The Effect of Treating Bacterial Vaginosis on Preterm Labor

Tebes, Christine C.; Lynch, Catherine; Sinnott, John T.

doi:10.1080/10647440300025509

Cited by 13 publications

(9 citation statements)

References 21 publications

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“…In addition, the intrauterine infection, which may have originated in the vaginal cavity, might account for 25-40% of preterm births [59]. The most commonly associated bacteria are bacteria from the class Mollicutes (Ureaplasma species, Mycoplasma genitalium, and M. hominis, for example) [60,61], but many other microbial species have been identified in cases of bacterial vaginosis, including Prevotella [62][63][64]. Those microbes might invade the uterus by migrating from the passage through the cervix from the vagina and infect the amniotic fluid [59].…”

Section: Discussionmentioning

confidence: 99%

Defining microbial biomarkers for risk of preterm labor

et al. 2019

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Preterm birth remains the main contributor to early childhood mortality. The vaginal environment, including microbiota composition, might contribute to the risk of preterm delivery. Alterations in the vaginal microbial community structure might represent a risk factor for preterm birth. Here, we aimed to (a) investigate the association between preterm birth and the vaginal microbial community and (b) identify microbial biomarkers for risk of preterm birth. Microbial DNA was isolated from vaginal swabs in a cohort of 69 women enrolled at hospital admission for their delivery. Microbiota was analyzed by high-throughput 16S rRNA sequencing. While no differences in microbial diversity measures appeared associated with the spontaneous preterm and full-term outcomes, the microbial composition was distinct for these groups. Differential abundance analysis showed Lactobacillus species to be associated with full-term birth whereas an unknown Prevotella species was more abundant in the spontaneous preterm group. Although we studied a very miscegenated population from Brazil, our findings were similar to evidence pointed by other studies in different countries. The role of Lactobacillus species as a protector in the vaginal microbiome is demonstrated to be also a protector of spontaneous preterm outcome whereas the presence of pathogenic species, such as Prevotella spp., is endorsed as a factor of risk for spontaneous preterm delivery.

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Section: Discussionmentioning

confidence: 99%

Defining microbial biomarkers for risk of preterm labor

et al. 2019

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“…It should therefore come as no surprise that treatment with oral or vaginal metronidazole, which efficiently kills anaerobes, but not aerobic bacteria, reduces BV in pregnancy, but fails to decrease the risk of PPROM or PTB in randomised, placebo-controlled series. [29][30][31] Carey et al 2 re-analysed their data after they failed to find a protective effect of metronidazole in a large population-based placebo-controlled treatment trial. They found that, at delivery, Klebsiella and E. coli were more often present in the flora of women delivering preterm than in the flora of other women.…”

Section: Discussionmentioning

confidence: 99%

“…Also, in case–control studies of women in labour investigating the difference between typical bacterial vaginosis with overgrowth of Gardnerella vaginalis /anaerobes and the presence of other abnormal flora types, an association between BV in labour and subsequent PTB was consistently lacking, while the association of PTB with the presence in labour of Klebsiella sp., E. coli , staphylococci and streptococci, 2,24 with or without signs of inflammation or neutrophils in the vagina, 25–28 was rather strong and consistent. It should therefore come as no surprise that treatment with oral or vaginal metronidazole, which efficiently kills anaerobes, but not aerobic bacteria, reduces BV in pregnancy, but fails to decrease the risk of PPROM or PTB in randomised, placebo‐controlled series 29–31 . Carey et al 2 .…”

