Amoxicillin treatment of bacterial vaginosis during pregnancy

The purpose of this investigation was to evaluate the efficacy of amoxicillin for treatment of bacterial vaginosis during pregnancy. The diagnosis of bacterial vaginosis was established by clinical examination and microscopic examination of a Gram stain and saline preparation of vaginal secretions. In a double-blind, randomized manner, 108 patients at 15-25 weeks' gestation were assigned to treatment with oral amoxicillin, 500 mg three times daily for 14 days, or placebo. Patients were evaluated 2 weeks after treatment, at 34-36 weeks' gestation, and at delivery. There were no significant differences between the two groups with respect to any clinical or microbiologic measure of treatment outcome. There were also no significant differences in the frequency of obstetric complications. We conclude that amoxicillin is not effective therapy for bacterial vaginosis in pregnant women.     

Self-collected vaginal swabs to diagnosis bacterial vaginosis during pregnancy: A pilot study

OBJECTIVE: To study the feasibility of a screening for bacterial vaginosis by a self-collected vaginal swab during pregnancy. To measure bacterial vaginosis prevalence in a non-representative sample of women. PATIENTS AND METHODS: A self-collected swab was suggested to 398 women who consulted between 15 and 33 weeks of gestation in three different centres. Gram stain evaluation using Nugent criteria was used for the diagnosis of bacterial vaginosis. RESULTS: Three hundred and forty-one women agreed to take part in the study (86%). The quality of the swabs was satisfactory in 93% of the cases. Concerning the 15 non-interpretable slides, the cellular and bacterial density was too poor, owing to a poor quality or a low vaginal flora. Thirty-one women (9%) had a bacterial vaginosis--Nugent score included between 7 and 10--and this frequency did not vary according to the centre. Thirty-five women (10%) had an intermediate flora--score between 4 and 6--and this result varied from 2 to 12% depending on the centre, but the difference was not significant. DISCUSSION AND CONCLUSION: Self-collected swabs to detect bacterial vaginosis are well accepted by most of pregnant women, and the quality of the swabs seems to be satisfactory. In case vaginal flora is intermediate--between 4 and 6--the interpretation of the slides could be difficult.     

The papanicolaou smear: inadequate screening test for bacterial vaginosis during pregnancy

OBJECTIVE: Our purpose was to evaluate the ability of the Papanicolaou smear to identify bacterial vaginosis in comparison with the Amsel clinical criteria. STUDY DESIGN: We retrospectively identified 159 pregnant women screened for bacterial vaginosis with the Amsel criteria who had a contemporaneous Papanicolaou smear and negative results on screening for Chlamydia trachomatis and Neisseria gonorrhoeae. Bacterial vaginosis was identified in 45 women. We used the McNemar chi(2) test to determine discrepancies between the two screening methods for the detection of bacterial vaginosis. RESULTS: Compared with the Amsel criteria, the sensitivity and specificity of the Papanicolaou smear for yielding a diagnosis of bacterial vaginosis were 49% (95% confidence interval, 36%-64%) and 93% (95% confidence interval, 86%-97%), respectively, with a positive predictive value of 73% and a negative predictive value of 82%. The detection of bacterial vaginosis by Papanicolaou smear was significantly different from that by Amsel criteria (P =. 01). CONCLUSION: The Papanicolaou smear is not a reliable screening test for bacterial vaginosis during pregnancy.     

A longitudinal study of serum adiponectin during normal pregnancy

Adiponectin is secreted from adipose tissue. Serum adiponectin levels are inversely correlated with body mass index (BMI) and also insulin resistance, independent of the BMI. A role for adiponectin in the development of insulin resistance has been implied in pregnancy. However, no studies have been performed to describe the individual longitudinal course of adiponectin in normal pregnancies. Therefore, we measured serum adiponectin during and after normal pregnancy in 11 healthy women. Serum levels peaked in midpregnancy and the lowest levels were seen in late pregnancy. An inverse association with maternal BMI was observed.     

