Bacterial vaginosis in pregnancy

Bacterial vaginosis is associated with adverse pregnancy outcomes across all gestational ages. It is linked to first and second trimester fetal loss, chorioamnionitis, preterm delivery, low-birthweight infants and maternal/neonatal infectious morbidity. Infants who survive preterm birth are at an increased risk of subsequent neurodevelopmental delays and handicap, more so if there was underlying choriomnionitis. The exact mechanisms and pathways through which bacterial vaginosis exerts these adverse effects are incompletely understood. Not surprisingly, intervention studies in bacterial vaginosis-positive pregnant women have shown conflicting results, both in women at high and low risk of preterm birth. A much better understanding of the pathobiology of bacterial vaginosis in pregnancy is required to focus the designs of intervention studies on the disturbed cellular and biochemical pathways. Such studies may address the benefits of the treatment of bacterial vaginosis before conception and during early pregnancy, to determine whether treatment in populations of pregnant women may be beneficial.     

Bacterial vaginosis in a cohort of Danish pregnant women: prevalence and relationship with preterm delivery, low birthweight and perinatal infections

OBJECTIVE: To determine the prevalence of bacterial vaginosis (BV) in the second trimester of pregnancy in a Danish population using the Schmidt criteria and to examine whether BV was associated with subsequent preterm delivery, low birthweight or perinatal infections. DESIGN: Prospective cohort study. SETTING: Department of Obstetrics and Gynaecology at a University Hospital, Denmark. POPULATION: Three thousand five hundred and forty pregnant women aged 18 years or more. METHODS: A smear from the vagina was obtained from all women, air-dried and stored for subsequent diagnosis of BV. After rehydration with isotonic saline, the smear was examined in a phase-contrast microscope at 400x, and the numbers of lactobacilli morphotypes and small bacterial morphotypes were counted. A score for BV was calculated according to the method described by Schmidt. The outcome of pregnancy from 20 weeks of gestation was examined in the 3262 singleton pregnant women who were included in this study before 20 weeks of gestation. The relationship between BV and adverse outcome of pregnancy was examined by univariate and multivariate analyses. MAIN OUTCOME MEASURES: Prevalence of BV, preterm delivery (<37 weeks), low birthweight (<2500 g), preterm delivery of a low-birthweight infant and clinical chorioamnionitis. RESULTS: The prevalence of BV was 16%, and the rate of preterm delivery was 5.2% in the study population of 3262 singleton pregnant women who were included before 20 weeks of gestation. Mean birthweight was significantly lower in infants of women with BV than in infants of women without BV (3408 versus 3511 g, P < 0.01). Univariate analyses showed that BV was marginally associated with preterm delivery but significantly associated with low birthweight, preterm delivery of a low birthweight infant, indicated preterm delivery and clinical chorioamnionitis. Multivariate analyses, which adjusted for previous miscarriage, previous preterm delivery, previous conisation, smoking, gestational diabetes, fetal death and preterm premature rupture of membranes, showed that BV was significantly associated with low birthweight (OR 1.95, 95% CI 1.3-2.9), preterm delivery of a low-birthweight infant (OR 2.5, 95% CI 1.6-3.9), indicated preterm delivery (OR 2.4, 95% CI 1.4-4.1) and clinical chorioamnionitis (OR 2.7, 95% CI 1.4-5.1). CONCLUSIONS: The prevalence of BV determined using the Schmidt criteria in the early second trimester of pregnancy was similar to that found in similar studies. The presence of BV before 20 weeks of gestation was an independent risk factor for delivery of an infant with low birthweight, preterm delivery of a low-birthweight infant, indicated preterm delivery and clinical chorioamnionitis.     

Bacterial vaginosis and preterm delivery: an open question

OBJECTIVE: To evaluate the prevalence of bacterial vaginosis in a population of Italian pregnant women and to study its association with adverse pregnancy outcomes, particularly preterm delivery. STUDY DESIGN: After giving informed consent, 598 women were consecutively enrolled at their first prenatal visit (13-18 weeks of gestation). The presence of bacterial vaginosis was assessed by Gram's method at 13-18 weeks of gestation (early bacterial vaginosis) and at 28-32 weeks of gestation (late bacterial vaginosis). Univariate and multiple logistic regression models of analysis were used to assess the statistical significance of the data. RESULTS: Preterm delivery occurred in 14.7% of pregnant women positivefor bacterial vaginosis at theirfirst prenatal visit and in 6.9% of healthy women (OR 1.6, CI 1.07-2.51). In patients with bacterial vaginosis, preterm delivery occurred more often in the 36th week of gestation (78.6%). CONCLUSION: The presence of bacterial vaginosis at an early gestational age is associated with preterm delivery, although in the study population the condition did not seem to be related to great prematurity.     