Section: Discussionmentioning

confidence: 99%

Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy

Donders¹,

Calsteren²,

Bellen³

et al. 2009

BJOG

366

291

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Introduction Abnormal vaginal flora (AVF) before 14 gestational weeks is a risk factor for preterm birth (PTB). The presence of aerobic microorganisms and an inflammatory response in the vagina may also be important risk factors.Aim The primary aim of the study was to investigate the differential influences of AVF, full and partial bacterial vaginosis, and aerobic vaginitis in the first trimester on PTB rate. The secondary aim was to elucidate why treatment with metronidazole has not been found to be beneficial in previous studies.Setting Unselected women with low-risk pregnancies attending the prenatal unit of the Heilig Hart General Hospital in Tienen, Belgium, were included in the study.Materials and methods At the first prenatal visit, 1026 women were invited to undergo sampling of the vaginal fluid for wet mount microscopy and culture, of whom 759 were fully evaluable. Abnormal vaginal flora (AVF; disappearance of lactobacilli), bacterial vaginosis (BV), aerobic vaginitis (AV), increased inflammation (more than ten leucocytes per epithelial cell) and vaginal colonisation with Candida (CV) were scored according to standardised definitions. Partial BV was defined as patchy streaks of BV flora or sporadic clue cells mixed with other flora, and full BV as a granular anaerobic-type flora or more than 20% clue cells. Vaginal fluid was cultured for aerobic bacteria, Mycoplasma hominis and Ureaplasma urealyticum. Outcome was recorded as miscarriage £13 weeks + 6 days [early miscarriage (EM), n = 8 (1.1%)], between 14 + 0 and 24 weeks + 6 days [late miscarriage (LM), n = 7 (0.9%)], delivery or miscarriage £34 weeks + 6 days n = 29 (3.8%)], £36 weeks + 6 days n = 70 (9.2%)]. PTB between 25 + 0 and 36 weeks + 6 days was further divided in severe PTB (SPTB, 25 + 0 to 34 weeks + 6 days) and mild PTB (MPTB, 35 + 0 to 36 weeks + 6 days).Results Women without abnormalities of the vaginal flora in the first trimester had a 75% lower risk of delivery before 35 weeks compared with women with AVF [odds ratio (OR) 0.26; 95% confidence interval (CI) 0.12-0.56]. The absence of lactobacilli (AVF) was associated with increased risks of PTB (OR 2.4; 95% CI 1.2-4.8), EPTB (OR 6.2; 95% CI 2.7-14) and miscarriage (OR 4.9; 95% CI 1.4-17). BV was associated with increased risks of PTB (OR 2.4; 95% CI 1.1-4.7), EPTB (OR 5.3; 95% CI 2.1-12.9) and miscarriage (OR 6.6; 95% CI 2.1-20.9) and coccoid AV was associated with increased risks of EPTB (OR 3.2; 95% CI 1.2-9.1) and miscarriage (OR 5.2; 95% CI 1.5-17). In women with BV, partial BV had a detrimental effect on the risk of PTB for all gestational ages, but full BV did not. Preterm deliveries later than 24 weeks+ 6 days were more frequent when M. hominis was present (EPTB OR 13.3; 95% CI 3.2-55).Discussion Bacterial vaginosis, AV and AVF are associated with PTB, especially LM and severe PTB between 25 and 35 weeks. The absence of lactobacilli (AVF), partial BV and M. hominis, but not full BV, were associated with an increased risk of preterm delivery after 24 weeks+ 6 days. As metronidazol...

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“…Some antibiotics showed increased risk of delivery < 37 weeks (RR with metronidazole versus placebo 1.6, 95% CI 1.05 -2.4) (74). Antibiotics are therefore only recommended in women with P-PROM because they are effective in restoring vaginal flora73, but not as prophylaxis in high-risk asymptomatic women (66,75,76). A review of all UK PSCs reflects this, as no centres used antibiotics prophylactically.…”

Section: Antibioticsmentioning

confidence: 99%

The Role of PTB Clinics: A Review of the Screening Methods, Interventions and Evidence for Preterm Birth Surveillance Clinics for High-Risk Asymptomatic Women

et al. 2017

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Context: Preterm birth accounts for significant neonatal mortality and morbidity as well as substantial health costs. As our understanding of aetiology and risk factors for preterm birth increases, predictive tools and prophylactic interventions have been developed to improve maternal and fetal outcomes. These are effective, but require surveillance of asymptomatic high-risk women, as well as ultrasound and surgical expertise. This has led to the development of preterm birth surveillance clinics (PSCs), which pool these resources together and have changed the focus of care from reactive to predictive and preventative management. Methods: A literature review of the evidence surrounding the predictive tests (cervical length, fetal fibronectin, Actim Partus, Partosure) and prophylactic interventions (cerclage, progesterone, Arabin pessary, antibiotics, and steroids) for preterm birth to understand what preterm birth surveillance clinics do and how effective they are. Results: Measuring cervical length and fetal fibronectin levels are two of the most accurate predictive tests preterm birth, especially when used in combination. Other predictive tools like Actim Partus and Partosure are effective for symptomatic women, but their role in surveillance of asymptomatic women is unclear. Cervical cerclage is effective in reducing preterm birth in women with previous losses, but the role of progesterone and pessaries remains debated. Steroids remain one of the most effective antenatal intervention, but they need to be administered within a tight timeframe in order to confer maximal benefit. The role of PSCs in predicting the timing of birth and targeting women at highest risk to appropriate interventions is therefore crucial in optimizing care and improving outcomes. Conclusions: Nearly every step of management is still debated although many have a strong evidence-base and effective interventions do exist. The challenge is finding the optimal management pathway, and details of which populations benefit from which interventions need to be evaluated. While evidence continues to be collated, the poor outcomes of preterm birth and the multiple options available to reduce them justify preterm birth surveillance clinics being resourced.Keywords: Preterm Birth, Predictive, Fetal Fibronectin, Cervical Length, Cervical Cerclage ContextDefined as spontaneous or induced birth before 37+ 0 weeks' gestation, preterm birth (PTB) is responsible for significant perinatal morbidity and mortality. Preterm labour affects 11.1% of live births worldwide (1) and 7.6% of live births in England and Wales (2), but incidence is rising globally (3). PTB causes more than 3 million perinatal deaths a year (1) and causes increased risks of neurodevelopmental impairment, behavioural problems and respiratory diseases, which constitute significant health costs and decreased quality of life (4-6). MethodsThe primary research question our review is addressing is "what predictive tests and prophylactic interventions to preterm birth surveillance clini...

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The Effect of Treating Bacterial Vaginosis on Preterm Labor

Cited by 13 publications

References 21 publications

Defining microbial biomarkers for risk of preterm labor

Defining microbial biomarkers for risk of preterm labor

Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy

The Role of PTB Clinics: A Review of the Screening Methods, Interventions and Evidence for Preterm Birth Surveillance Clinics for High-Risk Asymptomatic Women

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