Vaginal infection and preterm labour

Abstract

Objective— To study the vaginal flora of women in preterm labour (PTL) and determine whether the presence of specific vaginal microflora is significantly associated with onset of PTL.Design— A comprehensive prospective study of the vaginal microflora of women in early labour comparing women in PTL with term controls. Microbiological assessment included cultures for aerobic and anaerobic bacteria, yeasts, genital mycoplasmas and Trichomonas vaginalis. Multiple logistic regression analysis was used to adjust for confounding obstetric and demographic variables.Setting— The Queen Victoria Hospital, Adelaide.Patients— 428 Women in PTL compared to 568 women in labour at term.Main outcome measure— PTL and preterm prelabour rupture of membranes (PPROM) in relation to specific vaginal microflora.Results— After multiple logistic regression analysis, two distinct bacteriological groupings were associated with PTL <37 weeks gestation, namely, the bacterial vaginosis group of organisms, Gardnerella vaginalis and Bacteroides spp., and a group of enteropharyngeal organisms, E. coli, Klebsiella spp., Haemophilus spp. and S. aureus. G. vaginalis was found in 12% of women in PTL compared to 6% at term [regression odds ratio (ROR) 1.8, 95% confidence intervals (CI) 1.1–3.1] whereas Bacteroides spp. were detected in 45% of women in PTL compared with 35% at term (ROR 1.6, CI 1.2–2.1). The prevalence of G. vaginalis (17%) and Bacteroides spp. (50%) was even higher in women in PTL <34 weeks gestation. The enteropharyngeal group of organisms were more commonly present in women in PTL <37 weeks (E. coli 10% vs 6%, ROR 1.4, CI 0.8–2.4; Klebsiella spp. 3% vs <1%, ROR 5.4, CI 1.1–26.7; Haemophilus spp. 2% vs <1%, ROR 5.5, CI 1.1–28.6; aureus 6% vs 4%, ROR 1.8, CI 0.9–3.3) and were isolated even more frequently in women in PTL <34 weeks (E. coli 15%; Klebsiella spp. 4%; S. aureus 7%). Bacteroides spp., Klebsiella spp., and Haemophilus spp. were all found to be associated with PPROM.Conclusion— There are two distinct bacteriological groupings commonly found in women in PTL, especially in PTL <34 weeks gestation. These bacteriological groups are women with bacterial vaginosis in pregnancy and women who demonstrate enteropharyngeal bacteria in the vagina.

Bacterial vaginosis in pregnancy: distribution of bacterial species in different gram-stain categories of the vaginal flora

“…In a recent study by this group, the vaginal flora of women attending an antenatal clinic was graded in this way and an association was found between abnormal flora and an increased incidence of preterm delivery and late miscarriage [l I]. A similar association between abnormal flora and preterm labour has been found by others [7,16,171 but not between BV and late miscarriage. There was also some indication in this study (unpublished observation) that preterm labour was most closely associated with grade I11 flora, whereas late miscarriage was associated with grade I1 flora.…”

Comparison between different methods of sonographic cervical length assessment during pregnancy

“…Stone et al proposed a transabdominal cervical length less than 27 mm as the cutoff value for indicating preterm labor, which correlates with the 5 th -percentile transvaginal measurement. 19,20 In this study, the The evidence for the clinical application of cervical length screening using transabdominal sonography is still insufficient. It is necessary to determine a transabdominal sonographic measurement threshold and to follow patients until they deliver.…”

Spontaneous Midgestation Abortion Associated With Bacteroides Fragilis: A Case Report

“…Both microorganisms linked to bacterial vaginosis (G. vaginalis, Bacteroides) and aerobic organisms (E. coli, group B streptococci) were involved [5]. Bacteroides sp.…”

“…The role of ascending genital infection, leading to amniotic fluid infection and preterm labor is well recognized in midtrimester miscarriages [1][2][3][4][5][6][7][8][9][10]. Prior rupture of membranes is not necessary for Correspondence: Dr J Baekelandt, Neckersbeemd 3, 2540 Hove, Belgium.…”