Bacterial Vaginosis in Pregnancy: Diagnosis, Screening, and Management

ArticleinClinics in Perinatology 32(3):617-27 · October 2005with9 Reads
DOI: 10.1016/j.clp.2005.05.007 · Source: PubMed
Abstract
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.
    • "Vaginal infections, like bacterial vaginosis (BV), Candida vaginitis, and aerobic vaginitis (AV), occur frequently in all classes of women, worldwide, and are a frequent source of recurrent or recalcitrant complaints . They pose an increased risk of pelvic infection, postabortum infection , postoperative wound infections, and adverse pregnancy outcomes (Larsson et al., 1991Larsson et al., , 1992 Persson et al., 1996; Lee et al., 2009; Nelson et al., 2007; Svare et al., 2006; Daskalakis et al., 2006; Hauth et al., 2003; Jacobsson et al., 2002; Donders et al., 2000 Donders et al., , 2009 Gaudoin et al., 1999; Mass et al., 1999; Hillier et al., 1995; McDonald et al., 1991; Martius and Eschenbach, 1990; Eschenbach et al., 1984; Yudin, 2005). Acquisition of HIV, HSV-2, and Chlamydia is increased in women with abnormal vaginal flora (AVF) and BV (Cu-Uvin et al., 1996; Yoshimura et al., 2009; Cherpes et al., 2003). "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Is self-assessed vaginal pH measurement to detect abnormal vaginal bacterial microflora (AVF) an adequate prescreening method for detection of genital sexually transmitted infections (STIs)? Materials and methods: A total of 360 Ugandan women tested themselves with a gloved finger and a pH color strip. PCR for bacterial vaginosis (BV)-associated bacteria was tested by PCR for Mycoplasma hominis, Ureaplasma urealyticum, and/or Atopobium vaginae, while the STIs were diagnosed by positive PCR for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and/or Trichomonas vaginalis. Results: A strong correlation was found between self-assessed pH values and BV-associated bacteria (P<0.0001), but not with STIs, not as single infections, nor in general. Conclusion: Self-measured vaginal pH correlated well with markers of high-risk microflora types such as BV or aerobic vaginitis, but not with STIs. Hence, in a screening program addressing AVF in low-resource countries, extra specific tests are required to exclude STIs.
    Full-text · Article · Dec 2015
    • "TLR-4 recognizes the LPS of Gram-negative bacteria [30], including those found in bacterial vaginosis (BV), such as Bacteroides spp., Fusobacterium spp. and Prevotella [31] [32]. This study demonstrated gene expression of TLR-2 in the amniochorion membranes was significantly higher thanTLR-4 gene expression in the presence of histologic chorioamnionitis, which results from microbial invasion of the amniotic cavity [33] . "
    [Show abstract] [Hide abstract] ABSTRACT: Expression of Toll-like receptors at the maternal-fetal interface during normal and complicated pregnancies has aroused interest in the last few years. However, despite the importance of TLR-2 and TLR-4, which recognizes most microorganisms presenting in the amniotic cavity infections associated with prematurity, comparison of the expressions of these receptors is rare in the literature. Thus, the purpose of this study was to compare the gene expression between TLR-2 and TLR-4 in amniochorion membranes of pregnant women with preterm delivery in the presence of histologic chorioamnionitis (HCA). Amniochorion membranes were collected from 40 pregnant women with preterm delivery; 20 presented HCA and 20 did not. Fragments of the membranes were submitted to total RNA extraction, followed by cDNA production by reverse transcription. Real time quantitative PCR was used to quantify the gene expression of the TLRs. mRNA concentrations between TLR-2 and TLR-4 were compared using the nonparametric Mann-Whitney test. TLR-2 expression was higher than TLR-4 expression in the presence of HCA. No difference was observed between TLR-2 and TLR-4 expression in membranes in the absence of inflammatory infiltrate. In conclusion, amniochorion membranes express TLR-2 and TLR-4 and higher TLR-2 expression in the presence of histologic chorioamnionitis suggests that microorganisms recognizable by TLR-2 play an important role in the physiopathology of preterm labor.
    Full-text · Article · Nov 2014
    • "Consistent with their role in pathogen recognition, TLRs are expressed by cells involved in the first line of host defense, including neutrophils, macrophages, dendritic cells and epithelial cells of maternal tissues and reproductive organs [9,14,4344454647484950. The presence of bacterial vaginosis during pregnancy is closely related to the risk of ascending infection in the amniotic cavity [51], resulting in tissue neutrophil infiltration. The intraamniotic infection may present as a polymicrobial infection, which justifies the expression of these TLRs in amniochorion membranes, especially in the presence of inflammation. "
    [Show abstract] [Hide abstract] ABSTRACT: To determine whether histologic chorioamnionitis is associated with changes in gene expression of TLR-1, -2, -4 and -6, and to describe the localization of these receptors in fetal membranes. A total of 135 amniochorion membranes with or without histologic chorioamnionitis from preterm or term deliveries were included. Fragments of membranes were submitted to total RNA extraction. RNA was reverse transcribed and the quantification of TLRs expression measured by real time PCR. All amniochorion membranes expressed TLR-1 and TLR-4, whereas 99.1% of membranes expressed TLR-2 and 77.4% expressed TLR-6. TLR-1 and TLR-2 expressions were significantly higher in membranes with histologic chorioamnionitis as compared to membranes without chorioamnionitis in preterm pregnancies (p=0.003 and p<0.001, respectively). Among the membranes of term pregnancies there were no differences in the expressions of such receptors regardless of inflammatory status. Regarding TLR-4 and TLR-6 expression, there was no difference among membranes with or without histologic chorioamnionitis, regardless gestational age at delivery. TLR-1, TLR-2, TLR-4 and TLR-6 expressions were observed in amniotic epithelial, chorionic and decidual cells. Amniochorion membranes express TLR-1, TLR-2, TLR-4 and TLR-6 and increased expression of TLR-1 and TLR-2 is related to the presence of histologic chorioamnionitis in preterm pregnancies. This study provides further evidence that amniochorion membranes act as a mechanical barrier to microorganisms and as components of the innate immune system.
    Full-text · Article · Oct 2013
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