Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage

Abstract

Objective-To find out whether women with bacterial vaginosis detected early in pregnancy are at increased risk ofpreterm delivery.Design-Prospective description cohort study. Results-Multiple logistic analysis showed that there was an increased incidence ofpreterm delivery in women with a previous preterm delivery (9/24; odds ratio 25; 95% confidence interval 9 to 70; P < 0-001) and bacterial vaginosis (9/115; 2*8; 1.1 to 7-4; P = 0 04). A further logistic analysis of data from women recruited before 16 weeks' gestation showed that preterm deliveries or late miscarriages occurred more often in women with bacterial vaginosis (12/77;

Risk Score for Antenatal Bacterial Vaginosis: BV PIN Points

“…Two risk scores were developed using logistic regression modeling (SAS Institute, Cary, NC). A ''full model'' was developed using (1) all factors with unadjusted associations with BV!1.4 or 0.8 regardless of statistical significance; (2) factors thought to be important from the literature (vaginal pH, 4 douching, 23 -25 race, 10,11,26,27 and multiple sexual partners 27,28 ); and (3) subject to a minimum n=8 exposed cases. A reduced model was developed from the full model with backwards selection using À2 log likelihood ratio tests after each iteration.…”

“…Pregnant African Americans have increased prevalence of BV compared to other race/ethnicity groups. 10,11,26,27 Antenatal BV can recur and/or persist despite treatment, 9,32,33 thus lending credibility to the inclusion of previous BV diagnoses in the index pregnancy.…”

“…Little is known about the natural history of BV during pregnancy, because few studies have conducted serial assessments during gestation. Further complicating the situation is the fact that 12% to 50% of untreated antenatal BV cases resolve spontaneously, 11,35,36 and 9% to 20% of antenatal BV can recur and/or persist 4 to 12 gestational weeks later despite treatment. 9,32,33 Self-reported and clinician-identified vaginal symptoms at the time of enrollment would have helped to better assess the interrelationships between symptomatology, clinician-initiated BV testing, and Gram stain BV results.…”

Antibiotics for treating bacterial vaginosis in pregnancy

“…The majority of these cases will be asymptomatic. The natural history of bacterial vaginosis is such that it may spontaneously resolve without treatment although most women identified as having bacterial vaginosis in early pregnancy are likely to have persistent infection later in pregnancy (Hay 1994).…”

“…There is now a substantial body of evidence associating bacterial vaginosis in pregnancy with poor perinatal outcome, in particular an increased risk of preterm birth (Hay 1994a;Kurki 1992;McGregor 1990), with potential neonatal sequelae due to prematurity. There is also evidence associating intermediate flora with adverse pregnancy outcome (Hay 1994a).…”