9) and a LR− of 0.81 (0.64 to 1.0). Among symptomatic women, Gram staining (Spiegel's criteria) had a LR+ of 1.3 (1.0 to 1.6) and LR− of 0.9 (0.7 to 1.0). Conclusion There was a lack of difference in the accuracy of the various bacterial vaginosis tests for predicting preterm birth in both asymptomatic and symptomatic women of threatened preterm labour.