Bacterial vaginosis in preterm labor

Abstract

Preterm delivery is a major contributor to neonatal morbidity and mortality. Its etiology is multifactorial. Several studies in developed countries have reported an association between bacterial vaginosis in pregnancy and preterm birth. A prospective trial was conducted in the Department of Obstetrics and Gynecology of Nehru Hospital, attached to the Postgraduate Institute of Medical Education and Research, Chandigarh, India, in collaboration with the Department of Microbiology, to study the incidence of bacterial vaginosis and correlation of Gardnerella vaginalis, Mobiluncus species, bacteroids and Mycoplasma hominis in women with idiopathic preterm labor.One-hundred twenty women were recruited. Sixty women in spontaneous preterm labor with or without rupture of membranes were included in the study group, while another 60 women in spontaneous labor at term pregnancy with or without rupture of membranes were enrolled as the control group. Pregnant women with painless or painful uterine contractions occurring at frequency of 4 in 20 min or 8 in 60 min with documented cervical changes with or without leakage per vaginum were included in the study group and their gestational age was within 28-37 weeks. The period of gestation in the control group was N37 weeks. The vaginal discharge was subjected to pH test and amine test, and swabs were sent to the laboratory for smear, staining and culture. Table 1 shows the incidence of bacterial vaginosis in both the groups. The difference between the two groups was statistically significant ( p b 0.001). Swab cultures for bacterial vaginosis associated organisms showed growth of G. vaginalis 0020-7292/$ -see front matter D

Adverse pregnancy and birth outcomes associated withMycoplasma hominis, Ureaplasma urealyticumandUreaplasma parvum: a systematic review and meta-analysis

“…Of the 57 studies, we identified 42 reporting on M. hominis (proportion detected <1%–70%), 31 reporting on U. urealyticum (proportion detected 0%–91%) and 12 reporting on U. parvum (2%–100%) and median sample size 250, interquartile range (IQR) 145–613, range 3732 to 910533 (table 1, online supplemental file, table S1). There were 26 cohort studies (online supplemental file, table 2.1),1 6 8 12 15 33–53 25 case–control studies (online supplemental file, table 2.2)7 9–11 32 54–73 and six cross-sectional studies (online supplemental file, table 2.3). 74–79 Most studies were from high-income settings (39/57) (online supplemental file, table S3.1-S3.3); ethnicity was reported in 24 studies, and maternal smoking in 12 (online supplemental file, table S4.1-S4.3).…”

“…Only two studies presented findings for combinations of more than one genital mycoplasma6 47; the rest presented data separately, even if they had tested for more than one organism. Ten studies reported on the presence of BV33 36 43 47 51 53 58 59 65 72; we report the findings of these studies in the relevant section of the results for each genital mycoplasma. Twenty-three studies reported on other sexually transmitted infections (online supplemental file, tables S4.1-S4.3), including 2/23 reporting on syphilis, 5/23 gonorrhoea, 14/23 chlamydia, 5/23 M .…”

“…Based on the NICE checklists,27 28 none of the 57 studies met all or most (++/++) checklist criteria for internal and external validity, 29 studies met some (+/+)7 9 11 15 32 33 36 40 41 45–47 50 52 56–58 60 62 64 65 67–70 72–74 and 17 met few or no checklist criteria (−/−)6 8 10 12 38 39 42–44 49 53 55 61 66 71 79 (online supplemental file, tables S6.1–S6.3). Poor reporting of study methods meant that many items could not be assessed.…”

“…There were 42 studies with data about M. hominis , reporting on 66 outcomes (online supplemental file, tables S2.1–S2.3,S3.1). Of these, 30 included data about PTB 1 6 8 10 15 32 33 36 38 40 42–46 48 50–54 58 59 61 66 68 69 72 73 75 . M. hominis was associated with PTB in meta-analysis of unadjusted ORs (19 576 women, summary OR 1.87, 95% CI 1.49 to 2.34; I 2 29.2%; prediction interval 0.98, 3.55) (figure 1).…”

“…In two studies, no numerical results were reported (online supplemental file, table 2.1). In seven studies, authors also reported on BV 33 36 43 51 58 59 72. In one study, the associations between M. hominis , BV and PTB could be examined in detail 33 .…”