Role of Bacterial Vaginosis in Peripartum Infections

OBJECTIVE The purpose of this prospective investigation was to determine if the presence of bacterial vaginosis (BV) at the time of delivery was associated with the development of maternal and neonatal infection. METHODS Vaginal fluid was collected from 390 laboring patients. Smears of the vaginal secretions were gram stained, and slides were scored and interpreted as normal, intermediate, and BV based on Gram's stain criteria. Results of the Gram's stains were correlated with the clinical diagnoses of chorioamnionitis, endometritis, and neonatal sepsis. RESULTS Eighty-eight percent of patients were term and 12% were preterm. The overall prevalence of BV was 30%. The frequency of BV was similar in both term and preterm women. BV was significantly more prevalent among nonwhites than whites (37% vs. 25%, P = 0.005). Maternal characteristics such as mean age, parity, status of the membranes, mean duration of labor, mean duration of ruptured membranes, mean length of fetal monitoring, mean number of vaginal examinations, and mode of delivery were similar in patients with BV, intermediate, and normal Gram's stains. Forty-seven (12%) women developed peripartum infection. The frequencies of chorioamnionitis or endometritis in women with BV or intermediate Gram's stains were 19/116 (16.4%) and 11/63 (17.5%), respectively. The frequency in each of the 2 groups was significantly increased compared with the rate in women with normal Gram's stains: 17/211 (8.1%), [P = 0.034, OR = 2.0 (95% CI, 1.07-3.73) for BV and P = 0.054, OR = 2.1 (95% CI, 1.12-3.94) for intermediate Gram's stain]. The incidence of suspected or confirmed neonatal infection was significantly higher in mothers with intermediate Gram's stains compared with mothers with normal Gram's stains (P = 0.02, OR = 2.18, 95% CI, 1.12-3.94), while no difference in incidence was observed between mothers with BV and normal Gram's stains (P > 0.05). The rate of neonatal infection directly correlated with maternal group B streptococcal colonization rather than with BV. CONCLUSIONS In this population, patients with BV and intermediate Gram's stains had an increased frequency of peripartum infection.