Bacterial vaginosis and group B streptococcal colonization and preterm delivery in a low-risk population

OBJECTIVE: To evaluate the relationship between bacterial vaginosis (BV) and group B streptococcal (GBS) colonization in the 2nd trimester of pregnancy and preterm delivery. METHODS: 1,197 pregnant women between 22 and 25 weeks' gestation had a high vaginal swab for assessment of BV and GBS. Exclusion criteria were: previous preterm delivery, or mid-trimester abortion or termination of pregnancy, multiple gestation, oligo- or polyhydramnios, placenta previa, fetal abnormalities, uterine malformations, cervical incompetence, cervical cerclage, or receipt of an antibiotic effective against BV or GBS following the screening. All women had no risk factors for preterm delivery. The primary outcome measure in this analysis was spontaneous preterm delivery before 37 weeks' gestation. RESULTS: The preterm delivery rate was 8.7%, while the maternal BV and GBS colonization rates were 7.9 and 12.5%, respectively. Following adjustment for potential confounders BV was associated with an increased risk of preterm delivery (RR 2.19; CI: 1.21-3.98) (p = 0.01). On the contrary, GBS colonization was found to have a negative correlation with preterm birth (RR 0.43; 95% CI: 0.19-1.00). CONCLUSIONS: Although BV is a risk factor for preterm delivery, GBS colonization in the 2nd trimester of pregnancy has an inverse correlation with preterm delivery.     

Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis

OBJECTIVE: We performed a meta-analysis to evaluate bacterial vaginosis as a risk factor for preterm delivery. STUDY DESIGN: Selection criteria were (1). the data appeared in original, published English-language reports of prospective studies or control groups of clinical trials that included women at <37 weeks of gestation with intact amniotic membranes, (2). all the women had to have been screened for bacterial vaginosis that was diagnosed by either clinical criteria or criteria that were based on Gram stain findings, and (3). the outcomes were preterm delivery, spontaneous abortion, maternal or neonatal infection, and perinatal death. RESULTS: Eighteen studies with results for 20,232 patients were included. Bacterial vaginosis increased the risk of preterm delivery >2-fold (odds ratio, 2.19; 95% CI, 1.54-3.12). Higher risks were calculated for subgroups of studies that screened for bacterial vaginosis at <16 weeks of gestation (odds ratio, 7.55; 95% CI, 1.80-31.65) or at <20 weeks of gestation (odds ratio, 4.20; 95% CI, 2.11-8.39). Bacterial vaginosis also significantly increased the risk of spontaneous abortion (odds ratio, 9.91; 95% CI, 1.99-49.34) and maternal infection (odds ratio, 2.53; 95% CI, 1.26-5.08). No significant results were calculated for the outcome of neonatal infection or perinatal death. CONCLUSION: Bacterial vaginosis, early in pregnancy, is a strong risk factor for preterm delivery and spontaneous abortion.     

Maternal hematological status and risk of low birth weight and preterm delivery in Nepal

BACKGROUND: Our aim was to investigate associations between maternal characteristics, with emphasis on hematological status, and risk of low birth weight and preterm delivery among pregnant Nepali women. METHODS: In a case-control study, 1400 pregnant women attending Patan Hospital, Kathmandu, Nepal for antenatal care and delivery in the period 1994 to 1996 were included. Women with twin pregnancies (n=15) and those delivering infants with congenital malformations (n=13) were excluded from the study. Maternal characteristics including hematocrit values were recorded at the first antenatal visit. Main outcome measures included birth weight, gestation at delivery, Apgar score, mode of delivery, and perinatal death. Linear and logistic regression models were used to analyze data. RESULTS: Severe anemia (hematocrit < or =24%) was associated with a significantly increased risk of low birth weight (<2500 g) and preterm delivery (<37 weeks gestation). High hematocrit values (> or =40%) did not increase the risk of low birth weight or preterm delivery. The risk of low Apgar score or operative deliveries was significantly increased in women with severe anemia in the first trimester. Teenagers, women with short height or low body mass index, and those belonging to the ethnic group Brahmins, had significantly higher risks of delivering low birth weight infants. CONCLUSIONS: Severe maternal anemia, particularly in the first trimester, was significantly associated with adverse pregnancy outcome. Low maternal age, height or body mass index also increased the risk of low birth weight. Improvements in the nutritional status of young Nepali women could contribute to improved health among their infants.     

