Bacterial vaginosis and pregnancy

Bacterial vaginosis (BV) represents a disturbance in the vaginal microflora with a massive overgrowth of predominantly anaerobic bacteria resulting in a disagreeable vaginal discharge. The syndrome of BV has been described in the medical literature since the turn of the century. BV has been considered as an unpleasant but essentially harmleis disturbance of the vaginal micro-flora. However, during the last decade a number of clinical reports have appeared indicating that women with BV run an increased relative risk of postabortal pelvic inflammatory disease, preterm labor, premature rupture of the membranes and post par-tum and post-Cesarean endometritis. The present study was carried out.     

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.     

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.     

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.     

Bacterial vaginosis

Bacterial vaginosis (BV) is one of the most common lower genital tract infections among women of childbearing age. This paper is a survey of literature data concerning epidemiology, pathogenesis, clinical and laboratory diagnostic criteria of this clinical syndrome.     

Bacterial vaginosis

Bacterial vaginosis is the most prevalent microbiological cause of vaginal discharge. Sexual intercourse is considered as a main risk factor, however, bacterial vaginosis is not a true sexually transmitted disease and characterized as a dysbalance in the vaginal microbiological ecosystem. The diagnosis is based on the characteristic vaginal discharge, a pH greater than 4.5, a positive whiff test and on presence of clue cells. In therapy nitroimidazoles p.o. are considered as treatment of choice. Bacterial vaginosis is a significant risk factor for ascending as well as postoperative and pre- and post-partum genital infections.     

Bacterial vaginosis in pregnancy: diagnosis, screening, and management

Bacterial vaginosis is the most common lower genital tract infection among women of reproductive age. It has been associated with a number of significant obstetric and gynecologic complications, such as preterm labor and delivery, preterm premature rupture of membranes, spontaneous abortion, chorioamnionitis, postpartum endometritis, postcesarean delivery wound infections, postsurgical infections, and subclinical pelvic inflammatory disease. This article focuses on bacterial vaginosis in pregnancy, and discusses approaches to diagnosis, screening, and management.     

Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis

BACKGROUND: Bacterial vaginosis (BV) has been reported to be associated with spontaneous preterm delivery and infectious morbidity after birth in non-Swedish populations. Our intention was to investigate the situation in a Swedish population. METHODS: In this cohort study, 924 patients were enrolled consecutively. A Papanicolaou (Pap) smear, which included a posterior fornix sample, was obtained at the first visit (median: 12 weeks and 1 day) at the two antenatal care units in central G?teborg 1990-91. Clue cells in the Pap smear were considered to be consistent with BV. The principal outcome variables were spontaneous preterm birth (< 37 weeks) and postpartum endometritis. A relative risk (RR) was calculated with a 95% confidence interval. RESULTS: The prevalence of BV was 15.6%. An association was seen between BV in early pregnancy and postpartum endometritis [RR 3.26 (1.38-7.71)]. A non-significant association was found between BV and spontaneous preterm birth [RR 2.10 (0.90-4.94)]. A multiple logistic regression analysis was performed adjusting for primi-/multiparity and antibiotics during pregnancy and the odds ratio was 2.16 (0.87-3.64). CONCLUSIONS: The prevalence of BV was 15.6% in this Swedish pregnant population. The risk for postpartum endometritis was tripled among women with BV in early pregnancy. The risk for spontaneous preterm birth among women with BV was doubled but non-significant, although the samples were obtained early in pregnancy.     

Bacterial vaginosis and contraceptive methods

Objective: The aim of this study was to investigate if bacterial vaginosis is associated with the use of specific contraceptives. Methods: The study population consisted of 1314 women attending for periodical preventive examinations at our gynecology unit at the II Institute of Obstetrics and Gynecology of the University ‘La Sapienza’ in Rome. The patient’s history and any current genital symptom were recorded on a structured protocol. Current users of contraceptives were compared with non-users. The χ² test and the t-test were used in the statistical analysis; a stepwise logistic regression analysis was performed to assess the simultaneous effect of more than one variable and to identify for possible confounding factors. Results: Both oral contraceptive and condom use showed a significant protective effect against bacterial vaginosis. Our results also showed a significant increase of BV among IUD users, either before or after adjustments. Conclusions: This study showed a significant negative association between BV and OC and condom use, respectively, and a significant positive association between BV and IUD use. Therefore, we suggest that it is advisable to carry out a systematic microscopic evaluation in order to identify BV for IUD users.     

Bacterial vaginosis and preterm birth

Although it has been clear for more than 2 decades that bacterial vaginosis increases the risk for preterm birth in some women, it is not yet fully understood why this association exists or how best to modify the risk. Incomplete understanding of this polymicrobial condition and difficulties in classification contribute to the challenge. The relationship between altered vaginal microflora and preterm birth is likely mediated by host immune responses. Because treatment of bacterial vaginosis during pregnancy does not improve preterm birth rates, and may in fact increase them, screening and treatment of asymptomatic pregnant women is discouraged. Symptomatic women should be treated for symptom relief. This article reviews the pathophysiology of bacterial vaginosis and controversy surrounding management during pregnancy. Agents currently recommended for treatment of this condition are reviewed.     

Bacterial vaginosis and preterm delivery

Bacterial vaginosis (BV) is an imbalance of vaginal flora. There is a statistical association between BV in early pregnancy and the occurrence of obstetric complications including preterm delivery. If screening and treatment of asymptomatic BV in patients at low risk are not recommended, the management of patients at high risk of prematurity is controversial. Using molecular tool, a rational and objective approach to the imbalance of vaginal flora, would reassess the relationship between VB and obstetric complications.     

Bacterial vaginosis in a family practice population

BACKGROUND: To determine and evaluate the prevalence of bacterial vaginosis diagnosed according to three sets of diagnostic criteria in three well-defined groups of non-pregnant women attending a family practice, and to determine the proportion of women diagnosed with bacterial vaginosis during a year involving the entire population registered at the practice. METHODS: During a year, bacterial vaginosis was diagnosed both according to the composite clinical diagnosis, a new wet mount diagnosis, and Nugent's gram stain diagnosis for bacterial vaginosis in women of reproductive age attending with new episodes either of abnormal vaginal discharge, other genito-urinary symptoms, or for a routine check-up. RESULTS: In non-pregnant women, bacterial vaginosis was diagnosed in a third of those with abnormal vaginal discharge (n=189), and in a tenth of those without, regardless of whether they had other genito-urinary symptoms (n=186) or not (n=273). Including all examined women, at least 11%, 13%, and 16% of the 880 women registered at the practice, were diagnosed with bacterial vaginosis according to the composite clinical, the wet mount, and the gram stain diagnoses, respectively. The results were based on the 57% of the women who attended during the year. The prevalence data differed significantly according to which diagnostic method we used, the composite clinical lowest, the wet mount intermediate, and the gram stain highest. CONCLUSION: Both well-defined criteria of inclusion and unison diagnostic procedures are necessary for reliable comparison and generalization of prevalence data of bacterial vaginosis.     

Bacterial vaginosis in pregnant women--treatment with clindamycin

The authors discuss one of the most frequently founded cause of spontaneous abortions and prematurity birth--the bacterial vaginosis. The diagnostics is easy and not expensive. In the complex of health's caries it is necessary to include and the prophylaxis of diagnostics and harmless and efficient treatment with local drug as example "Dalacin V".