Bacterial Vaginosis in Pregnancy: Diagnosis, Screening, and Management

Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, 15 Cardinal Carter Wing, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
Clinics in Perinatology (Impact Factor: 2.44). 10/2005; 32(3):617-27. DOI: 10.1016/j.clp.2005.05.007
Source: PubMed


Bacterial vaginosis is the most common lower genital tract infection among women of reproductive age. It has been associated with a number of significant obstetric and gynecologic complications, such as preterm labor and delivery, preterm premature rupture of membranes, spontaneous abortion, chorioamnionitis, postpartum endometritis, postcesarean delivery wound infections, postsurgical infections, and subclinical pelvic inflammatory disease. This article focuses on bacterial vaginosis in pregnancy, and discusses approaches to diagnosis, screening, and management.

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    • "Several hormonal changes are produced during pregnancy that can increasingly predispose to infections of the lower genital tract [1] [2] [3] [4]. "
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    ABSTRACT: Objective. To assess the vaginal inflammatory status (VIS) in pregnant women, whether symptomatic or asymptomatic, by leukocyte quantification in relation to the microbiota during each pregnancy trimester (T). Materials and Methods. A thousand two hundred and forty eight vaginal exudates from pregnant women were prospectively examined. All the patients underwent a clinical and colposcopic examination and a microbiological study of vaginal exudates. Leukocyte quantification was determined by May-Grunwald Giemsa staining as LNR per field (400X). Results. Statistically significant differences (SSD) in LNR were observed in the VIS of asymptomatic patients (AP) compared with that of symptomatic ones (SP) with normal microbiota: 10–15 for the 1st T, <10, 20 to 25 and >25 for the 2nd T and >25 for the 3rd; with candidiasis: <10 for the 1st T, <10, 15 to 20 and >25 for the 2nd T and <10 and >25 for the 3rd T. In women with trichomoniasis, SSD in the LNR were observed between SP with LNR ≥ 10 and AP with NLR < 10 in the three trimesters altogether. In women with BV, no SSD were observed in the LNR of any AP with respect to SP for the three T. Conclusion. The VIS is influenced by vaginal microbiota and depends on the state of pregnancy and also, on gestational age. The pronounced leukocyte increase in asymptomatic patients in the absence of lower genital tract infection during the third trimester of pregnancy should be highlighted.
    ISRN obstetrics and gynecology 04/2011; 2011:835926. DOI:10.5402/2011/835926
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    • "Oral or topical antimicrobials include metronidazole and clindamycin. Screening of partners does not affect the recurrence rate, which can be as high as two thirds of treated women, due to relapse or reinfection (Yudin 2005). "
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    ABSTRACT: Infection continues to account for a major proportion of maternal, fetal, and neonatal mortality and morbidity worldwide. In the developing world, maternal systemic infections, such as pneumonia, malaria, tuberculosis, typhoid fever, and pyelonephritis, which are often functions of poverty, crowding, and malnutrition, impose health costs to the mother and risks to the fetus. These risks include spontaneous abortion, stillbirth, preterm labor and preterm birth, low birth weight, intrauterine growth restriction (IUGR), and infection. This is in addition to the rapidly escalating rates of a number of sexually transmitted diseases, in particular, human immunodeficiency virus (HIV) infection with its associated comorbidities.
    Fetal and Neonatal Pathology, 07/2009: pages 379-423;
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    ABSTRACT: BACKGROUND: Vagina like all other mucosal organs owns its especial bacterial/microbial flora. Though may be pathogen in other circumstances, members of vaginal normal flora do not cause disease on healthy vaginal mucosa. In this study, we tried to determine the relationship between microscopic findings on Methenamine silver stained cervicovaginal smears and clinical symptoms. METHODS: A total of 389 cervicovaginal smears were examined cytologically from April to August 2005, among which 103 satisfactory smears of patients who were normally menstruating were subsequently selected. The originally Papanicolaou–stained smears were stained with Methenamine silver method. The cervicovaginal flora in symptomatic and asymptomatic patients was classified into four groups. The relationship between the type of genital flora and the presence of Candida or Actinomyces spp was also determined. Data were analyzed with SPSS software using Chi–square test. RESULTS: In 103 evaluated patients, 46 (44.7%) were symptomatic and the rest were asymptomatic. The most prevalent genital microbial flora in both symptomatic (21.7%) and asymptomatic (37.9%) patients was type II (Lactobacilli). Microbial frequency differences were significant for types II (P = 0.034) and III (P = 0.039) in both groups. Coexistence of microbial flora of type I (P = 0.02) and type IV (P = 0.033) with Candida was statistically significant. Coexistence of all types of microbial flora with Actinomyces was not proved significant. CONCLUSIONS: Symptomatic women, except those with potential pathogens, tend to have Lactobacillus flora. Therefore, it is advisable that all Lactobacilli types be investigated through microbiological methods in symptomatic patients. In silver stained slides, there was a clear relationship between the type of vaginal microbial flora and the presence of Candida spp. KEY WORDS: Microbial flora, cervicovaginal smears, methenamine silver, symptomatic, asymptomatic.
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