Antibiotics for bacterial vaginosis or Trichomonas vaginalis in pregnancy: a systematic review

OBJECTIVE: To determine whether antibiotic treatment for bacterial vaginosis or Trichomonas vaginalis during pregnancy decreases the risk of preterm birth and associated adverse outcomes. DATA SOURCES: Pre-MEDLINE and MEDLINE (1966-2003), EMBASE (1980-2003), and the Cochrane Library were searched using the keywords "bacterial vaginosis", "Trichomonas", "Trichomonas vaginalis", "Trichomonas vaginitis", "Trichomonas infections", "pregnancy", "pregnant", "antibiotics", and "antibiotic prophylaxis". METHODS OF STUDY SELECTION: The search produced 1,888 titles, of which 1,256 abstracts were reviewed further. Of these, 1,217 were ineligible. Inclusion criteria were the following: randomized controlled trials in which antibiotics were compared with no antibiotic or placebo, for women in the second or third trimester of pregnancy with symptomatic or asymptomatic bacterial vaginosis or Trichomonas vaginalis, intact membranes, and not in labor. Exclusion criteria were as follows: published in a language other than English, dropout rate of more than 20% of women in either group, and lack of usable outcomes. Of the 39 papers reviewed in detail, 14 studies were included in the meta-analysis. TABULATION, INTEGRATION, AND RESULTS: One of the authors reviewed titles obtained from the searches, and 2 reviewers independently reviewed the abstracts, excluded those that were ineligible, identified eligible papers, and abstracted the data. For women with bacterial vaginosis, antibiotics reduced the risk of persistent infection but did not reduce the risk of preterm birth or the incidence of associated adverse outcomes for the general population or for any subgroup analyzed. For women with Trichomonas vaginalis, metronidazole reduced the risk of persistent infection but increased the incidence of preterm birth. CONCLUSION: Contrary to the conclusions of 3 recent systematic reviews, we found no evidence to support the use of antibiotic treatment for bacterial vaginosis or Trichomonas vaginalis in pregnancy to reduce the risk of preterm birth or its associated morbidities in low- or high-risk women.     

Bacterial vaginosis in early pregnancy and pregnancy outcome.

OBJECTIVE: We assessed the association between bacterial vaginosis in early pregnancy and adverse pregnancy outcome. METHODS: Vaginal swabs for bacterial culture, Gram stain, and Papanicolaou stain were taken at the first prenatal visit between 8-17 weeks' gestation in 790 healthy nulliparous women. RESULTS: Culture-proven bacterial vaginosis was detected in 169 of 790 women (21.4%), 167 (98.8%) of whom could also be identified by Gram stain. Papanicolaou smears were available from 299 women, among whom 101 had bacterial vaginosis on culture; of these 101, 78 (77.2%) could be detected by Papanicolaou stain. Of the 751 women whose clinical follow-up was completed, 42 had been treated for preterm uterine contractions (preterm labor), but only 17 delivered between 20-36 weeks' gestation (preterm birth). Premature rupture of membranes (PROM) occurred more than 6 hours before delivery in 80 cases (nine preterm and 71 term). Bacterial vaginosis in early pregnancy predicted preterm labor, preterm birth, or preterm PROM with a sensitivity of 41-67%, specificity of 79%, and negative predictive value of 96-99%, but the positive predictive value was low at 4-11%. However, bacterial vaginosis was associated with a 2.6-fold risk (95% confidence interval [CI] 1.3-4.9) for preterm labor, a 6.9-fold risk (95% CI 2.5-18.8) for preterm birth, and a 7.3-fold risk (95% CI 1.8-29.4) for preterm PROM. CONCLUSIONS: Bacterial vaginosis in early pregnancy can be detected reliably by Gram stain and, in most cases, by Papanicolaou smear. Although bacterial vaginosis is associated with preterm labor, preterm birth, and preterm PROM, the clinical usefulness of its assessment is limited because of the high rate of false-positive findings.     

