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Bacterial Vaginosis in

Pregnancy: Current Findings

and Future Directions

Pembimbing : dr. Eko Krisnarto, Sp.KK

Penyusun : Hernita Ferliyani ( 030.07.107 )

JOURNAL READING

Epidemiologic

Reviews, 2002, Vol. 24



INRODUCTION

Bacterial vaginosis (BV) is thenumber one cause of vaginitis

among both pregnant andnonpregnant women.

Prevalence of BV among nonpregnant women to range from

15% to 30 %,

Up to 50% of pregnant women

have been found to have BV.

Related to manygynecologic conditionsand complications ofpregnancy includingpelvic inflammatory

disease, endometritis,preterm delivery,

preterm labor, andspontaneous abortion.



BACKGROUNDBV is a polymicrobial, superficial vaginal infection involving a reduction in theamount of hydrogen-peroxide producing Lactobacillus and an overgrowth

of anaerobic and Gram-negative or Gram-variable bacteria.

Reduced number of Lactobacillus anaerobic bacteria,including Mycoplasma hominis, Gardnerella vaginalis,etc

The most important predictor in subsequent BVdevelopment

No studies pregnant women to describe the changes in vaginal flora or BV prevalence during gestation

The presence of BV at a particular gestational age may be a factor inthe subsequent development of pregnancy complications,



DIAGNOSIS



TREATMENT

Metronidazole, given a 7-day,

twice-daily course of 500 mg of

metronidazole ranges from 84% to

96%

Clindamycin reported that a 300-

mg, twice-daily course of

clindamycin for 7 days resulted in a

94% cure rate

Metronidazole during the first trimester ofpregnancy before the completion of

organogenesis no evidence of long-term teratogenic effects.

All of the efficacy studies havebeen conducted amongnonpregnant women, with the

assumption that the cure rate for BV among pregnant woman is

similar.

Oral



TOPIKAL

Metronidazole0.75% vaginal

gel

Clindamycin 2% vaginal

cream

A twice-daily, 5-daytherapy of vaginal

metronidazole had a

reported cure rate of 75 –

81%

Clindamycin cream wasreported to resolve 82 – 96 %

of cases of BV

These topical treatments result in the resolution of lower genital tract

infection but do not treat BV occurring in the upper genital tract



EPIDEMIOLOGY : RISK FACTORS

Race

Sexualactivitty

Socio

Economic/Stress

Vaginaldouching

Education



Reported prevalence of BVamong pregnant women

ranges from 10 to 35 %, withhigher rates occurring amongAfrican-American women, low-

income women, or womenwith prior sexually transmitted

diseases

The Vaginal Infections andPrematurity Study, which

measured BV among pregnant

women between 23 and 26weeks of gestation, found a

2.0- to 2.5-fold increased risk ofBV among African-American

compared with White pregnantwomen.

Numerous studies have confirmed at

least a twofold increased risk of BV

among African-American womenpresumably due to

environmental/behavioral exposures or

stressors

RISKFACTORS



In recent studies among obstetricspopulations, the reported

prevalence of BV ranged from alow of 10 percent among privatepatient to a high of 35 percentamong women reporting low

monthly incomes and loweducational levels.

Epidemiologic studies have found thatearly sexual activity, a high number of

lifetime sexual partners, women with anew sexual partner, and women with aprior sexually transmitted disease are also

at increased risk of BV.

Some behaviors, such as vaginaldouching, have been examined as

potential risk factors for BV.

Vaginal douching may change thevaginal flora, reduce the amount of

Lactobacillus, and create anenvironment promoting excessive

anaerobic growth

RISKFACTORS



EPIDEMIOLOGY : ADVERSE PREGNANCY

OUTCOMES

Bacterial Vaginosis Related to :

An increased potential for other vaginal

pathogens to gain access to the upper genital tract

The presence of enzymes that reducethe ability of leukocytes to reduce

infection

An increased level of endotoxinsstimulating cytokine and prostaglandin

production



EPIDEMIOLOGY : ADVERSE PREGNANCY OUTCOMES

Many studies twofold increased risk of preterm delivery among womendiagnosed with BV in the early second trimester

A recent meta-analysis reviewing studies examining the role of BV and the risk of pretermdelivery reported a summary odds ratio of 1.6, indicating a 60 percent increased risk of

preterm delivery among pregnant women with BV

One study examining several pregnancy outcomes related to BV diagnosed during thefirst trimester of 2.6 fold increased risk of preterm labor, a 6.9-fold increased risk ofpreterm delivery, and a 7.3 fold increased risk of preterm, premature rupture of the

membranes

Studies have reported a three to fivefold increased risk of spontaneous abortion among pregnantwomen with BV in the first trimester

Another study found that BV diagnosed in the second trimester was associated with an increasedrisk of preterm delivery and premature rupture of the membranes and that BV that BV accounted

for 83 percent of the attributable risk for preterm birth

a recent clinical trial did not find a reduction in the occurrence of preterm delivery among either high-risk or low-risk asymptomatic pregnant women following treatment with oral metronidazole



CONCLUSIONBV is an enormous public health problem,

accounting for the majority of cases of vaginitis andvaginal discharge in the United States. Current studiesrelating BV to adverse pregnancy outcomes have

measured and categorized BV positivity from samples ofthe lower genital tract.

These lower genital tract measurements of BV havebeen moderately related to the risk of adverse events,with the corresponding assumption being the eventualascension of these organisms to the upper genital tract.

Currently, BV is related to many gynecologic conditionsand complications of pregnancy including pelvicinflammatory disease, endometritis, preterm delivery,preterm labor, and spontaneous abortion.

journal bv

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