Bacterial vaginosis during pregnancy. An association with prematurity and postpartum complications.

Although bacterial vaginosis (BV) is a common disorder associated with high concentrations of potentially pathogenic micro-organisms, BV has not yet been linked to infections outside the vagina. To investigate the association of BV with adverse outcomes during or following pregnancy, we analysed the prevalence of BV among women with and without premature labor, and early-onset postpartum endometritis. Bacterial vaginosis was identified by gas-liquid chromatographic criteria in 28 (49%) of 57 women giving birth at less than or equal to 37 weeks gestation or with birthweight less than 2500 g and in 27 (24%) of 114 women bearing an infant at term (p = 0.001). Organisms associated with BV, such as Gardnerella vaginalis, anaerobic bacteria, and/or genital mycoplasmas, were recovered from the endometrium of 61 of 101 women with clinical signs of endometritis. G. vaginalis was the most frequent isolate from both the endometrium (38 patients) and the blood (8 patients) of women with postpartum endometritis. Bacteroides bivius was the most frequent anaerobic isolate from the endometrium (11 cases) and blood (4 cases). Patients with both G. vaginalis and anaerobes isolated remained febrile significantly longer after beginning antibiotic therapy than did other patients (57.1 hours. vs. 36.3 hours, p = 0.02). These data suggest that BV may be associated with prematurity and that BV may contribute to postpartum maternal infectious morbidity.