Elective cervical cerclage versus serial ultrasound surveillance of cervical length in a population at high risk for preterm delivery

OBJECTIVE: To compare pregnancy outcome for women at risk of preterm delivery undergoing elective cervical cerclage in the first trimester or serial transvaginal assessment of cervical length with cerclage only if indicated (control cases). DESIGN: A matched case control study. SETTING: Prematurity clinic at two London teaching hospitals. POPULATION: Women at high risk for preterm delivery. METHODS: Cases of elective cervical cerclage were matched for maternal age, ethnic group, previous cervical surgery, previous second trimester loss and early preterm delivery to women undergoing serial ultrasound surveillance of cervical length. Pregnancy outcome data was collected. Data was analysed using Fisher's exact, Mann-Whitney and Student's t-tests. MAIN OUTCOME MEASURES: Gestation at delivery, rate of delivery <24, 24-32 and 32-37 weeks gestation. RESULTS: Thirty-nine cases of elective cervical cerclage were matched to control cases. Both groups were similar for maternal age, ethnic group, previous cervical surgery, previous second trimester loss and early preterm delivery. Cervical cerclage was performed in 14 (36%) of the control cases due to cervical changes. There was no significant difference in median gestation at delivery (266 days versus 260 days P=0.9), number delivering <24 weeks (15% versus 13% P=0.9), at 24-32 weeks (7.5% versus 15% P=0.6) and at 32-37 weeks (15% versus 13% P=0.9). CONCLUSION: Serial transvaginal ultrasound surveillance of cervical length in women at high risk of preterm delivery appears to reduce cerclage rates without compromising pregnancy outcome. A large multicentered randomised trial is required to confirm these findings.     

Fetal fibronectin and bacterial vaginosis are associated with preterm birth in women who are symptomatic for preterm labor

OBJECTIVE: The purpose of this study was to codify the relationship between bacterial vaginosis/fetal fibronectin and preterm labor/birth. STUDY DESIGN: In this prospective study, 185 women who were symptomatic for preterm labor were assessed for bacterial vaginosis and fetal fibronectin. RESULTS: These women comprised 4 groups: group A (n=23 women; +bacterial vaginosis/+fetal fibronectin); group B (n=31 women; -bacterial vaginosis/+fetal fibronectin); group C (n=47 women; +bacterial vaginosis/-fetal fibronectin); and group D (n=84 women; -bacterial vaginosis/-fetal fibronectin). The time interval from gestational age at testing until delivery was significantly shorter for groups A and B versus groups C and D (P < or =.05 and P <.001, respectively). Similarly, delivery at <32 weeks of gestation was increased in group B (26%) compared with groups A (9%), C (2%), and D (5%; P <.009; odds ratio, 165.90; 95% CI, 30.02, 916.08). CONCLUSION: Women who are symptomatic for preterm labor should be considered for fetal fibronectin and bacterial vaginosis testing.     

Effect of oral N-acetyl cysteine on recurrent preterm labor following treatment for bacterial vaginosis

OBJECTIVE: To evaluate the effect of N-acetyl cysteine (NAC) on gestational age at delivery in women with previous preterm labor and bacterial vaginosis. METHODS: A randomized, double-blind, placebo-controlled trial with 280 women between 16 and 18 weeks of pregnancy who had 1 previous preterm birth and had just been successfully treated for bacterial vaginosis with metronidazole for 1 week. The women were randomized to receive 0.6 g of NAC per day plus 17-hydroxyprogesterone caproate (17-OHPC) or placebo plus 17-OHPC until 36 completed weeks of pregnancy or active labor. A vaginal swab was taken during labor. RESULTS: Reaching 36 weeks of pregnancy was more frequent (P<0.05) and gestational age at delivery was significantly higher in the NAC than in the placebo group (37.4 weeks+/-0.4 weeks vs 34.1 weeks+/-1.2 weeks, P<0.05). The discontinuation rate was 11.4% in the NAC group. CONCLUSIONS: Oral NAC was found to reduce the recurrence of preterm birth in patients with bacterial vaginosis.     

Periodontal disease and bacterial vaginosis increase the risk for adverse pregnancy outcome

OBJECTIVES: To determine whether periodontal disease or bacterial vaginosis (BV) diagnosed before pregnancy increase the risk for adverse pregnancy outcome. METHODS: We enrolled a total of 252 women who had discontinued contraception in order to become pregnant. The first 130 pregnant women were included in the analyses. RESULTS: Multivariate analysis showed a strong association between periodontal disease and adverse pregnancy outcome (OR 5.5, 95% confidence interval 1.4-21.2; p = 0.014), and a borderline association between BV and adverse pregnancy outcome (OR 3.2, 95% confidence interval 0.9-10.7; p = 0.061). CONCLUSION: Our study suggests that pre-pregnancy counseling should include both oral and vaginal examinations to rule out periodontal disease and BV. This may ultimately have an impact on antenatal healthcare, and decrease the risk for adverse pregnancy outcome.     