Prevalence and risk factors of bacterial vaginosis during the first trimester of pregnancy in a large French population-based study

Objectives

Bacterial vaginosis is a risk factor for preterm delivery. Its prevalence and risk factors in Europe are not well known. Our objective was to assess both in early pregnancy.

Study design

As part of the PREMEVA randomized controlled trial, this population-based study included 14,193 women screened before 14 weeks’ gestation for bacterial vaginosis in the 160 laboratories of the Nord-Pas-de-Calais region in France. Bacterial vaginosis was defined by a Nugent score ≥ 7. Data were collected about maternal tobacco use, age, education, and history of preterm birth. We estimated the prevalence of bacterial vaginosis and used a multilevel logistic regression model to identify significant risk factors for it.

Results

Among the 14,193 women assessed before 14 weeks’ gestation, the prevalence of bacterial vaginosis was 7.1% (95% CI: 6.6–7.5%). In the multivariate analysis, smoking during pregnancy tobacco (adjusted OR: 1.38; 95% CI: 1.19–1.60), maternal age 18–19 years (adjusted OR: 1.40; 95% CI: 1.01–1.93), and educational level (completed only primary school: adjusted OR: 1.77; 95% CI: 1.35–2.31; completed only secondary school: adjusted OR: 1.27; 95% CI: 1.10–1.48) were independent risk factors for bacterial vaginosis. History of preterm delivery was not an independent risk factor of bacterial vaginosis: adjusted OR: 1.15; 95% CI: 0.90–1.47.

Conclusion

In a large sample of women in their first trimester of pregnancy in France, the prevalence of bacterial vaginosis was lower than rates reported in other countries, but risk factors were similar: young age, low level of education, and tobacco use during pregnancy. These results should be considered in future strategies to reduce preterm delivery.     

A longitudinal study of B lymphocyte responses during normal human pregnancy

The lymphocyte responses in 22 normal human pregnancies to a B-lymphocyte mitogen, Escherichia coli LPS, were tested in a single sequence using stored lymphocytes. Evidence was found for decreased B lymphocyte function at delivery which was most pronounced for first pregnancies resulting in female infants without HLA-B matching.     

Antibiotic treatment of bacterial vaginosis in pregnancy: a meta-analysis

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of antibiotic treatment of bacterial vaginosis in pregnancy to reduce preterm delivery. STUDY DESIGN: We performed a meta-analysis of published, English-language, randomized, placebo-controlled clinical trials of antibiotic treatment of bacterial vaginosis in pregnant women with intact amniotic membranes at <37 weeks of gestation. Primary outcomes included preterm delivery, perinatal or neonatal death, and neonatal morbidity. RESULTS: Ten studies with results for 3969 patients were included. In patients without preterm labor, antibiotic treatment did not significantly decrease preterm delivery at <37 weeks of gestation, in all patients combined (odds ratio, 0.83; 95% CI, 0.57-1.21) nor in high-risk patients with a previous preterm delivery (odds ratio, 0.50; 95% CI, 0.22-1.12). In both groups, significant statistical heterogeneity was observed. A significant reduction in preterm delivery and no statistical heterogeneity were observed in 338 high-risk patients who received oral regimens with treatment durations of > or =7 days (odds ratio, 0.42; 95% CI, 0.27-0.67). Nonsignificant effects and no statistical heterogeneity were observed in low-risk patients (odds ratio, 0.94; 95% CI, 0.71-1.25) and with vaginal regimens (odds ratio, 1.25; 95% CI: 0.86-1.81). In one study antibiotic treatment in patients with preterm labor led to a nonsignificant decrease in the rate of preterm deliveries (odds ratio, 0.31; 95% CI, 0.03-3.24). CONCLUSION: The screening of pregnant women who have bacterial vaginosis and who have had a previous preterm delivery and treatment with an oral regimen of longer duration can be justified on the basis of current evidence. More studies are needed to confirm the effectiveness of this strategy, both in high-risk patients without preterm labor and in patients with preterm labor.     

