The Ecology of the Vaginal Flora at First Prenatal Visit is Associated with Preterm Delivery and Low Birth Weight

Abstract

Abstract:Objective: Can assessment of vaginal microbial flora at first prenatal visit predict the outcome of pregnancy?Material and methods: Pap smears and vaginal cultures were taken from 222 pregnant women at their first prenatal visit. Lactobacillary grades (LBG I-III) on Pap smears were used as a basis for the scoring. Points were added or subtracted according to the morphotypes of the lactobacilli, the presence of abnormal cellular morphology, increased vaginal leukocytosis, visible pathogens or red blood cells, or the finding of cytolysis of epithelial cells. The total score, reflecting the health of the vaginal microflora, was termed "Vaginal Ecology Score (VECO score)" and compared with pregnancy outcome.Results: A strong correlation was found between the vaginal eco-score (VECO) at first prenatal visit and the birth weight (r 2 0.85, p = 0.003), and between the VECO score and the number of days before term delivery took place (r 0.57, p = 0.048). This association persisted after multivariate analysis. After standardization for positive vaginal culture, a VECO score of 4 or more at first visit was associated with lower birth weight, earlier delivery and smaller fetal head circumference, but not with histological chorioamnionitis. Chorioamnionitis, on the other hand, was found more often in the group with positive vaginal cultures at first prenatal visit.Discussion: Vaginal micro-ecology can be scored at the first antenatal visit to predict delivery before 40 weeks and lowered birth weight, even in the absence of overt or detectable infectious disease. To assess prematurity below 37 weeks, larger studies are needed. This assessment of the vaginal ecology could also easily be applied on fresh wet mounts or gram stained specimens of vaginal fluid.

Isolation and characterization of organisms in high vaginal swab culture in preterm pregnancy (28-37 week)

“…6 Donders also records abnormal status of lactobacilli, that is, their absence, which is a negative factor and enables development of infection, especially in pregnancy. [7][8][9][10][11] In our study most common organism is the E. Coli amounting 34% followed by Candidial spp. 21%.…”

Composition of Vaginal Microflora in Relation to Vaginal pH and Wet Mount Diagnostic Tests in the First Trimester of Pregnancy

“…Not only BV, but also aerobic vaginitis in early pregnancy is linked to preterm deliveries and chorionamnionitis (Rezeberga et al, 2008;Donders et al, 2008;. Since the extent of the inflammatory reaction has a particularly important role in the pathogenesis of preterm deliveries (Jacobson et al, 2003), the association of E. coli in the presence of leucocytosis found in our study can be important.…”

“…Although there is strong evidence that microscopic findings indicating abnormal vaginal microflora (AVM) are associated with complications in pregnancy, such as preterm birth, chorionamnionitis and preterm rupture of the membranes (Hay et al, 1994;Donders et al, 2008), there is no consensus on using culture results as a substitute for these findings. We strongly object to start treatment based solely on culture of vaginal microorganisms, as this leads to overtreatment, exposes the mother and foetus to unnecessary toxins, increases the risk of bacterial antimicrobial resistance in both mother and new-born, and enhances the risk of hard to treat, recurrent vulvovaginal candidosis, along with other disturbances of the vaginal ecology.…”

Effect of Lyophilized Lactobacilli and 0.03 mg Estriol (Gynoflor®) on Vaginitis and Vaginosis with Disrupted Vaginal Microflora: A Multicenter, Randomized, Single-Blind, Active-Controlled Pilot Study

“…AV elicits an intense immune response with high levels of interleukin-6, interleukin-1 ␤ and leukemia inhibitory factor in the vaginal fluid [11,13] , and may be a potential cofactor in the pathogenesis of infection-related complications in pregnancy such as cervix shortening, chorioamnionitis, preterm rupture of the membranes and preterm delivery [15][16][17] . Although some treatment trials have shown some success with topical antibiotics like kanamycin, standard therapy is not yet available for AV [18,19] .…”