Bacterial vaginosis in pregnancy and Its maternal and fetal outcome

Abstract

Bacterial vaginosis (BV) is one of the most common vaginal conditions, characterised by a decrease in lactobacilli and an increase in anaerobic bacteria. Data from antenatal clinics and in the literature was examined to determine the prevalence, maternal and foetal outcome and management of BV in pregnancy. About 28% of the women studied were found to have BV, concordant with global trends. It was associated with a 2.5 fold increased risk of preterm labour and increased prevalence of postpartum endometritis. Notable were foetal outcomes such as low birth weight (3-fold increased risk), neonatal sepsis. Amsel’s criteria, Nogent’s score and PCR based tests were evaluated as diagnostic methods. Amsel’s criteria are cost effective and applicable in the clinical setting; however Nugent’s scoring is more precise, and PCR based methods exhibited better sensitivity and specificity. They analysed therapeutic approaches, such as antibiotics (metronidazole and clindamycin), but these showed promise while being associated with recurrence and antimicrobial resistance. As an adjunct therapy, probiotics were identified as a promising candidate, with capacity to reduce recurrence rates and restore balance of the vaginal microbiota. The findings stress the importance of routine screening for BV in high risk pregnancies including poor resource settings. Suggested strategies included public health efforts to reduce rates of BV, such as educational programmes relating to risk factors such as smoking or douching. Future work should focus on neonatal outcomes over the longer term, optimising probiotic therapies and evaluating the cost effectiveness of universal screening initiatives to improve maternal and neonatal health outcomes worldwide.