Risk factors for bacterial vaginosis in pregnancy: a population-based study on Danish women

BACKGROUND: No larger population-based study of bacterial vaginosis in pregnancy has previously been available. The objective of this study was to examine risk factors for bacterial vaginosis in pregnancy. DESIGN: From a prospective population-based cohort of 3,596 eligible pregnant women, 2,927 (81.4%) completed the study. METHODS: Women were asked to participate in this study at their first prenatal visit at 17 gestational weeks (range 7 + 3 - 24 + 0). Samples from the genital tract were taken at enrollment. Bacterial vaginosis was determined by Amsel's clinical criteria (3 out of 4: pH > 4.5, homogenous discharge, clue cells, and positive amine test). Data were collected from three questionnaires completed during the second and third trimesters and correlated with the diagnosis of bacterial vaginosis. Crude and adjusted relative risks (reproductive, medical, behavioral, sexual, and sociodemographic factors) were computed. RESULTS: At enrollment, bacterial vaginosis was diagnosed in 13.7% of Danish pregnant women. Significant risk factors for bacterial vaginosis were: daily coitus (adjusted relative risk 2.09 [1.43-3.04]), being single (1.76 [1.21-2.56]), smoking more than 10 cigarettes daily at conception (1.59 [1.29-1.93]), previous genital infection with Chlamydia trachomatis or Neisseria gonorrhoeae (1.39 [1.07-1.79]), and consuming 2 or more drinks per week (1.33 [1.02-1.74]) after control for confounding factors. CONCLUSION: In pregnancy, women who have daily coitus, are single, smokers, with a previous sexually transmitted disease, or with high alcohol consumption in pregnancy are at increased risk for bacterial vaginosis. Information on these risk factors may be important when planning preventive and treatment strategies of bacterial vaginosis in pregnancy.     

Longitudinal trajectory of vulvovaginal candidiasis,trichomoniasis, and bacterial vaginosis during pregnancy as well as the impact on pregnancy outcomes: a preliminary study

Objectives: The aims of this study were to describe the course of vulvovaginal candidiasis (VVC), trichomoniasis, and bacterial vaginosis (BV) in pregnancy and to explore the association between these longitudinal changes and pregnancy outcomes.

Methods: A total of 793 pregnant women were enrolled at the first trimester of pregnancy and were followed prospectively twice at the second and third trimester. VVC, trichomoniasis, and BV were evaluated at each trimester of pregnancy. Results were evaluated for trends of these three diseases and the association between these changes of trends and pregnancy outcomes.

Results: The trend of negative at all three time points was dominant for all three diseases compared with trend of positive throughout pregnancy was the most rare. In addition, for VVC, a trend toward positive can’t be ignored (7.5%). However, for BV, the distribution of other three trends (trend negative, trend positive, status random) were basically the same. Different trends of these three diseases were not associated with adverse pregnancy outcomes, with the exception of women who had a trend of BV positive throughout pregnancy were more likely to suffer from amniotic fluid infection (AFI) compared with women who were negative at all three time points (p?=?.016, OR: 17.29, 95% CI: 1.70–175.54).

Conclusions: In this population, the trend of negative throughout pregnancy was dominant for all three diseases compared with few women were positive across their pregnancy. BV may be associated with AFI during pregnancy.     

Socioeconomic and environmental risk factors of bacterial vaginosis in early pregnancy

