Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy (original) (raw)
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Clinical Microbiology: Open Access, 2016
Background: This study was conducted to investigate whether screening and treatment of bacterial vaginosis (BV) in early pregnancy reduces the risk of spontaneous preterm delivery or preterm premature rupture of membranes (PPROMs). Material and methods: Women were screened for BV during their first visit to the maternal health care unit. After the vaginal samples were air dried, they were sent to the gynecological department and were analyzed using Hay/ Ison modified classification. Eligible women were those who lived in Skaraborg County and delivered at Skaraborgs Hospital in Skövde, Sweden. The women were divided into two groups, namely, screened women (with BV or with lactobacilli flora) and unscreened women. Women with BV were offered treatment with vaginal clindamycin. Results: During 2007-2015, 22,084 deliveries occurred at Skaraborgs Hospital; a total of 6,899 women were screened for BV, out of which 746 (10.8%) had BV flora. Survival analysis showed that women with BV had spontaneous preterm delivery significantly earlier than those with normal lactobacilli flora, even after treatment with vaginal clindamycin (log rank p=0.01). During the same period, 15,189 deliveries occurred at Skaraborgs Hospital; they were not screened for BV. The survival analysis showed that the unscreened women delivered slightly earlier than the screened women (t-test p<0.05), with mean delivery days of 239.4-241.7. Conclusion: Even though patients with BV had been treated with clindamycin, they still suffered from an increased risk of spontaneous preterm delivery as compared to women with normal lactobacilli flora. The difference between the screened women and the unscreened women could be attributed to the positive effect of the treatment of BV with clindamycin if it can be assumed that there is the same amount of untreated BV in the unscreened group.
Early Pregnancy Changes in Bacterial Vaginosis-Associated Bacteria and Preterm Delivery
Paediatric and Perinatal Epidemiology, 2014
Background-We evaluated the importance of measuring early vaginal levels of eight BVassociated bacteria, at two points in pregnancy, and the risk of spontaneous preterm delivery (SPTD) among pregnant women and the subgroup of pregnant women with a history of preterm delivery (PTD). Methods-This prospective cohort study enrolled women at five urban obstetric practices at Temple University Hospital in Philadelphia PA. Women with singleton pregnancies less than 16 weeks gestation self-collected vaginal swabs at two points in pregnancy, prior to 16 weeks gestation and between 20-24 weeks gestation, to measure the presence and level of eight BVassociated bacteria. Women were followed-up for gestational age at delivery via medical records. Results-Among women reporting a prior PTD, women with higher levels of Leptotrichia/ Sneathia species, BVAB1 and Mobiluncus spp., prior to 16 weeks gestation, were significantly more likely to experience a SPTD. In addition, pregnant women with a prior PTD and increasing levels of Leptotrichia/Sneathia species (aOR: 9.1, 95% CI: 1.9-42.9), BVAB1 (aOR: 16.4, 95% CI: 4.3-62.7) or Megasphaera phylotype 1 (aOR: 6.2, 95% CI: 1.9-20.6), through 24 weeks gestation, were significantly more likely to experience a SPTD. Among the overall group of pregnant women, the levels of BV-associated bacteria were not related to SPTD. Conclusion-Among the group of women reporting a prior PTD, increasing levels of BVAB1, Leptotrichia/Sneathia species, and Megasphaera phylotype 1, through mid-pregnancy were related to an increased risk of SPTD.
Bacterial Vaginosis: Risk of Adverse Pregnancy Outcome
The reproductive health of a woman is vital not only for her general health but also for that of her partner and child. Bacterial infections can affect pregnant women from implantation of the fertilized ovum through the time of delivery and peripartum period. They may also affect the fetus and newborn. Symptomatic pregnant women with confirmed bacterial vaginosis should be treated. Treatment of pregnant women with asymptomatic bacterial vaginosis is controversial. Guidelines from the Centers for Disease Control and Prevention (CDC) recommend treating asymptomatic high-risk pregnant women with bacterial vaginosis. Antibiotic treatment can eradicate bacterial vaginosis during pregnancy but the overall risk of preterm birth (PTB) is not significantly reduced. Present antibiotic therapy (metronidazole and clindamycin), both oral and vaginal, do not reduce the risk of PTB. Probiotics have the capability to increase vaginal lactobacilli, restore the vaginal microbiota to normal and hence helps to cure bacterial vaginosis. Therefore, Probiotics should be considered as part of the prevention and as an adjunct to antimicrobial the treatment approach for BV.
A longitudinal study of bacterial vaginosis during pregnancy
BJOG: An International Journal of Obstetrics and Gynaecology, 1994
Objective To determine the longitudinal changes in the incidence of bacterial vaginosis in Design A prospective study of women during pregnancy. Setting A District General Hospital in North-West London. Subjects Seven hundred and eighteen pregnant women attending antenatal clinics. At their first attendance and subsequently, Gram-stained vaginal smears were examined and Mycoplasma horninis and Gardnerella vaginalis were sought by culture. Results Initially, 87 (12 YO) women had bacterial vaginosis diagnosed on Gram-stained reading of the vaginal smears. Examination of further smears, obtained from 176 women at 36 weeks of gestation, showed that those whose vaginal flora was normal initially, and who went to term, rarely developed vaginosis (three of 127, 24%). Samples were obtained at 36 weeks gestation from 32 women who had bacterial vaginosis initially, and went to term. In almost 50 YO (1 5 of 32) of these a normal lactobacillus-dominated flora had regenerated. Thirty-five women (5 Yo) had initial vaginal smears graded as intermediate. From this group, six of the 17 (35 YO) women from whom samples were obtained at 36 weeks gestation still had flora of an intermediate pattern; 10 (59 YO) now had normal flora and only one (6 YO) had developed bacterial vaginosis. Women with bacterial vaginosis were more likely to be culture-positive for M . hominis than those with normal flora (34/78 versus 10/563, odds ratio 42.73 (18.9 to 102.3) P < 0.001), or to be culture-positive for G . vaginalis than those with normal flora (35/78 versus 21/563, odds ratio 21.0 (10.75 to 41.2) P < 0.001).
