BACTERIAL VAGINOSIS AND PREGNANCY OUTCOME AT ILORIN
Introduction: Bacterial vaginosis is a condition of vaginal flora imbalance in which the normally H2O2 producing lactobacilli are reduced or absent and are replaced by anaerobic bacteria. It has also been associated with poor pregnancy outcome. Complications associated with bacterial vaginosis in pregnancy include spontaneous miscarriage, premature rupture of membranes, preterm delivery, low birth weight babies, chorioamnionitis, increased acquisition of Human Immunodeficiency Virus infection and postpartum endometritis.
Aim: To determine the pregnancy outcome of pregnant women diagnosed with bacterial vaginosis.
Objectives: To determine the prevalence, clinical presentation, diagnosis and pregnancy outcome among pregnant women treated for bacterial vaginosis.
Research methods: This was a prospective cohort study of parturient within the gestational age of 20 to 26 weeks attending the antenatal clinic of University of Ilorin Teaching Hospital. A study proforma was administered after taking informed consent; thereafter, high vaginal swab samples were collected and analyzed for all participants. Diagnosis of bacterial vaginosis was made by Amsel criteria and Nugent score. Patients diagnosed with bacterial vaginosis were treated with Tablet Metronidazole 400mg thrice daily for a week. All participants were followed up and monitored till delivery to determine the pregnancy outcome and data analysis was done using SPSS version 20.0.
Results: The prevalence of bacterial vaginosis among participants was 24.1%; the mean age was 29.52±4.57 years and mean gestational age at recruitment was 23.09± 1.94 weeks. Vulvar itching was a statistically significant symptom in the clinical presentation of bacterial vaginosis (p=0.011) while vaginal discharge, offensive odour and low abdominal pains were not statistically significant. Vaginal douching was a statistically significant risk factor in the onset of bacterial vaginosis. Persistence of bacterial vaginosis following treatment was 25%. Pregnancy outcome showed higher occurrence of premature rupture of membranes (OR8.185, 95%CI 3.196-20.962; p=0.005), preterm delivery (OR24.517, 95%CI 6.985-86.049; p<0.001) and low birth weight (OR 6.460, 95% CI 2.893-14.429; p=0.005) among women with bacterial vaginosis compared to controls. However, neonatal outcome parameters were comparable in both groups. Sub analysis of those who had persistence of BV infection compared to those who had resolution post treatment showed worse outcome in those with persistence of BV infection.
Conclusion: BV in pregnancy is associated with worse pregnancy outcome compared to women without BV. Persistence of BV infection occurred in a quarter of treated participants. Pregnancy outcome is worse in those that have persistence of BV infection post treatment.
Recommendations: Pregnant women should be screened and treated for bacterial vaginosis in pregnancy. Post treatment screening is recommended to determine persistence or resolution of BV infection in pregnancy. Post treatment smear positive women should be further evaluated in future research to determine the effect of repeat treatment.