The main aim of this prospective study was to determine the socioeconomic, demographic and environmental factors that may be associated with the occurrence of bacterial vaginosis at early pregnancy in an indigent population from Central Poland. A group of 196 pregnant women was selected randomly from the patients of 10 district maternity units in the Lodz region, Central Poland. Only singleton pregnancies between 8 and 16 week of gestation were qualified for inclusion in the survey. A standard questionnaire covering medical, socioeconomic, demographic, constitutional and environmental items was administered to every subject and was verified with medical records. Cervico-vaginal swabs were collected from the women under study and tested for bacterial vaginosis (BV) according to Spiegel's criteria. Based on the results of Gram stain, BV was diagnosed in 51 women (28.5%), grade I microflora among 66 (36.9%) and grade II among 62 women (34.6%). In the univariate analysis, only single marital status proved to be an important risk factor associated with BV during pregnancy, this was confirmed in the multivariate analysis. Pregnant women who present risk factors for abnormal cervico-vaginal microflora should be covered by comprehensive prenatal surveillance, which enables early detection and treatment of this pathology. Research that identifies the causal pathways and mechanisms through which social disadvantage leads to a higher risk of preterm birth may help to reduce current socioeconomic and demographic disparities and improve pregnancy outcome.     

Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study

In a prospective study 32 leiomyomas (fibroids) in 29 pregnant women were examined with ultrasound every 3-8 weeks. Each patient had between 3 and 6 scans (mean 4.4) during the course of pregnancy, and 13 patients had a final scan at 6 weeks postpartum. An individual growth curve was established for each tumour and the patterns of growth were analysed. No increase in size during the pregnancy was observed in 25 fibroids (78%). Only 7 (22%) increased in size but by no more than 25% of the initial volume. At 6 weeks postpartum the size of the fibroids did not differ significantly from the size during pregnancy.     

Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study

Summary. In a prospective study 32 leiomyomas (fibroids) in 29 pregnant women were examined with ultrasound every 3–8 weeks. Each patient had hetween 3 and 6 scans (mean 4.4) during the course of pregnancy, and 13 patients had a final scan at 6 weeks postpartum. An individual growth curve was established for each tumour and the patterns of growth were analysed. No increase in size during the pregnancy was observed in 25 fibroids (78%). Only 7 (22%) increased in size but by no more than 25% of the initial volume. At 4 weeks postpartum the size of the fibroids did not differ significantly from the size during pregnancy.     

Bacterial vaginosis and vaginal fluid defensins during pregnancy

OBJECTIVE: The purpose of this study was to examine the association between Gram stain findings of vaginal fluid and the concentration of vaginal fluid neutrophil defensins. STUDY DESIGN: Vaginal fluid specimens obtained from 749 women at 24 to 29 weeks of gestation were tested for bacterial vaginosis and assayed for neutrophil defensins. Bacterial vaginosis was studied as a categoric variable (negative, intermediate, and positive), whereas defensins were examined as a continuous measure and dichotomized on the basis of presence versus absence and at the 90th percentile. Multiple linear and logistic regression models were used to assess the relationship between bacterial vaginosis and defensins. RESULTS: Women with intermediate bacterial vaginosis were more likely to have elevated vaginal fluid neutrophil defensins (>90th percentile) than women with normal vaginal flora (adjusted odds ratio, 2.3; 95% CI, 1.3, 4.2), whereas women with frank bacterial vaginosis were not (adjusted odds ratio, 1.3; 95% CI, 0.7, 2.6). Among women with any detectable defensin (69.5% of the study population), intermediate bacterial vaginosis was associated positively with defensin concentrations in multiple linear regression models (P =.007). Women with intermediate and frank bacterial vaginosis had 5.9 microg/mL and 2.2 microg/mL higher defensin concentrations, respectively, than women who did not have bacterial vaginosis. The presence of leukocytes in vaginal fluids was associated positively with defensin concentrations (P <.0001). CONCLUSION: Changes in vaginal microflora during mid pregnancy are associated with an increased concentration of vaginal fluid neutrophil defensins.     

Cytology of bacterial vaginosis

Bacterial vaginosis seems to be one of the most frequent cause of vaginal diseases which may be ascending and separates a not aesthetical discharge. A pH greater than 4.5 is found, the presence of clue cells, and a positive sniff test referring to Mobiluncus. The main microorganisms causing bacterial vaginosis are Gardnerella vaginalis and Mobiluncus sp. These are anaerobic ones. Cytology is able to give a quick and sure diagnosis.