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2003
Objectives: Assess the predictive values of bacterial vaginosis (BV) for preterm delivery (PD) and neonatal infection and compare them with standard markers of infection among women with preterm labour (PL). Study design: Prospective blinded study in a tertiary referral centre in Paris. Women hospitalised for PL with intact membranes at a term between 24 and 34 weeks were included. Vaginal fluid, collected at inclusion was Gram-stained, scored, and interpreted according to Nugent's criteria. Results: Out of 354 women tested, 254 had normal flora (72.3%), 76 intermediate (21.7%) and 24 BV (6.8%). A history of spontaneous miscarriage after 14 weeks was the only risk factor significantly associated with BV. BV was not significantly associated with PD < 35 weeks or neonatal infection. Very preterm delivery (before 33 weeks) was significantly associated with the flora grade (P ¼ 0:02): women with normal, intermediate and abnormal flora, respectively had 27 (10.6%), 14 (18.4%) and 6 (25.0%) births before 33 weeks. Of the markers tested, the highest risk of very preterm delivery was associated with BV (odds ratio 2.95, 95% CI (1.1-0.8.1)) and CRP > 20 mg/dl (4.23 95% CI (1.8-9.7)). Predictive value of BV for preterm birth before 33 weeks were: sensitivity 12.8%, specificity 95.0%, positive predictive value 35.3%, and negative predictive value 84.3%. Conclusions: The frequency of BV and its association with PD are probably very variable and must be interpreted differently from one population to another. While we found an association between BV results and delivery before 33 weeks, the predictive value of BV was disappointing. Although these findings reinforce the importance of a useful marker of subclinical infection, the usefulness of testing for BV in women with PL has not been demonstrated. #
Vojnosanitetski pregled, 2014
Bacground/Aim. Preterm delivery is one of the most common complications in pregnancy, and it is the major cause (75- 80%) of all neonatal deaths. Bacterial vaginosis predisposes to an increased risk of preterm delivery, premature rupture of membrane and miscarriage. In this syndrome normal vaginal lactobacilli, which produce protective H2O2, are reduced and replaced with anaerobic, gram-negative bacteria and others. The aim of this study was to evaluate the influence of bacterial vaginosis on the week of delivery and biochemical markers of inflammation in the serum. Methods. A total of 186 pregnant women were included into this study, between the week 16 and 19 of pregnancy. In the study group there were 76 pregnant women with diagnosed bacterial vaginosis by the criteria based on vaginal Gram-stain Nugent score and Amsel criteria. In the control group there were 110 healthy women with normal vaginal flora. Ultrasound examination was performed in both groups. Vaginal fluid and blood...
Acquisition and Elimination of Bacterial Vaginosis During Pregnancy: A Danish Population-Based Study
Infectious Diseases in Obstetrics & Gynecology, 2006
Objectives: the aim was to examine factors associated with acquisition and elimination of bacterial vaginosis in pregnancy. Methods: a group of 229 pregnant women were randomly selected from a population-based prospective cohort study of 2927. They were examined at enrollment (mean gestational weeks 16w + 0d) and again in mid-third trimester (mean gestational age 32w + 3d). Measures: BV (Amsel's clinical criteria), microbiological cultures of the genital tract and questionnaire data. Results: BV prevalence decreased from 17% in early second trimester to 14% in mid-third trimester due to a tenfold higher elimination rate (39%) than incidence rate (4%). Heavy smokers (> 10/d) in early pregnancy were at increased risk (5.3 [1.1-25]) for the acquisition of BV during pregnancy, as were women receiving public benefits (4.8 [1.0-22]), having a vaginal pH above 4.5 (6.3 [1.4-29]) or vaginal anaerobe bacteria (18 [2.7-122]) at enrollment. A previous use of combined oral contraceptives was preventive for the acquisition of BV (0.2 [0.03-0.96]). Elimination of BV in pregnancy tended to be associated with a heavy growth of Lactobacillus (3.2 [0.8-13]) at enrollment. Conclusions: acquisition of BV during pregnancy is rare and is associated with smoking, while the presence of anaerobe bacteria and a vaginal pH > 4.5 are interpreted as steps on a gradual change towards BV. In the same way heavy growth of Lactobacillus spp in early pregnancy may be an indicator of women on the way to eliminate BV.
Vojnosanitetski Pregled, 2014
Summary: Introduction : Preterm delivery is one of the most common complication in pregnancy, and it is the major cause of (75%-80%) of all neonatal deaths. Bacterial vaginosis predisposes to an increased risk of preterm delivery, premature rupture of membrane and miscarriage. In this syndrome normal vaginal lactobacili, which produce protective H 2 O 2, are reduced and replaced with anaerobic, gram-negative bacteria and others. Aim: of this study was to evaluate the influence of bacterial vaginosis on the week of delivery and biochemical markers in serum. Material and methods: 186 pregnant women enter into our study, between 16 th and 19 th week of pregnancy. In the study group there were 76 pregnant women with diagnosed bacterial vaginosis by criteria based on vaginal Gram-stain Nugent score and Amsel criteria. In the control group there were 110 healthy women, with normal vaginal flora. Ultrasound examination was performed in both groups . Vaginal fluid and blood samples were tak...