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Metronidazole, sold under the brand name Flagyl among others, is an antibiotic and antiprotozoal medication. [10] It is used either alone or with other antibiotics to treat pelvic inflammatory disease , endocarditis , and bacterial vaginosis . [ 10 ]
Treatment for both pregnant and non-pregnant women is usually with metronidazole, [32] by mouth once. [31] Caution should be used in pregnancy, especially in the first trimester. [33] Sexual partners, even if they have no symptoms, should also be treated. [23] Single oral dose of nitroimidazole is sufficient to kill the parasites. [34]
Women should speak to their doctor or healthcare professional before starting or stopping any medications while pregnant. [1] Drugs taken in pregnancy including over-the counter-medications, prescription medications, nutritional supplements, recreational drugs, and illicit drugs may cause harm to the mother or the unborn child.
During pregnancy, paromomycin is the preferred treatment drug because of its poor intestinal absorption, resulting in less exposure to the foetus. [64] Alternatively, metronidazole can be used after the first trimester as there has been wide experience in its use for trichomonas in pregnancy. [20] [65]
For acute cystitis and pyelonephritis in pregnant women, empiric antibiotic treatment is often initiated. Commonly used antibiotics for uncomplicated cystitis include amoxicillin-clavulanate and fosfomycin, while parenteral beta-lactams are preferred for acute pyelonephritis .
In addition, bacterial vaginosis as either pre-existing, or acquired, may increase the risk of pregnancy complications, most notably premature birth or miscarriage. [25] [26] Pregnant women with BV have a higher risk of chorioamnionitis, miscarriage, preterm birth, premature rupture of membranes, and postpartum endometritis. [27]
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A sensitive serum pregnancy test is typically obtained to rule out ectopic pregnancy. Culdocentesis will differentiate hemoperitoneum (ruptured ectopic pregnancy or hemorrhagic cyst) from pelvic sepsis (salpingitis, ruptured pelvic abscess, or ruptured appendix). [28] Pelvic and vaginal ultrasounds are helpful in the diagnosis of PID.