Bacterial Vaginosis and Preterm Birth: A Comprehensive Review of the Literature (original) (raw)
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Effect of bacterial vaginosis on preterm birth: a meta-analysis
Archives of Gynecology and Obstetrics
Purpose Bacterial vaginosis is a common genital tract disorder. It can lead to preterm birth but its contribution and extent is equivocal. Bacterial vaginosis is a treatable cause of preterm birth if diagnosed and treated correctly. The study desired to con rm the relationship between bacterial vaginosis and preterm. Methods It was a meta-analysis. Articles published from 2008 to 2018 were included. The studies conducted to measure the strength of association between Bacterial Vaginosis and Preterm Birth by any statistical test were included. Studies with only conceptual aspects and qualitative data were excluded from the meta-analysis. Four search engines were identi ed, PubMed, Google Scholar, Cochrane, and LILAC. Forest plots were plotted separately for Odds Ratio (OR) and Relative Risk. Results After extensive search 11 studies giving 14 relevant results with 20,894 participants were included. This meta-analysis proves that Bacterial Vaginosis is strongly associated with preterm birth. The risk of preterm delivery is >2-folds in women with bacterial vaginosis (OR, 2.79; 95% CI, 2.29 to 3.41). The combined or pooled risk ratio (RR) of pregnant women with bacterial vaginosis having a preterm birth or preterm delivery is 1.52 (RR, 95% C.I.=1.33 to 1.74). Conclusion Our study shows a strong association between Bacterial vaginosis and preterm birth. The study concludes that investigation for bacterial vaginosis and management accordingly should be a part of the routine examination of a pregnant woman. The health system must initiate this strategy at the earliest to reduce prevalence of preterm births and thereby neonatal mortality.
Influence of early self-diagnosis and treatment of bacterial vaginosis on preterm birth rate
International Journal of Gynecology & Obstetrics, 2012
To assess whether early self-diagnosis and treatment of bacterial vaginosis (BV) could lower the preterm birth rate among a group of Indonesian women. Methods: A randomized controlled trial of 331 pregnant women (14-18 weeks) was conducted. Participants were randomly assigned to either the active model group (n = 176) or the control group (n = 155). Women in the active model group were equipped with a kit to self-evaluate vaginal pH; those with a positive test result were treated with a twice daily dose of 500 mg of metronidazole for 7 days. The primary end point was preterm birth rate. Results: There were 6 (3.8%) and 8 (5.4%) preterm births in the active model and control groups, respectively (P = 0.468). No spontaneous abortions were recorded in either group. When compared with the gold standard (Gram staining), the vaginal acidity test had low ability to detect BV, with 88.7% specificity and 36.9% sensitivity. The positive predictive value of the test was 35.0% PPV, while the negative predictive value was 89.4%. Conclusion: Early selfdiagnosis and treatment of BV did not reduce the preterm birth rate of the study group. ClinicalTrial.gov number: NCT01232192.
Bacterial Vaginosis as a Risk Factor for Preterm Labour-An Analysis of Age and Duration of Marriage
Journal of gynecology and obstetrics, 2016
Preterm labour is the onset of labour between ≥ 24 weeks to < 37 weeks of gestation. Bacterial Vaginosis (BV) is a polymicrobial condition with predominant lactobacilli in the vaginal flora. It is an important risk factor for preterm labour with an incidence of 5-18% of all deliveries causing increased perinatal morbidity and mortality with subsequent neurodevelopmental problems as cerebral palsy. We aimed to determine the association of BV with preterm labour population. A case control study was conducted comparing the prevalence of bacterial vaginosis in women having term labour with those who had preterm delivery. Chi square test was used to compare differences in participants' age, duration of pregnancy and duration of marriage. Odd ratio and CI was calculated for the association between BV and preterm labour. Nearly half of the participants that experienced preterm labour were between 21 and 25 years old (46.7%, n = 35) and nearly half of the participants that experienced term pregnancy were between 21 and 25 years old as well (48.0%, n = 36). Additionally, the majority of participants had been married for three to four years, for those that experienced preterm labour (64.0%, n = 48) and term pregnancy (52.0%, n = 39). Furthermore, nearly half of the participants' duration of pregnancy was between 33 and 34 weeks (49.3%, n = 37) and 52.0% of participants who experienced term pregnancy had been pregnant for 37 to 38 weeks (n = 39). Women with Bacterial Vaginosis, experienced preterm labour in 26.7% cases (n = 20) as compared to those who had term pregnancy 12.0% (n = 9). BV was significantly associated with preterm labour (OR=7.3, 95% CI =1.9-27.5, P=0.003). There was no significant difference in participants' age between preterm labour and term pregnancy groups, (p value=0.880). Additionally, there was no significant difference in participants' duration of marriage between preterm labour and term pregnancy groups, (p value=0.801). Bacterial Vaginosis is a risk factor for preterm labor. The study also concluded that there is no significant association between age, duration of pregnancy and duration of marriage between preterm labour and term pregnancy groups.
