Bacterial Vaginosis in Early Pregnancy and Adverse Pregnancy Outcome

Purwar, Manorama; Ughade, Suresh; Bhagat, B.D.; Agarwal, Vandana; Kulkarni, Hemant

doi:10.1111/j.1447-0756.2001.tb01248.x

Cited by 57 publications

(29 citation statements)

References 16 publications

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“…The observed PTB rate of 7% in this study is similar to the expected rate in Flanders during the same period (7.4%; singletons 6.3%) 11 . Numerous studies have consistently shown that bacterial vaginosis and AVF at 12–24 weeks are associated with increased risks of PTB, preterm rupture of the membranes, chorioamnionitis, fetal infection and cerebral palsy 12–22 . However, studies applying strict criteria for full bacterial vaginosis (a Nugent score above 7, overall granular flora, >20% clue cells and LBG III) did not find a significant correlation between BV and the risk of PTB 14,18,23 …”

Section: Discussionmentioning

confidence: 99%

Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy

Donders¹,

Calsteren²,

Bellen³

et al. 2009

BJOG

369

291

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Introduction Abnormal vaginal flora (AVF) before 14 gestational weeks is a risk factor for preterm birth (PTB). The presence of aerobic microorganisms and an inflammatory response in the vagina may also be important risk factors.Aim The primary aim of the study was to investigate the differential influences of AVF, full and partial bacterial vaginosis, and aerobic vaginitis in the first trimester on PTB rate. The secondary aim was to elucidate why treatment with metronidazole has not been found to be beneficial in previous studies.Setting Unselected women with low-risk pregnancies attending the prenatal unit of the Heilig Hart General Hospital in Tienen, Belgium, were included in the study.Materials and methods At the first prenatal visit, 1026 women were invited to undergo sampling of the vaginal fluid for wet mount microscopy and culture, of whom 759 were fully evaluable. Abnormal vaginal flora (AVF; disappearance of lactobacilli), bacterial vaginosis (BV), aerobic vaginitis (AV), increased inflammation (more than ten leucocytes per epithelial cell) and vaginal colonisation with Candida (CV) were scored according to standardised definitions. Partial BV was defined as patchy streaks of BV flora or sporadic clue cells mixed with other flora, and full BV as a granular anaerobic-type flora or more than 20% clue cells. Vaginal fluid was cultured for aerobic bacteria, Mycoplasma hominis and Ureaplasma urealyticum. Outcome was recorded as miscarriage £13 weeks + 6 days [early miscarriage (EM), n = 8 (1.1%)], between 14 + 0 and 24 weeks + 6 days [late miscarriage (LM), n = 7 (0.9%)], delivery or miscarriage £34 weeks + 6 days n = 29 (3.8%)], £36 weeks + 6 days n = 70 (9.2%)]. PTB between 25 + 0 and 36 weeks + 6 days was further divided in severe PTB (SPTB, 25 + 0 to 34 weeks + 6 days) and mild PTB (MPTB, 35 + 0 to 36 weeks + 6 days).Results Women without abnormalities of the vaginal flora in the first trimester had a 75% lower risk of delivery before 35 weeks compared with women with AVF [odds ratio (OR) 0.26; 95% confidence interval (CI) 0.12-0.56]. The absence of lactobacilli (AVF) was associated with increased risks of PTB (OR 2.4; 95% CI 1.2-4.8), EPTB (OR 6.2; 95% CI 2.7-14) and miscarriage (OR 4.9; 95% CI 1.4-17). BV was associated with increased risks of PTB (OR 2.4; 95% CI 1.1-4.7), EPTB (OR 5.3; 95% CI 2.1-12.9) and miscarriage (OR 6.6; 95% CI 2.1-20.9) and coccoid AV was associated with increased risks of EPTB (OR 3.2; 95% CI 1.2-9.1) and miscarriage (OR 5.2; 95% CI 1.5-17). In women with BV, partial BV had a detrimental effect on the risk of PTB for all gestational ages, but full BV did not. Preterm deliveries later than 24 weeks+ 6 days were more frequent when M. hominis was present (EPTB OR 13.3; 95% CI 3.2-55).Discussion Bacterial vaginosis, AV and AVF are associated with PTB, especially LM and severe PTB between 25 and 35 weeks. The absence of lactobacilli (AVF), partial BV and M. hominis, but not full BV, were associated with an increased risk of preterm delivery after 24 weeks+ 6 days. As metronidazol...

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Section: Discussionmentioning

confidence: 99%

Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy

Donders¹,

Calsteren²,

Bellen³

et al. 2009

BJOG

369

291

View full text Add to dashboard Cite

show abstract

“…Patient with BV have a sixfold increased rate of postpartum endometritis after cesarean section, a threefold increased rate of pelvic inflammatory disease after therapeutic abortion, and a three–fourfold increased rate of vaginal cuff cellulitis after abdominal hysterectomy. Pregnant patients with BV have a 50–100% increased rate of preterm low birthweight delivery, amniotic fluid infection and chorioamnionitis 8–10 …”

Section: Introductionmentioning

confidence: 99%

“…Pregnant patients with BV have a 50-100% increased rate of preterm low birthweight delivery, amniotic fluid infection and chorioamnionitis. [8][9][10] Various studies have shown an association between urinary tract infection and abnormal vaginal infection. Harmanli et al studied women who presented for routine gynecologic examination and found that 22.4% with urinary tract infection also had BV compared with 9.7% without BV.…”

Section: Introductionmentioning

confidence: 99%

Metronidazole with Lactacyd vaginal gel in bacterial vaginosis

Decena

Manalastas

et al. 2006

J of Obstet and Gynaecol

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“…The vast amount of interest in these areas is because of the adverse effects disturbances of the urogenital flora present, especially during pregnancy (including premature births, low birth weight children and other complications). 37,38,39 The urogenital tract can be divided into two distinct regions: the urinary tract and the vagina. In health, the urinary tract is generally considered to harbour minimal levels of bacteria.…”

Section: The Microflora Of the Female Urogenital Tractmentioning

confidence: 99%

Probiotics and prebiotics in female health

Smejkal

Kolida

Bingham

et al. 2003

British Menopause Society Journal

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Functional foods such as probiotics, prebiotics and nutraceuticals are of extreme interest to researchers. There is growing evidence that these food ingredients may improve and in some cases treat certain conditions that are implicated in women's health. The use of probiotics (live, beneficial bacteria) in improving gastrointestinal and non-gastrointestinal tract conditions such as irritable bowel syndrome, candidiasis and other female urogenital tract conditions are reviewed. Emphasis is also given to the importance of prebiotics (non-digestible food ingredients) in osteoporosis management and alleviation of menopausal symptoms and reducing the onset of cancer.

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Bacterial Vaginosis in Early Pregnancy and Adverse Pregnancy Outcome

Abstract: Presence of BV in early pregnancy is associated with an increased risk of PTB and PROM. Multicentric interventional study is recommended.

Cited by 57 publications

References 16 publications

Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy

Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy

Metronidazole with Lactacyd vaginal gel in bacterial vaginosis

Probiotics and prebiotics in female health

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