Abstract
The relationship between bacterial vaginosis (BV) and preterm delivery has become well known in recent years, although there are few studies on: (i) the differences in test results during the early gestational (EGP) and middle gestational (MGP) periods; (ii) the significance of the intermediate (I) group that does not develop overt BV; or (iii) the therapeutic effects of metronidazole. We performed a retrospective study to analyze the relationship between the vaginal bacterial status and the preterm delivery rate. Without treatment, the preterm delivery rate was higher in the BV subgroup than in the I and normal (N) subgroups (p = 0.021) in the EGP, whereas the rates in the BV and I subgroups were higher than in the N subgroup in the MGP (p = 0.0003). Although treatment of BV by metronidazole vaginal tablets significantly increased the N subgroup in the MGP (p = 0.020), there was no significant improvement in the preterm delivery rate. Decreasing the rate of preterm delivery requires development of treatment methods that will further increase the percentage of patients who test N during the MGP after BV during the EGP.
Highlights
Bacteria such as Lactobacillus lactis have an intravaginal cleansing effect in normal pregnancies, minimizing the presence of common bacterial species[1]
Group 1 comprises of 867 patients tested for bacterial vaginosis (BV) during the early gestational period (EGP) and/or middle gestational period (MGP) from 2004 to 2008 (Fig. 1A). 668 patients were tested during both the EGP and MGP
Among the 668 patients tested for BV during both the EGP and the MGP, a significant correlation was observed between the Nugent score (NS) in the EGP and the NS in the MGP (r = 0.39, p < 0.0001, Spearman’s correlation test)
Summary
Bacteria such as Lactobacillus lactis have an intravaginal cleansing effect in normal pregnancies, minimizing the presence of common bacterial species[1]. There are intravaginal microorganisms other than Lactobacillus species in some pregnancies that cause chorioamnionitis This is because the normal flora (commensal bacteria) that colonize the vagina during pregnancy do not cause inflammatory conditions or vaginitis, such as occurs with infection by pathogenic bacteria. Many clinical trials and a 2013 Cochrane review reported no preventive effects on preterm delivery, despite administration of treatment for BV7–9. This discrepancy mandates further research on the role of BV treatment in this setting. We performed BV screening on all pregnant women during the EGP from 2010 onwards at our hospital All of the latter patients diagnosed with BV were treated with metronidazole vaginal tablets. We analyze the therapeutic effects of metronidazole vaginal tablet administration and its preventive effects on preterm delivery
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