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. 1994 Jan 29;308(6924):295–298. doi: 10.1136/bmj.308.6924.295

Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage.

P E Hay 1, R F Lamont 1, D Taylor-Robinson 1, D J Morgan 1, C Ison 1, J Pearson 1
PMCID: PMC2539287  PMID: 8124116

Abstract

OBJECTIVE--To find out whether women with bacterial vaginosis detected early in pregnancy are at increased risk of preterm delivery. DESIGN--Prospective description cohort study. SETTING--Antenatal clinic in a district general hospital. SUBJECTS--783 women examined during their first antenatal clinic visit and screened for recognised risk factors for preterm delivery and the presence of bacterial vaginosis or intermediate abnormal flora detected by examination of a vaginal smear stained by Gram's method. MAIN OUTCOME MEASURES--Gestational age at delivery classified as late miscarriage (16-24 weeks' gestation), preterm delivery (24-37 weeks' gestation), term delivery (> or = 37 weeks' gestation). RESULTS--Multiple logistic analysis showed that there was an increased incidence of preterm delivery in women with a previous preterm delivery (9/24; odds ratio 25; 95% confidence interval 9 to 70; P < 0.001) and bacterial vaginosis (9/115; 2.8; 1.1 to 7.4; P = 0.04). A further logistic analysis of data from women recruited before 16 weeks' gestation showed that preterm deliveries or late miscarriages occurred more often in women with bacterial vaginosis (12/77; 5.5; 2.3 to 13.3; P < 0.001). CONCLUSIONS--Late miscarriage and preterm delivery are associated with the presence of bacterial vaginosis in early pregnancy. This is independent of recognised risk factors such as previous preterm delivery.

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Selected References

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  1. Gibbs R. S., Romero R., Hillier S. L., Eschenbach D. A., Sweet R. L. A review of premature birth and subclinical infection. Am J Obstet Gynecol. 1992 May;166(5):1515–1528. doi: 10.1016/0002-9378(92)91628-n. [DOI] [PubMed] [Google Scholar]
  2. Gravett M. G., Nelson H. P., DeRouen T., Critchlow C., Eschenbach D. A., Holmes K. K. Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome. JAMA. 1986 Oct 10;256(14):1899–1903. [PubMed] [Google Scholar]
  3. Hay P. E., Taylor-Robinson D., Lamont R. F. Diagnosis of bacterial vaginosis in a gynaecology clinic. Br J Obstet Gynaecol. 1992 Jan;99(1):63–66. doi: 10.1111/j.1471-0528.1992.tb14395.x. [DOI] [PubMed] [Google Scholar]
  4. Hemminki E., Starfield B. Prevention and treatment of premature labour by drugs: review of controlled clinical trials. Br J Obstet Gynaecol. 1978 Jun;85(6):411–417. doi: 10.1111/j.1471-0528.1978.tb14906.x. [DOI] [PubMed] [Google Scholar]
  5. Hillier S. L., Krohn M. A., Nugent R. P., Gibbs R. S. Characteristics of three vaginal flora patterns assessed by gram stain among pregnant women. Vaginal Infections and Prematurity Study Group. Am J Obstet Gynecol. 1992 Mar;166(3):938–944. doi: 10.1016/0002-9378(92)91368-k. [DOI] [PubMed] [Google Scholar]
  6. Kurki T., Sivonen A., Renkonen O. V., Savia E., Ylikorkala O. Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol. 1992 Aug;80(2):173–177. [PubMed] [Google Scholar]
  7. Leveno K. J., Cunningham F. G. Beta-adrenergic agonists for preterm labor. N Engl J Med. 1992 Jul 30;327(5):349–351. doi: 10.1056/NEJM199207303270510. [DOI] [PubMed] [Google Scholar]
  8. Lockwood C. J., Senyei A. E., Dische M. R., Casal D., Shah K. D., Thung S. N., Jones L., Deligdisch L., Garite T. J. Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery. N Engl J Med. 1991 Sep 5;325(10):669–674. doi: 10.1056/NEJM199109053251001. [DOI] [PubMed] [Google Scholar]
  9. McGregor J. A., French J. I., Lawellin D., Todd J. K. Preterm birth and infection: pathogenic possibilities. Am J Reprod Immunol Microbiol. 1988 Mar;16(3):123–132. doi: 10.1111/j.1600-0897.1988.tb00181.x. [DOI] [PubMed] [Google Scholar]
  10. McGregor J. A., French J. I., Reller L. B., Todd J. K., Makowski E. L. Adjunctive erythromycin treatment for idiopathic preterm labor: results of a randomized, double-blinded, placebo-controlled trial. Am J Obstet Gynecol. 1986 Jan;154(1):98–103. doi: 10.1016/0002-9378(86)90401-1. [DOI] [PubMed] [Google Scholar]
  11. McGregor J. A., French J. I., Richter R., Vuchetich M., Bachus V., Seo K., Hillier S., Judson F. N., McFee J., Schoonmaker J. Cervicovaginal microflora and pregnancy outcome: results of a double-blind, placebo-controlled trial of erythromycin treatment. Am J Obstet Gynecol. 1990 Nov;163(5 Pt 1):1580–1591. doi: 10.1016/0002-9378(90)90632-h. [DOI] [PubMed] [Google Scholar]
  12. McGregor J. A., French J. I., Seo K. Adjunctive clindamycin therapy for preterm labor: results of a double-blind, placebo-controlled trial. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 1):867–875. doi: 10.1016/0002-9378(91)90430-y. [DOI] [PubMed] [Google Scholar]
  13. Miettinen O. S. Stratification by a multivariate confounder score. Am J Epidemiol. 1976 Dec;104(6):609–620. doi: 10.1093/oxfordjournals.aje.a112339. [DOI] [PubMed] [Google Scholar]
  14. Minkoff H., Grunebaum A. N., Schwarz R. H., Feldman J., Cummings M., Crombleholme W., Clark L., Pringle G., McCormack W. M. Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy. Am J Obstet Gynecol. 1984 Dec 15;150(8):965–972. doi: 10.1016/0002-9378(84)90392-2. [DOI] [PubMed] [Google Scholar]
  15. Romero R., Mazor M., Wu Y. K., Sirtori M., Oyarzun E., Mitchell M. D., Hobbins J. C. Infection in the pathogenesis of preterm labor. Semin Perinatol. 1988 Oct;12(4):262–279. [PubMed] [Google Scholar]
  16. Spiegel C. A., Amsel R., Holmes K. K. Diagnosis of bacterial vaginosis by direct gram stain of vaginal fluid. J Clin Microbiol. 1983 Jul;18(1):170–177. doi: 10.1128/jcm.18.1.170-177.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]

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