Authors :
Dr. Harshini Thirumaran; Dr. Gauri Bapat; Dr. Swati Shiradkar
Volume/Issue :
Volume 10 - 2025, Issue 2 - February
Google Scholar :
https://tinyurl.com/ykzx28at
Scribd :
https://tinyurl.com/4e3ktj2h
DOI :
https://doi.org/10.5281/zenodo.14930546
Abstract :
Objective:
To study the prevalence of bacterial vaginosis in second trimester pregnancy and its effect on pregnancy outcome
Methods:
A study was conducted over a period of 2 years from October, 2018 to October, 2020 wherein 240 patients in their
second trimester cases were examined. In addition, data of deliveries collected during the past few years has been
compared vis-a-vis 240 cases and analyzed.
Results:
The prevalence of bacterial vaginosis was 36% in our study. There was no significant association of demographic
factors like literacy, age and parity. Anemia was assessed as a high risk factor for bacterial vaginosis, but no significant
association could be derived. The number of patients presenting with symptomatic bacterial vaginosis was more than the
asymptomatic positive patients. The most common presenting complaint was of vaginal discharge and on examination,
homogenous mucoid discharge was found in majority of the patients. Presence of homogenous mucoid discharge, alkaline
pH and presence of clue cells was the most common diagnostic triad fulfilled by patients with bacterial vaginosis.
Recurrence was seen in 2 patients inspite of completing the entire course of treatment. PROM and preterm vaginal
delivery were the common complications noted. Bacterial vaginosis did not have a significant effect on the neonatal
outcome.
Conclusion:
Bacterial vaginosis, the polymicrobial inflammation of the vagina, has a high prevalence rate of upto 36%. All
pregnant women in their second trimester coming for antenatal checkup should undergo per speculum examination and
the three most common parameters of the Amsel’s criteria, that is, homogenous mucoid discharge, raised vaginal pH and
presence of clue cells in vaginal smear can be used to diagnose bacterial vaginosis. Pregnant women in their second
trimester presenting without any symptoms should also undergo per speculum examination for the diagnosis of
asymptomatic bacterial vaginosis and its treatment. The presence of bacterial vaginosis in the second trimester of
pregnancy does not affect the maternal and neonatal outcome significantly because after its diagnosis and treatment, the
recurrence rate was very low but detection of bacterial vaginosis before the onset of labour for its effect on maternal and
neonatal outcome needs further research. Anemia is not a risk factor for bacterial vaginosis, but further studies are
required for identification of other potential high risk factors.
Keywords :
Bacterial vaginosis, Anemia, Amsel Criteria, Nugent Criteria, Mucoid, pH, Clue Cells, PROM, PPROM, Preterm Vaginal Delivery.
References :
- Mark H Yudin - Bacterial vaginosis in pregnancy: Diagnosis, screening, and management – Published in “Clinics in Perinatology”, September 2005, Volume 32, Issue 3, Pages617-627
- Mark H Yudin, Deborah M Money – Screening and management of bacterial vaginosis in pregnancy; SOGC clinical practice guideline, No.211, August2008,
- Hay PE, Lamont RF, Taylor‐Robinson D, Morgan DJ, Ison C, Pearson J - Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage; Published in |BMJ, Volume 308, 29thJanuary 1994, Pages295-298
- Hillier SL, Nugent RP, Eschenbach DA, Krohn M, Gibbs RS, Martin DH, et al. - Association between bacterial vaginosis and preterm delivery of alow‐birth‐weight infant – The New England Journal of Medicine, December 28,1995
- JA Svare, H Schmidt, BB Hansen, G Lose – Bacterial vaginosis in a cohort of Danish pregnant women:Prevalence and relationship with preterm delivery, low birth weight and prenatal infections; Published in BJOG, An international journal ofObstetrics and Gynaecology, 10 November,2006
- Jia Xu, Claudia B. Holzman, Cindy G. Arvidson, Hwan Chung - Mid-pregnancy vaginal fluid defensins, bacterial vaginosis, and risk of preterm delivery –Published in ObstetGynaecol, 2008September
- Javed Ali, S I Borah, D. Barkataki, NungdilaImsong - Association of bacterial vaginosis with preterm labour – Published in The New Indian Journal of OBGYN, 11thSeptember, 2015, Pages93-97.
