Am J Perinatol 2000; Volume 17(Number 02): 083-088
DOI: 10.1055/s-2000-9275
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

BACTERIAL VAGINOSIS AND CERVICAL DILATION AND EFFACEMENT AT 24-29 WEEKS' GESTATION

Lisa M. Pastore1 , Katherine E. Hartmann1,2 , John M. Thorp Jr.1,2 , Rachel A. Royce1 , Tracy P. Jackson,2 , David A. Savitz1
  • 1Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill
  • 2Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina at Chapel Hill. Reprints not available
Further Information

Publication History

Publication Date:
31 December 2000 (online)

ABSTRACT

The purpose of this study was to investigate the association between bacterial vaginosis (BV) and cervical dilation and effacement, as measures of impending preterm delivery. The Pregnancy, Infection, and Nutrition Study collected genital tract specimens and documented cervical change from 807 eligible women between 24 and 29 weeks' gestation. BV was assessed with Nugent-scored vaginal smears, and analyzed in relation to cervical measurements. At 24-29 weeks' gestation, <7% of women had a dilated cervix, 31% had a cervix ≤2 cm, and 17.3% had BV. Unadjusted analyses found no associations between BV and cervical measurements. Adjusted logistic regression suggested an association between BV and cervical effacement among women with a sexually transmitted disease (STD) earlier in pregnancy (odds ratio = 1.9, 95% CI 0.8-4.3). Stratified analyses for BV/dilation also suggested interaction with STDs. Overall, BV was not association with cervical dilation or effacement at 24-29 weeks' gestation.

REFERENCES

  • 1 Hartmann K, Thorp J M, McDonald T L, Savitz D A, Granados J L. Cervical dimensions and risk of preterm birth: a prospective cohort study.  Obstet Gynecol . 1999;  93 504-509
  • 2 Iams J D, Goldenberg R L, Meis P J. The length of the cervix and risk of spontaneous preterm delivery. National Institutes of Child Health and Human Development Maternal-Fetal Medicine Units Network.  N Engl J Med . 1996;  334 567-572
  • 3 Chambers S, Pons J C, Richard A, Chiesa M, Bouyer J, Papiernik E. Vaginal infections, cervical ripening and preterm delivery.  Eur J Obstet Gynecol Repro Biol . 1990;  38 103-108
  • 4 Papiernik E, Charleman C, Goffinet F, Paul G, Keith L G. Vaginal bacterial colonization, the uterine cervix and preterm births.  Prenat Neonat Med . 1998;  3 98-102
  • 5 Savitz D A, Pastore L M. Causes of prematurity. In: McCormick MC, Siegel JE, eds. Prenatal Care: Effectiveness and Implementation New York: Cambridge University Press 1999: 63-104
  • 6 Hill G B. The microbiology of bacterial vaginosis.  Am J Obstet Gynecol . 1993;  169 450-454
  • 7 French J I, McGregor J A. Bacterial vaginosis: history, epidemiology, microbiology, sequelae, diagnosis, and treatment. In: Borchadt KA, Noble MA, eds. Sexually Transmitted Diseases: Epidemiology, Pathology, Diagnosis, and Treatment New York: CRC Press 1997: 3-39
  • 8 Meis P J, Goldenberg R L, Mercer B. The preterm prediction study: significance of vaginal infections.  Am J Obstet Gynecol . 1995;  173 1231-1235
  • 9 Hay P E, Lamont R F, Taylor-Robinson D, Morgan D J, Ison C, Pearson J. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage.  BMJ . 1994;  308 295-298
  • 10 Holst E, Goffeng A R, Andersch B. Bacterial vaginosis and vaginal microorganisms in idiopathic premature labor and association with pregnancy outcome.  J Clin Microbiol . 1994;  32 176-186
  • 11 Martius J, Krohn M A, Hillier S L, Stamm W E, Holmes K K, Eschenbach D A. Relationships of vaginal lactobacillus species, cervical chlamydia trachomatis, and bacterial vaginosis to preterm birth.  Obstet Gynecol . 1988;  71 89-95
  • 12 McGregor J A, French J I, Jones W, Milligan K, McKinney P J, Patterson E, Parker R. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream.  Am J Obstet Gynecol . 1994;  170 1048-1060
  • 13 Riduan J M, Hillier S L, Utomo B, Wiknjosastro G, Linnan M, Kandun N. Bacterial vaginosis and prematurity in Indonesia: association in early and late pregnancy.  Am J Obstet Gynecol . 1993;  169 175-178
  • 14 Hillier S L, Nugent R P, Eschenbach D A. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant.  N Engl J Med . 1995;  333 1737-1742
  • 15 Savitz D A, Dole N, Williams J. Determinants of participation in an epidemiological study of preterm delivery.  Paediatr Perinat Epidemiol . 1999;  13 114-125
  • 16 Pastore L M, Royce R A, Jackson T P, Thorp Jr M J, Savitz D A, Kreaden U S. Association between bacterial vaginosis and fetal fibronectin at 24-29 weeks' gestation.  Obstet Gynecol. . 1999;  93 117-123
  • 17 Royce R, Jackson T, Thorp Jr M J. Ethnicity/race, vaginal flora patterns, and pH during pregnancy.  Sex Transm Dis . 1999;  26 96-102
  • 18 Nugent R P, Krohn M A, Hillier S L. Reliability of diagnosing bacterial vaginosis is improved by standard method of gram stain interpretation.  J Clin Microbiol . 1991;  29 297-301
  • 19 Houlton M CC, Marivate M, Philpott R H. Factors associated with preterm labor and changes in the cervix before labor in twin pregnancy.  Br J Obstet Gynaecol . 1982;  89 190-194
  • 20 Breslow N E, Day N E. Statistical methods in cancer research, Vol. 1. The analysis of case-control studies IARC Scientific Pub. No. 82. Lyon: International Agency for Research on Cancer; 1980
  • 21 Hosmer D W, Lemeshow S. Applied Logistic Regression.  New York: John Wiley & Sons 1989: 82-91
  • 22 Mortensen O A, Franklin J, Lofstrand T, Svanberg B. Prediction of preterm birth.  Acta Obstet Gynecol Scand . 1987;  66 507-512
  • 23 Copper R L, Goldenberg R L, Davis R O. Warning symptoms, uterine contractions, and cervical examination findings in women at risk of preterm delivery.  Am J Obstet Gynecol . 1991;  162 748-754
  • 24 Floyd W S. Cervical dilatation in the mid-trimester of pregnancy.  Obstet Gynecol . 1961;  18 380-381
  • 25 Bouyer J, Papiernik E, Dreyfus J, Collin D, Winisdoerffer B, Gueguen S. Maturation signs of the cervix and prediction of preterm birth.  Obstet Gynecol . 1986;  68 209-214