Bacterial vaginosis in pregnancy and early labour using Nugent scoring and the implication on foetal outcome.

Adewale O Sule-Odu,Babatunde A Andu,Adedayo A Oluwole,Olubunmi A Osinupebi,Kolawole S Oritogun,Ismail A Lawal,Adeniyi K Akiseku,Adebayo A Akadri

doi:10.4314/gmj.v54i1.3

Abstract

To compare the pattern of vaginal microflora during pregnancy with pattern in early labour using Nugent scoring and determine the effect of these changes on fetal outcome. A prospective longitudinal study. Pregnant women attending antenatal clinics of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between June 2017 and May 2018. Consenting pregnant women who attended antenatal clinics were recruited. Vaginal secretions were obtained for Nugent scoring during pregnancy and at presentation in labour. Prevalence of abnormal vaginal flora in pregnancy and early labour, birth outcome, birth weight, gestational age at delivery, APGAR scores, need for neonatal ward admission. Sixty-seven (33.3%) of pregnant women had abnormal flora which was consistent with bacterial vaginosis. At the presentation of these women in labour, 14.4% of them had bacterial vaginosis thus indicating a significant reduction in abnormal vaginal flora in labour compared to the proportion of abnormal flora in antenatal period (P<0.001). There were no significant differences in the fetal outcomes of mothers with bacterial vaginosis when compared with those with normal vaginal flora (P-value >0.05). Persistence of abnormal vaginal microflora from pregnancy till early labour did not seem to be associated with poorer foetal outcomes when compared with women with normal vaginal microflora in labour. The possibility of persistent infection or re-infection before labour may justify the need for re-evaluation of vaginal smears in the late third trimester to allow for prompt treatment before the onset of labour. This research work was sponsored by the Tertiary Education Trust Fund, Nigeria (TETFund) with reference number OOU/IBR/010.

Highlights

The vagina of a normal asymptomatic reproductive-aged woman is populated by several bacterial organisms which include aerobes and obligate anaerobic species.Of these, the Lactobacillus constitutes the main bacterial flora.[1]
Loss of the indigenous Lactobacilli strongly predisposes to ascending genital tract infection, which in pregnancy is a major cause of chorioamnionitis, amniotic fluid infection and preterm birth.[6,7,8]
Studies have shown that the depletion of vaginal Lactobacillus microflora predisposes women to the acquisition of sexually transmitted infectious diseases caused by organisms such as Neisseria gonorrhea, Chlamydia species and Human Immunodeficiency Virus.[9,10]

Summary

Introduction

The vagina of a normal asymptomatic reproductive-aged woman is populated by several bacterial organisms which include aerobes and obligate anaerobic species.Of these, the Lactobacillus constitutes the main bacterial flora.[1]. In a considerable number of women, vaginal lactobacilli fail to retain dominance. This usually results in vaginal flora’s symbiotic relationship shifting to one in which there is an overgrowth of anaerobic species including Gardnerella vaginalis, Ureaplasma-urealyticum, Mobiluncus species, Mycoplasma hominis, and Prevotella species, a condition referred to as bacterial vaginosis. Loss of the indigenous Lactobacilli strongly predisposes to ascending genital tract infection, which in pregnancy is a major cause of chorioamnionitis, amniotic fluid infection and preterm birth.[6,7,8] Studies have shown that the depletion of vaginal Lactobacillus microflora predisposes women to the acquisition of sexually transmitted infectious diseases caused by organisms such as Neisseria gonorrhea, Chlamydia species and Human Immunodeficiency Virus.[9,10]

Objectives

Methods

Conclusion