نبذة مختصرة : International audience ; One of the risk factors for preterm birth (PTB) is bacterial vaginosis (BV), a common, often asymptomatic, vaginal dysbiosis. The earlier BV is diagnosed based on gestational age, the higher the risk of PTB. The effectiveness of a screen-and-treat strategy for BV during pregnancy remains a source of debate. One meta-analyses, including 5 studies and 2346 patients, showed a benefit to screen and treat using clindamycin. Another, with 21 studies and 7847 patients, did not recommend BV screening but observed reductions in preterm delivery by 50% and miscarriages by 80%. In another systematic review, with 48 studies, there was varying accuracy across conventional screening tests for BV and suggested no or inconclusive efficacy in the treatment of asymptomatic BV in the general obstetric population and in those with a history of preterm delivery. Based on these studies, French and international organizations recommend against screening for BV with conventional diagnosis tools in low-risk populations. However, molecular diagnostic tools have been shown to be more accurate in identifying vaginal microbiota than conventional tools, such as clinical diagnosis based on Amsel or Nugent criteria. Molecular tools have been shown to provide an objective, reproducible, quantitative diagnosis of BV, identifying emergent pathogen species, such as Atopobium vaginae (now known as Fannyhessea vaginae). To date, no randomized studies have been conducted to assess the impact of molecular tools on a screen-and-treat intervention to BV. The aim of this study was to assess whether a screen-and-treat intervention using a molecular diagnostic tool is cost-effective in reducing the rate of PTB. The AuTop Trial was a prospective, open-label superiority trial conducted in 19 French maternity hospitals from March 9, 2015, to December 18, 2017. Included were adult women in early pregnancy (<20 weeks of gestation), with no history of PTB or late abortion and no major risk factors for prematurity. Excluded were ...
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