- Riduan JM, Hillier SL, 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 Jul;169(1):175-8. doi: 10.1016/0002-9378(93)90157-e. PMID: 8333449
- Gaikwad V., Patvekar M., Gupta S., Chaudhari S., Gandham N., and Jadhav S.V. – A study of the roles of bacterial vaginosis in preterm labour from Tertiary Care Hospital in India; Published in “International Journal of Medical and Clinical Research”, Page 221-224, Issue 7,2012
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- R. Elgantri, A. Mohamed, and F. Ibrahim - Diagnosis of Bacterial Vaginosis by Amsel Criteria and Gram Stain Method. Sebha MedicalJournal, vol. 9, no. 1, pp. 20–27, 2010
- S. Mullick, D. Watson-Jones, M. Beksinska, and D. Mabey, “Sexually transmitted infections in pregnancy: Prevalence, impact on pregnancy outcomes, and approach to treatment in developing countries,” Sexually Transmitted Infections, vol. 81, no. 4, pp. 294–302, 2005
- Ranjit, E., Raghubanshi, B. R., Maskey, S., and Parajuli, P. (2018). Prevalence of bacterial vaginosis and its association with risk factors among nonpregnant women: a hospital based study. Int. J. Microbiol. 2018:8349601
- Ambike, Abhijit S. et al. - Prevalence of asymptomatic and symptomatic bacterial vaginosis in pregnant women attending antenatal clinic in a tertiary care rural hospital. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, [S.l.], v. 9, n. 9, p. 3672-3676, aug. 2020. ISSN 2320-1789
- Gjerdingen D, Fontaine P, et al. "The Impact of Regular Vaginal pH Screening on the Diagnosis of Bacterial Vaginosis in Pregnancy." Journal of Family Practice, vol. 49, no. 1, Jan. 2000, p. 39.
- Krauss-Silva, L., Almada-Horta, A., Alves, M.B. et al. Basic vaginal pH, bacterial vaginosis and aerobic vaginitis: prevalence in early pregnancy and risk of spontaneous preterm delivery, a prospective study in a low socioeconomic and multiethnic South American population. BMC Pregnancy Childbirth 14, 107 (2014)
- Modak T, Arora P, Agnes C, Ray R, Goswami S, Ghosh P, Das NK (2010) - Diagnosis of bacterial vaginosis in cases of abnormal vaginal discharge: comparison of clinical and microbiological criteria. J Infect Dev Ctries 5:353-360
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Objective:
To study the prevalence of bacterial vaginosis in second trimester pregnancy and its effect on pregnancy outcome
Methods:
A study was conducted over a period of 2 years from October, 2018 to October, 2020 wherein 240 patients in their
second trimester cases were examined. In addition, data of deliveries collected during the past few years has been
compared vis-a-vis 240 cases and analyzed.
Results:
The prevalence of bacterial vaginosis was 36% in our study. There was no significant association of demographic
factors like literacy, age and parity. Anemia was assessed as a high risk factor for bacterial vaginosis, but no significant
association could be derived. The number of patients presenting with symptomatic bacterial vaginosis was more than the
asymptomatic positive patients. The most common presenting complaint was of vaginal discharge and on examination,
homogenous mucoid discharge was found in majority of the patients. Presence of homogenous mucoid discharge, alkaline
pH and presence of clue cells was the most common diagnostic triad fulfilled by patients with bacterial vaginosis.
Recurrence was seen in 2 patients inspite of completing the entire course of treatment. PROM and preterm vaginal
delivery were the common complications noted. Bacterial vaginosis did not have a significant effect on the neonatal
outcome.
Conclusion:
Bacterial vaginosis, the polymicrobial inflammation of the vagina, has a high prevalence rate of upto 36%. All
pregnant women in their second trimester coming for antenatal checkup should undergo per speculum examination and
the three most common parameters of the Amsel’s criteria, that is, homogenous mucoid discharge, raised vaginal pH and
presence of clue cells in vaginal smear can be used to diagnose bacterial vaginosis. Pregnant women in their second
trimester presenting without any symptoms should also undergo per speculum examination for the diagnosis of
asymptomatic bacterial vaginosis and its treatment. The presence of bacterial vaginosis in the second trimester of
pregnancy does not affect the maternal and neonatal outcome significantly because after its diagnosis and treatment, the
recurrence rate was very low but detection of bacterial vaginosis before the onset of labour for its effect on maternal and
neonatal outcome needs further research. Anemia is not a risk factor for bacterial vaginosis, but further studies are
required for identification of other potential high risk factors.
Keywords :
Bacterial vaginosis, Anemia, Amsel Criteria, Nugent Criteria, Mucoid, pH, Clue Cells, PROM, PPROM, Preterm Vaginal Delivery.