Reproducibility of interpretation of Gram-stained vaginal smears for the diagnosis of bacterial vaginosis

Mazzulli, Tony; Simor, A. E.; D, Low

doi:10.1128/jcm.28.7.1506-1508.1990

Cited by 39 publications

(15 citation statements)

References 19 publications

(23 reference statements)

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“…In order to assess inter-and intra-observer variability, 10% of slides will be randomly selected for blinded review both by a second technician and repeat reading by the original technician. 176 Fetal fibronectin analyses are performed with a specialised immuno-serology technician using the enzyme immunoassay (EIA) kits supplied by the manufacturer (Adeza, Sunnyvale, CA) and read on a standard EIA microtiter plate reader (Sanofi Diagnostics Pasteur, Montreal, Canada).…”

Section: Laboratory Studiesmentioning

confidence: 99%

Socio‐economic disparities in preterm birth: causal pathways and mechanisms

Kramer

Goulet

Lydon³

et al. 2001

Paediatric Perinatal Epid

323

221

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SummaryPreterm birth is the leading cause of infant mortality in industrialised societies. Its incidence is greatly increased among the socially disadvantaged, but the reasons for this excess are unclear and have been relatively unexplored. We hypothesise two distinct sets of causal pathways and mechanisms that may explain social disparities in preterm birth. The first set involves chronic and acute psychosocial stressors, psychological distress caused by those stressors, increased secretion of placental corticotropin releasing hormone (CRH), changes in sexual behaviours or enhanced susceptibility to bacterial vaginosis and chorioamnionitis, cigarette smoking or cocaine use, and decidual vasculopathy. The second hypothesised pathway is a gene±environment interaction based on a highly prevalent mutation in the gene for methylenetetrahydrofolate reductase (MTHFR), combined with low folate intake from the diet and from prenatal vitamin supplements, consequent hyperhomocysteinemia, and decidual vasculopathy.We propose to test these hypothesised pathways and mechanisms in a nested casecontrol study within a prospectively recruited and followed cohort of pregnant women with singleton pregnancies who deliver at one of four Montreal hospitals that serve an ethnically and socio-economically diverse population. Following recruitment during the late first or early second trimester, participating women are seen at 24±26 weeks, when a research nurse obtains a detailed medical and obstetric history; administers several scales to assess chronic and acute stressors and psychological function; obtains blood samples for CRH, red blood cell and plasma folate, homocysteine, and DNA for the MTHFR mutation; and performs a digital and speculum examination to measure cervical length and vaginal pH and to obtain swabs for bacterial vaginosis and fetal fibronectin. After delivery, each case (delivery at 5 37 completed weeks following spontaneous onset of labour or prelabour rupture of membranes) and two controls are selected for placental pathological examination, hair analysis of cotinine, cocaine, and benzoylecgonine, and analysis of stored blood and vaginal specimens. Statistical analysis will be based on multiple logistic regression and structural equation modelling, with sequential construction of models of potential aetiological determinants and covariates to test the hypothesised causal pathways and mechanisms.The research we propose should improve understanding of the factors and processes that mediate social disparities in preterm birth. This improved understanding should help not only in developing strategies to reduce the disparities but also in suggesting preventive interventions applicable across the entire socioeconomic spectrum.

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Section: Laboratory Studiesmentioning

confidence: 99%

Socio‐economic disparities in preterm birth: causal pathways and mechanisms

Kramer

Goulet

Lydon³

et al. 2001

Paediatric Perinatal Epid

323

221

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“…Microbiologically, bacterial vaginosis is characterized by a shift in the vaginal flora from the dominant flora of Lactobacillus spp. to a mixed vaginal flora that includes Gardnerella vaginalis, Bacteroides spp., Mobiluncus spp., and Mycoplasma hominis (11,12). Because bacterial vaginosis is a clinical syndrome which has been associated with a group of genital microorganisms rather than a single etiologic agent, it has been defined primarily by the following clinical signs: vaginal pH >4.5, the presence of adherent white discharge, detection of "clue cells," and the presence of an amine odor after the addition of KOH (1).…”

mentioning

confidence: 99%

Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation

Nugent¹,

Krohn²,

Hillier³

1991

J Clin Microbiol

2,812

1,368

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The purpose of the study was to examine intercenter variability in the interpretation of Gram-stained vaginal smears from pregnant women. The intercenter reliability of individual morphotypes identified on the vaginal smear was evaluated by comparing them with those obtained at a standard center. A new scoring system that uses the most reliable morphotypes from the vaginal smear was proposed for diagnosing bacterial vaginosis. This scoring system was compared with the Spiegel criteria for diagnosing bacterial vaginosis. The scoring system (0 to 10) was described as a weighted combination of the following morphotypes: lactobacilli, Gardnerella vaginalis or bacteroides (small gram-variable rods or gram-negative rods), and curved gramvariable rods. By using the Spearman rank correlation to determine intercenter variability, gram-positive cocci had poor agreement (0.23); lactobacilli (0.65), G. vaginalis (0.69), and bacteroides (0.57) had moderate agreement; and small (0.74) and curved (0.85) gram-variable rods had good agreement. The reliability of the 0 to 10 scoring system was maximized by not using gram-positive cocci, combining G. vaginalis and bacteroides morphotypes, and weighting more heavily curved gram-variable rods. For comparison with the Spiegel criteria, a score of 7 or higher was considered indicative of bacterial vaginosis. The standardized score had improved intercenter reliability (r = 0.82) compared with the Spiegel criteria (r = 0.61). The standardized score also facilitates future research concerning bacterial vaginosis because it provides gradations of the disturbance of vaginal flora which may be associated with different levels of risk for pregnancy complications.

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“…The reproducibility of interpretation of Gram-stained smears has been evaluated recently (127). Eighty consecutive vaginal swabs from 80 patients were used.…”

Section: Bvmentioning

confidence: 99%

Bacterial vaginosis.

Spiegel

1991

Clinical Microbiology Reviews

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Reproducibility of interpretation of Gram-stained vaginal smears for the diagnosis of bacterial vaginosis

Cited by 39 publications

References 19 publications

Socio‐economic disparities in preterm birth: causal pathways and mechanisms

Socio‐economic disparities in preterm birth: causal pathways and mechanisms

Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation

Bacterial vaginosis.

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