Is bacterial vaginosis a stronger risk factor for preterm birth when it is diagnosed earlier in gestation?

OBJECTIVE: It is stated commonly that the earlier in pregnancy bacterial vaginosis is diagnosed, the greater is the increase in risk of preterm birth compared with women without bacterial vaginosis. However, this contention is based on small numbers of women. STUDY DESIGN: In this analysis of 12,937 women who were screened for bacterial vaginosis as part of a previously conducted clinical trial, the odds ratio of preterm birth (<7 weeks of gestation) for asymptomatic bacterial vaginosis-positive versus bacterial vaginosis-negative women was evaluated among women who were screened from 8 to 22 weeks of gestation. RESULTS: The odds ratio of preterm birth among bacterial vaginosis-positive versus bacterial vaginosis-negative women ranged from 1.1 to 1.6 and did not vary significantly according to the gestational age at which bacterial vaginosis was screened. The odds ratio for preterm birth did not vary significantly by gestational age at diagnosis when bacterial vaginosis was subdivided into Gram stain score 7 to 8 or 9 to 10. CONCLUSION: Although bacterial vaginosis was associated with an increased risk of preterm birth, the gestational age at which bacterial vaginosis was screened for and diagnosed did not influence the increase.     

Uterine leiomyoma in pregnancy: its influence on obstetric performance.

OBJECTIVE: To assess the effects of uterine leiomyoma on obstetrical performance. METHODS: We reviewed the medical records of 102 women with singleton pregnancies who were found ultrasonographically to have uterine leiomyomas during the first half of their pregnancy and who gave birth at our hospital at > or = 22 weeks of gestation between January 1990 and December 1997. RESULTS: The 102 women gave birth to 101 healthy infants, weighing 2,974 +/- 579 g at 38.8 +/- 2.6 weeks of pregnancy. One woman experienced an unexplained antepartum fetal death at 24 weeks of gestation. Bleeding at the first trimester occurred in 16% of the women. Pain localized in the lower abdomen and requiring relief occurred in 28% of the women during the first or second trimester. Tocolytic treatment was required in 25% of the pregnancies, and preterm delivery occurred in 12% thereof. A cesarean section was performed in 39% of the pregnancies. Bleeding > or = 500 ml occurred at delivery in 48% of the cases. The largest fibroid, > 6 cm in diameter, which was seen in 51 women, was associated with higher frequencies of tocolytic treatment (41%), preterm delivery (24%), bleeding > or = 500 ml at delivery (59%), and cesarean delivery (51%). In 76 women (75%) who attempted vaginal delivery, the obstetrical outcome was comparable to that of 115 control women who were matched regarding age, parity, and gestational week. CONCLUSIONS: Although pain in the lower abdomen, the requirement of tocolytic treatment, preterm delivery, and cesarean delivery were common, the neonatal outcome was fairly good in women with uterine leiomyomas. The present data might be encouraging to pregnant women with uterine leiomyomas.     

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.     

Midpregnancy vaginal fluid defensins, bacterial vaginosis, and risk of preterm delivery

OBJECTIVE: To assess relations among midpregnancy vaginal defensin levels, a component of the host innate immune response, bacterial vaginosis, and risk of preterm delivery. These relations are compared across race groups because previous studies have repeatedly shown that the prevalence of bacterial vaginosis and the risk of preterm delivery are greater in African-American women compared with that in white women. METHODS: Data are from a prospective study that enrolled pregnant women from 52 clinics in five Michigan communities. In the study subcohort, defensins (human neutrophil peptides 1, 2 and 3) and bacterial vaginosis (Nugent criteria) were measured in vaginal fluid collected at enrollment (15th through 27th week of pregnancy) from 1,031 non-Hispanic white and African-American women (787 term, 244 preterm). Preterm deliveries were categorized by clinical circumstances, ie, spontaneous and medically indicated. RESULTS: Among African Americans, vaginal human neutrophil peptides 1-3 levels greater than or equal to the median were associated with bacterial vaginosis and specifically with spontaneous preterm delivery only (adjusted odds ratio 2.3, 95% confidence interval 1.2-4.3). Once African-American women were stratified by human neutrophil peptide 1-3 levels, bacterial vaginosis added nothing to the prediction of spontaneous preterm delivery risk. None of the above associations were observed in non-Hispanic whites. CONCLUSION: The relations among human neutrophil peptide 1-3 levels, bacterial vaginosis, and preterm delivery vary by race group. In African Americans, midpregnancy human neutrophil peptide 1-3 levels were more informative to preterm delivery risk than was bacterial vaginosis, suggesting an important role for host response. In addition, elevated human neutrophil peptide 1-3 levels may be a marker for particular high-risk vaginal milieus that are not distinguished by the current bacterial vaginosis Nugent scoring system.     

