Role of Bacterial Vaginosis in Peripartum Infections

摘要

Objective:The purpose of this prospective investigation was to determine if the presence of bacterialvaginosis (BV) at the time of delivery was associated with the development of maternal and neonatalinfection.Methods:Vaginal fluid was collected from 390 laboring patients. Smears of the vaginal secretionswere gram stained, and slides were scored and interpreted as normal, intermediate, and BV based onGram's stain criteria. Results of the Gram's stains were correlated with the clinical diagnoses ofchorioamnionitis, endometritis, and neonatal sepsis.Results:Eighty-eight percent of patients were term and 12% were preterm. The overall prevalence of BV was 30%. The frequency of BV was similar in both term and preterm women. BV wassignificantly more prevalent among nonwhites than whites (37% vs. 25%,P= 0.005). Maternalcharacteristics such as mean age, parity, status of the membranes, mean duration of labor, meanduration of ruptured membranes, mean length of fetal monitoring, mean number of vaginal examinations,and mode of delivery were similar in patients with BV, intermediate, and normal Gram'sstains. Forty-seven (12%) women developed peripartum infection. The frequencies of chorioamnionitisor endometritis in women with BV or intermediate Gram's stains were 19/116 (16.4%) and11/63 (17.5%), respectively. The frequency in each of the 2 groups was significantly increasedcompared with the rate in women with normal Gram's stains: 17/211 (8.1%), [P= 0.034, OR = 2.0(95% CI, 1.07–3.73) for BV andP= 0.054, OR = 2.1 (95% CI, 1.12–3.94) for intermediate Gram'sstain]. The incidence of suspected or confirmed neonatal infection was significantly higher in motherswith intermediate Gram's stains compared with mothers with normal Gram's stains (P= 0.02,OR = 2.18, 95% CI, 1.12–3.94), while no difference in incidence was observed between motherswith BV and normal Gram's stains (P> 0.05). The rate of neonatal infection directly correlatedwith maternal group B streptococcal colonization rather than with BV.Conclusions:In this population, patients with BV and intermediate Gram's stains had an increasedfrequency of peripartum infection.