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Flagyl for bacterial Vaginosis following pregnancy with cramping and discharge

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I am 20 weeks pregnant. I had bacterial vaginosis at 16 and 18 weeks. Each time, my OB prescribed 500 mg flagyl twice a day for 7 days. I was in the child birth unit at the hospital last night for unusual cramping and discharge My OB was on call and again, I had clue cells and bv. I am again prescribed the flagyl for 7 days; if this course does not work, then OB will prescribe something else in two weeks. I know I need to take the flagyl as I am already at risk for pre-term labor. I have a high-risk pregnancy because of my age and pre-term labor with my last child. I am concerned, however, that taking flagyl for a third time in less than two months will hurt my baby. I know flagyl crosses the placenta and just want to be reassured that other pregnancy women who have had recurrent (persistent) bv in pregnancy have taken flagyl ongoing without complications. I do not have any lifestyle factors that cause me to get bv (I have no sexual contact, changed diet, etc). Will my baby be okay if I take this course of flagyl? Do some women have recurrent bv throughout their pregnancies and continue on to have successful pregnancies? Thank you for your help.

Category: OBGYN

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Dr. Aarti Vazirani
Category: Infertility Specialist
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Expert:  Dr. Aarti Vazirani
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Thanks for choosing doctorspring.com

Thanks for writing to us with your health concern.

Let me elaborate a few points which will reassure you, backing up my statements with studies attached, which maybe in medical terminology, but the gist of which will be grasped by a perceptive patient like you.

1. BV ( bacterial vaginosis ) is known for recurrence. Almost 30 % women relapse in the first month of therapy. Apart from sexual partners, other factors are being incriminated - stress, lack of sleep, vaginal douching or over cleaning with various agents etc.

2. During pregnancy too, recurrence is common, and recurrent BV has an association with adverse pregnancy outcomes, but by far, the number of successful pregnancies outnumbers the adverse outcomes. IN your case, with a prior history of preterm labour and your age ( not specified by you in the query ), there is more room for caution.

3. Metronidazole ( flagyl ) is completely safe in pregnancy, yes, even a third course. Rest assured.

4. It is better to combine topical therapy ( clindamycin cream ) with oral Flagyl, please discuss this with your OB.

Am attaching a few links, please go through them in detail -
http://epirev.oxfordjournals.org/content/24/2/102.full
http://jac.oxfordjournals.org/content/44/6/854.full
http://www.ncbi.nlm.nih.gov/pubmed/7856680
Take care, and please feel free to discuss further.
Regards

Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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