Bacterial vaginosis in early pregnancy and adverse pregnancy outcome.

OBJECTIVE: To assess the prevalence of bacterial vaginosis (BV) in asymptomatic pregnant women and its association with preterm birth (PTB) and premature rupture of membranes (PROM). METHODS: In a cohort study 1,006 pregnant women between 16-28 weeks' gestation were screened for BV (Nugent's criteria) and for lower genital tract infection. Women were followed to confirm pregnancy outcome. Data were analyzed using STATA software. Univariate and multivariate methods were used to investigate the association between bacterial vaginosis and adverse pregnancy outcome. RESULTS: Prevalence of BV was 11.53%. Baseline characteristics were similar for both groups, 6.8% women were lost to follow-up. Incidence of PTB was higher in BV positive women compared to BV negative women (p = 0.001). On multiple logistic regression (MLR), BV was associated with an increased risk of PTB (p = 0.001) and PROM (p = 0.001), other correlates being previous PTB (p = 0.003) and the presence of enteropharyangeal organisms in vagina (p = 0.03). BV accounted for 82.53% of the attributable risk for PTB. CONCLUSION: Presence of BV in early pregnancy is associated with an increased risk of PTB and PROM. Multicentric interventional study is recommended.     

Association between vaginal 70-kd heat shock protein, interleukin-1 receptor antagonist, and microbial flora in mid trimester pregnant women

OBJECTIVE: This study investigated the association among the inducible 70-kd heat shock protein, cytokines, and microbial flora in the vagina in mid trimester pregnant women and subsequent preterm delivery. STUDY DESIGN: Vaginal samples from 205 pregnant women, which were collected at 18 to 22 weeks of gestation, were analyzed for qualitative and quantitative vaginal microflora and for 70-kd heat shock protein, interleukin-1beta, interleukin-1 receptor antagonist, and tumor necrosis factor-alpha by enzyme-linked immunosorbent assay. Pregnancy outcome data were obtained subsequently. RESULTS: The 70-kd heat shock protein was detected in 38 vaginal samples (18.5%). Its presence was associated with elevated vaginal pH, a diagnosis of bacterial vaginosis, and elevated interleukin-1 receptor antagonist levels (P < .001). Among women with bacterial vaginosis, 70-kd heat shock protein-positive subjects had a >80% increase in median vaginal concentration of interleukin-1 receptor antagonist (P < .05). CONCLUSION: Vaginal 70-kd heat shock protein expression is associated with the down-regulation of the proinflammatory immune response to abnormal vaginal flora in mid trimester pregnant women.     

Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination

BACKGROUND: Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination. AIM: To assess the obstetric outcome when the interval between the estimated date of delivery by last menstrual period and the estimated date of delivery by second trimester ultrasound exceeds 14 days. MATERIALS AND METHODS: Population-based prospective cohort study. Included were all women (n = 16 302) with a singleton pregnancy, in one Norwegian county from 1989 to 1999, with a reliable menstrual history and whose second trimester ultrasound examination was conclusive with a 35-60-mm biparietal diameter. RESULTS: Adverse outcome was defined as preterm birth (< 37 weeks), perinatal death, low birthweight (< 2500 g) and small-for-gestational age (< 2 standard deviation). The risk for perinatal death (odds ratio = 2.3), preterm birth (odds ratio = 1.7), low birth weight (odds ratio = 1.5), and small-for-gestational age (odds ratio = 1.5) was highly significantly increased in deliveries where the discrepancy between the two terms was more than 14 days. The increased risk is not explained by differences in parity, maternal age, smoking, fetal malformations, or use of oral contraceptives before pregnancy. CONCLUSION: Fetuses that are smaller than expected at the mid-second trimester ultrasound corresponding to a discrepancy of more than 14 days have an increased risk for adverse obstetric outcome.     

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.