Obstetrics
Relationship of bacterial vaginosis and mycoplasmas to the risk of spontaneous abortion

https://doi.org/10.1067/mob.2000.105738Get rights and content

Abstract

Objective: This study was undertaken to investigate a possible link between first-trimester diagnosis of bacterial vaginosis and cessation of pregnancy at ≤20 weeks' gestation. Study Design: Women (n = 228) who received routine prenatal care in Flanders, Belgium, during the first trimester (14 weeks' gestation) and had a living singleton fetus were examined for microbiologic flora of the vagina. Bacterial vaginosis was assessed either clinically (Amsel et al criteria), microscopically (clue cells), or by culture of bacterial vaginosis–associated bacteria. Data were analyzed univariately (relative risk) and multivariately. Results: The presence of bacterial vaginosis at the first prenatal visit was strongly associated with subsequent early pregnancy loss (relative risk, 5.4; 95% confidence interval, 2.5-11). After multivariate analysis bacterial vaginosis, Mycoplasma hominis, and Ureaplasma urealyticum but not other microorganisms remained associated with an increased risk of miscarriage. Conclusion: Bacterial vaginosis and mycoplasmas may play causative roles in spontaneous abortion and early pregnancy loss. (Am J Obstet Gynecol 2000;183:431-7.)

Section snippets

Subjects and specimen sampling

From March 1989 to March 1994 a total of 228 unselected women who were seen for routine pregnancy checkup at <14 completed gestational weeks and had a living singleton fetus agreed to undergo a standardized vaginal speculum examination. All were new patients being seen on the same day of the week, and all were <14 weeks' pregnant. The specification of the day of the week allowed examination by Gilbert G.G. Donders, MD, who is experienced in infectious diseases and vaginal fluid microscopy.

Results

Of the 218 consecutive women with a viable first-trimester fetus and complete culture results at the first prenatal visit, 21 (10%) had spontaneous abortions. Women in this group came in for the first prenatal visit at a mean (± SD) of 7.5 ± 1.9 weeks' gestation, compared with 9.3 ± 2.5 weeks' gestation for the women with evolving pregnancies (P =.001). Miscarriage occurred at a mean of 11.3 ± 2.9 gestational weeks (range, 5-13 gestational weeks), which was a mean of 25.7 ± 29.6 days (range,

Comment

The cause of spontaneous miscarriage is ill understood. Classically, women who have a miscarriage are told that natural selection has taken place and that complex polygenetic or immunologic influences may have played a role. Data on the possible role of cervicovaginal infection in the causation of early pregnancy loss are scarce. C trachomatis may lead to abortion through excessive maternal immunogenic reaction to its heat shock protein 60 antigen,13 and some authors have found an association

Acknowledgements

We thank Mrs Alison Odds for the critical review of the manuscript.

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    Reprint requests: Gilbert G.G. Donders, MD, University Hospital Gasthuisberg, Herestraat 49, Leuven 3000, Belgium.

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