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. #
Role of Bacterial Vaginosis in threatened preterm and preterm labour, and its screening
Innovative publication, 2016
Background: 8-10% pregnancies end in preterm labour or threatened preterm labour which has maternal and foetal complications just due to infections such as bacterial vaginosis, which can be identified by simple tests like Amsel Criteria and treated at the earliest with appropriate antibiotics. Aim: To establish the role of bacterial vaginosis in preterm labour and threatened preterm labour based on Amsel criteria. Materials and Methods: 100 pregnant women with gestational age between 28 and 36 weeks, of which 50 women with symptoms of threatened preterm labour and preterm labour were kept as study group and another 50 pregnant women in the same gestational age without any symptoms of threatened preterm or preterm labour were kept as control group. Examination of vaginal discharge, vaginal pH, microscopy for clue cells and Whiff test, which are Amsel's criteria, were done. Chi-square test was used to find out the association of variables and p value less than 0.05 was taken as statistically significant. Results: The women in study group had higher incidence of vaginal discharge than control group. All the bacterial vaginosis cases had vaginal pH >4.5. The negative predictive value of vaginal fluid pH > 4.5 in our study is 100%. In our study 27% cases in all groups were found to have whiff test positive. 20% had clue cells on microscope examination. All the Amsel's criterion was statistically highly significant between the study and the control group. Conclusion: The strong correlation between presence of Bacterial Vaginosis and the incidence of threatened preterm and preterm labour is established. Amsel's criteria are simple, inexpensive, easily reproducible method of diagnosing BV and can be used on a mass scale. By diagnosing and treating bacterial vaginosis in threatened preterm labour, preterm deliveries can be prevented to a certain extent, if not atleast in order to buy time for the inclusion of steroids which will decrease the perinatal morbidity and mortality by decreasing Respiratory Distress Syndrome and intraventricular haemorrhage.
Bacterial vaginosis and adverse outcomes among full-term infants: a cohort study
BMC pregnancy and childbirth, 2016
Bacterial vaginosis (BV) during pregnancy is a well-established risk factor for preterm birth and other preterm pregnancy complications. Little is known about adverse neonatal outcomes associated with BV exposure in full-term births, nor its influence on adverse outcomes independent of its effect on gestational age. The purpose of this study was to examine the relationship between BV during pregnancy and adverse neonatal outcomes among full-term and preterm infants. We conducted a retrospective cohort study of Washington State mother/infant pairs from 2003-2013, stratified by full-term (primary outcomes) and preterm births (secondary outcomes). BV-exposed and unexposed women were frequency-matched based on year of delivery. BV exposure and adverse outcomes [assisted ventilation/respiratory distress, neonatal intensive care unit (NICU) admission, neonatal sepsis, fetal mortality, and infant mortality] were identified using birth certificates, ICD-9 codes from linked hospital records,...
Bacterial vaginosis – a risk factor for preterm labour: a case-control study
IP Innovative Publication Pvt. Ltd., 2017
Aim: To estimate the prevalence of bacterial vaginosis in preterm labour patients when compared to term labour patients. Materials and Method: It was a hospital based prospective case-control study conducted over a period of two years. Study population was selected as per our study criteria. Speculum examination was done for both control and cases and evaluated for any abnormal vaginal discharge and vaginal pH. Smear from posterior fornix was taken using sterile cotton swabs for wet mount and KOH test (Whiff test). Diagnosis of bacterial vaginosis was made if three of the four signs of Amsel criteria were found. The data were analysed using SPSS software 20 and results were derived. Results: Among the patients bacterial vaginosis was present in 24 of the preterm labour (26.7%) patients and 5 of the term labour (5.6%) patients (Table 1). It was statistically significant (p < 0.001) by Chi-square test. Considering the relative risk(RR), women with bacterial vaginosis has increased risk of preterm labour when compared to patients without bacterial vaginosis(Odds ratio-6.182;RR-4.800). Conclusion: Our study concluded that bacterial vaginosis is one of the most important causes of preterm labour. Routine screening and treatment of bacterial vaginosis for women at high risk for preterm labour will help in reduction of preterm birth related perinatal morbidity and mortality.
AbstrAct Introduction: Bacterial vaginosis (BV) is a vaginal infection involving a reduction in the amount of hydrogen-peroxide-producing Lactobacillus and an overgrowth of anaerobic and gram-negative or gram-variable bacteria. Its prevalence in pregnancy is upto 15-30% and it can have a bearing on pregnancy outcome. It has been associated with preterm labor and preterm delivery, premature rupture of membranes (PROM), amniotic fluid infections and postpartum endometritis. Material and methods: Five hundred antenatal patients admitted or attending antenatal outpatient clinic in Dept. of Obstetrics and Gynecology, LLRMMC and associated SVBP Hospital, Meerut, Uttar Pradesh in last one year were enrolled after a written and informed consent. Patients included were <28 weeks gestation and without any known risk factors for premature delivery. BV was diagnosed by Nugent's criteria and correlated with occurrence of preterm labor, PROM and postpartum endometritis. Result: BV was found in 98 of the 500 patients studied. Twenty-three of the 98 BV patients had preterm delivery and this association was significant (p < 0.0001). Fourteen patients of BV had PROM and this association was also significant (p < 0.001). Six patients of BV also had postpartum endometritis. Conclusion: The above results suggest that screening for BV should start in early pregnancy and a high index of suspicion for preterm delivery should be kept in antenatal patients with BV.