Pregnancy outcome after early detection of bacterial vaginosis

Department of Obstetrics and Gynecology, Policlinico S.Orsola-Malpighi, Alma Mater Studiorum-University of Bologna, Italy.
European Journal of Obstetrics & Gynecology and Reproductive Biology (Impact Factor: 1.7). 01/2007; 128(1-2):40-5. DOI: 10.1016/j.ejogrb.2005.12.024
Source: PubMed


To assess if detecting bacterial vaginosis either in early pregnancy or at midtrimester may predict adverse pregnancy outcome in women at risk for preterm delivery.
242 pregnant women with a previous preterm delivery were evaluated for bacterial vaginosis either in the first trimester (prior to 10+0 weeks) or in the second one (24-26 weeks). Adverse outcome was intended as miscarriage (< or =25 weeks), or premature delivery (< or =36+6).
The risk of adverse pregnancy outcome was significantly increased in women diagnosed at first trimester with bacterial vaginosis (OR: 4.56; 95% CI: 2.54-8.93); the same finding at midtrimester did not increase significantly the risk of preterm delivery.
Early screening for bacterial vaginosis in pregnant women who experienced a preterm delivery may help in predicting the risk of adverse outcome.

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    ABSTRACT: Background: The development of neonatology has led to survival of extremely preterm neonates. Sequels for the neonate might be serious, and for that reason very preterm delivery has been recognised as one of the main problems of public health. But, too many lay persons and even professionals are not aware of the fact that there are, before pregnancy as well as in pregnancy, possibilities of prevention of extremely preterm delivery. There are many causes for preterm delivery and not all are known. It is not probable that one method or one drug would effectively stop preterm labor or prevent delivery. Most of preterm deliveries occur in the group of pregnant women without risk factors. Methods: Prediction model for preterm delivery risk estimation is used in Slovenia with suggestion that additional tests are performed. Screening tests should be used for all pregnant women. These tests would improve the prediction in the group of pregnant population with no risk factors in their medical history. Besides, such risk factors could be found that could be influenced. Some risk factors can not be changed: previous preterm delivery and conisation, e.g. Some risk factors can be removed before pregnancy, like operative correction of uterine anomalies. In pregnancy, combination of short cervix and obstetric history is a good predictor of preterm delivery. Examples of secondary prevention are treatment with progesterone in high risk women, treatment of vaginal infection early in pregnancy, cerclage when cervix is short, psychological and social support. Even when preterm delivery is unavoidable, we can prolong pregnancy with efficient tocolysis so corticosteroids can be applied and the pregnant woman is transported to the centre with neonatal intensive care unit (tertiary prevention), which improves the outcome for the newborn. Prolongation of pregnancy is allowed only when it does not harm the mother or the fetus. Conclusions: We have to use the existing knowledge regarding preterm delivery prevention. In the future, genomics, proteomics and pharmacogenomics will make prediction and prevention of preterm delivery more specific.
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    ABSTRACT: We updated a previously published meta-analysis to evaluate bacterial vaginosis (BV) and intermediate vaginal flora as risk factors for adverse pregnancy outcome. Selection criteria were original, published, English-language reports of cohort studies or control groups of clinical trials including women <37 weeks' gestation with intact amniotic membranes. All women had to be screened for BV, diagnosed either by clinical criteria or by criteria based on Gram-stain findings. Outcomes were preterm delivery, late miscarriages, maternal or neonatal infections, and perinatal mortality. Fourteen new studies with results for 10,286 patients were included, so that results for 30,518 patients in 32 studies were available for this meta-analysis. BV more than doubled the risk of preterm delivery in asymptomatic patients (OR: 2.16, 95% CI: 1.56-3.00) and in patients with symptoms of preterm labor (OR: 2.38, 95% CI: 1.02-5.58). BV also significantly increased the risk of late miscarriages (OR: 6.32, 95% CI: 3.65-10.94) and maternal infection (OR: 2.53, 95% CI 1.26-5.08) in asymptomatic patients. No significant results were calculated for the outcomes of neonatal infection or perinatal mortality. Also, intermediate vaginal flora was not significantly associated with any outcome included. The results of this meta-analysis confirm that BV is a risk factor for preterm delivery and maternal infectious morbidity and a strong risk factor for late miscarriage.
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