Literature Review On Bacterial Vaginosis And Preterm Labour

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Introduction

Preterm labor is a serious issue of perinatal morbidity and mortality. Bacterial vaginosis (BV) is assumed to be the most common cause of preterm labor and low- birth weight delivery. BV is the most prevalent vaginal infection that occurs during the gestational age. The previous studies have identified a strong relation between BV and preterm labor. This literature review tries to establish the association of BV with preterm membrane rupture, the onset of preterm labor and low-weight fetus on the basis of available literary databases and chart audits. This review also focuses on the reliable evidences that support the administration of antibiotics for BV to avoid preterm labor and other complications.

Literature Review

According to Donders et al., Abnormal vaginal flora (AVF) prior to 14th week pregnancy is harmful to the fetus and can become a reason of preterm birth (PTB). To investigate the impacts of AVF and BV on the first trimester and produce an antibiotic based treatment option. For this research, they conducted a randomized placebo-controlled study on 1026 subjects. The study found 75% lesser risk normal vaginal flora, but women with BV were at 95% higher risk of Preterm labor and birth. The presence of BV is more severe between the 25 to 35 gestational weeks. In this research, the metronidazole has been successfully administered to BV positive women and effect in controlling preterm birth. This study presents useful data for the proposed research (Donders et al., 2009).
Donati and co-researchers suggest that healthy bacteria of vagina maintains the healthy vaginal environment, but an abnormality in this flora yields poor perinatal results such as preterm labor and delivery of the premature low-weight fetus. Based on the previous literature this article presents a descriptive analysis of BV, AV (Aerobic vaginitis), and healthy bacteria and associated risks of abnormality in vaginal microbes. It will be a very beneficial article that provides very significant knowledge for the link between BV and Preterm labor (Donati et al., 2010).
BV results in symptomatic vaginal discharge in 40-50% cases. Martinez et al., in his research proposed that probiotic containing Lactobacillus rhamnosus and reuteri will provide additional strength to the antimicrobial therapies in treating BV. In a randomized control study, 64 Brazilian women were administered the single dose of tinidazole with probiotic capsules. In this 28 day long study the group receiving probiotic exhibited higher cure rates (87.5%). According to the Gram-stain Nugent score, this group showed the presence of normal vaginal microbes, (75% vs. 34.4%). This study is of high importance and can be helpful in further research on BV and preterm labor connection (Martinez et al., 2009).
According to Morency and Bujold, more than 50% vaginal infections are caused by Mycoplasma. Based on a meta-analysis they conducted a systematic review on 61 articles, 1807 subjects with the vaginal infection. They concluded that Macrolides and clindamycin when administered during the second trimester they expressed sufficient impact and lower risk of preterm labor. This paper offers a comparative analysis of antibiotics provided to patients for treating BV in pregnancy. This article provides authentic and strong evidences about the antibiotic treatment strategies to combat the risk of preterm (Morency & Bujold, 2007)
An article by Sharp and Alfirevic, (2014), addresses prenatal and postpartum set of clinical intrusions and associated risk factors. It is a practice-based study that focused on the improving quality care among ten medicine training sites, United States. This study design involves a retrospective chart audit of 3936 pregnancies during the period from January 2003 to September 2007. In this study, the five standard interventions were evaluated, and chart analyses were conducted to compare the pre and post implementation effects. Results for vaginal infections and asymptomatic bacteriuria showed positive impact concluding that consistent quality improvement results in successful outcomes (Sharp & Alfirevic, 2014).

Conclusion

All these peer reviewed articles prove a strong association between BV and pregnancy complications. This review concludes that proper antibiotic treatment on right time and appropriate quality care can reduce the risk of preterm labor.

Refrerences

Donders, G. G., Van Calsteren, K., Bellen, G., Reybrouck, R., Van den Bosch, T., Riphagen, I.,
& Van Lierde, S. (2009). Predictive value for preterm birth of abnormal vaginal flora,
bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG:

An International Journal of Obstetrics & Gynaecology, 116(10), 1315-1324.

Donati, L., Di Vico, A., Nucci, M., Quagliozzi, L., Spagnuolo, T., Labianca, A., & Paradisi,
G. (2010). Vaginal microbial flora and outcome of pregnancy.Archives of gynecology and
obstetrics, 281(4), 589-600.
Martinez, R. C., Franceschini, S. A., Patta, M. C., Quintana, S. M., Gomes, B. C., De Martinis,
E. C., & Reid, G. (2009). Improved cure of bacterial vaginosis with single dose of
tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a ran
domized, double-blind, placebo-controlled trial. Canadian journal of microbiolo
gy, 55(2), 133-138.
Morency, A., & Bujold, E. (2007). The effect of second-trimester antibiotic therapy on the rate
of preterm birth. JOGC-TORONTO-, 29(1), 35.
Sharp, A. N., & Alfirevic, Z. (2014). Provision and practice of specialist preterm labour clinics: a

UK survey of practice. BJOG: An International Journal of Obstetrics & Gynaecology,

121(4), 417-421.