Jean Pierre Menard, MD, Chafika Mazouni, MD, Inesse Salem-Cherif, Florence Fenollar, MD, PhD, ´ Didier Raoult, MD, PhD, Leon Boubli, MD, Marc Gamerre, MD, and Florence Bretelle, MD, PhD
OBJECTIVE: To estimate the relationship between vaginal quantification of the main microorganismsrelated with bacterial vaginosis and the risk of preterm delivery among women with preterm labor. METHODS: Molecular methods were used to prospectively quantify Lactobacillus species, Gardnerella vaginalis, Atopobium vaginae, and Mycoplasma hominis in vaginal fluid samples from women admitted for spontaneous preterm labor with intact membranes from July 2007 through July 2008. The primary outcomemeasure was the relationship between bacterial concentration at admission and preterm delivery, before 37 weeks of gestation. Sensitivity and specificity of molecular cutoff values and 95% confidence intervals (CIs) were calculated using the University of British Columbia Bayesian Calculator type 2. RESULTS: Of the 90 women included, 36 delivered before 37 weeks of gestation (40%). Preterm deliverywas not associated with the presence of Lactobacillus species, G vaginalis, A vaginae, or M hominis. In contrast, molecular quantification detected high concentrations of A
From the Department of Obstetrics and Gynecology, Marseille Public Hospital System (APHM); Unite des rickettsies, IFR 48, CNRS-IRD UMR 6236, ´ Faculte de Medecine, Universite de la Mediterranee; and Centre d’investigation ´ ´ ´´ ´ clinique 9502, Marseille, France. Supported by the Programme Hospitalier National de Recherche Clinique 2006, CPP: 07.019. The authors thank Jo Ann Cahn for editing the manuscript, the Credits Ministeriels Programme Hospitalier National de Recherche Clinique 2006 for ´ financial support, Dr. Mireille Henry for her expertise in molecular biology, Stephanie Junoy for her technical assistance, andJean-Francois Cocallemen for ´ ¸ data management. Corresponding author: Jean-Pierre Menard, MD, Department of Obstetrics and Gynecology, Marseille Public Hospital System, 13915 Marseille Cedex 20, France; e-mail: email@example.com. Financial Disclosure The authors did not report any potential conflicts of interest. © 2009 by The American College of Obstetricians and Gynecologists.Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/09
vaginae (106/mL or more: 25.0% in the preterm group and 9.3% in the term group, P .04) and G vaginalis (107/mL or more: 16.7% and 3.7%, P .03) more often in women with preterm deliveries compared with term deliveries. Moreover, high vaginal concentrations of these two microorganisms together were associated with a significantly (P.03) shorter interval between preterm labor and delivery (46 days, 95% CI 30 – 61) than were lower concentrations (85 days, 95% CI 75–95). The hazard ratio for a short preterm labor-to-delivery interval was three times higher for high vaginal fluid concentrations of A vaginae and G vaginalis than for lower concentrations (hazard ratio 3.3, 95% CI 1.1–9.5, P .03). CONCLUSION: The risk of pretermdelivery is significantly associated with high vaginal concentrations of A vaginae and G vaginalis in women with preterm labor. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00484653.
(Obstet Gynecol 2010;115:134–40)
LEVEL OF EVIDENCE: III
reterm delivery, defined as a birth before 37 weeks of gestation, occurs in 5–13% of all pregnancies.1 It is the leading causeof neonatal mortality and severe morbidity, and its economic and human costs are great.2 Bacterial vaginosis is a bacterial imbalance of vaginal flora, initially defined according to the clinical criteria of Spiegel et al.3 Its prevalence during pregnancy ranges from 6% to 55%,4,5 and it is associated with a doubled risk of preterm delivery.6,7 The earlier bacterial vaginosis is diagnosed, the...