Vaginal lactobacilli and preterm birth.
OBJECTIVE
To assess the relationship between the absence of vaginal lactobacilli and preterm birth at < 33 weeks of gestation.


METHODS
A prospective study of the vaginal flora in the second trimester was undertaken in 1958 women with singleton pregnancies. The contribution of various microorganisms to preterm delivery was analyzed using a multivariate-logistic regression model.


RESULTS
Lactobacillus species were not cultured from 28% of 118 women who delivered at < 33 weeks, 10% of 224 women who delivered between 33 and 36 weeks, and 5% of 1616 women who delivered at > 37 weeks of gestation. Lactobacilli (odds ratio and 95% confidence interval: 0.15 [0.09 to 0.24]), Mycoplasma hominis (2.3 [1.0 to 5.4]), and glucose non-fermentative gram-negative rods (2.1 [1.0 to 4.2]) were identified as independent risk factors for preterm delivery at < 33 weeks of gestation. Absence of lactobacilli (sensitivity and positive predictive value: 28% and 25%) was a better predictor of preterm delivery at < 33 weeks of gestation than the presence of Mycoplasma hominis (7% and 13%, respectively) or glucose non-fermentative rods (9% and 11%).


CONCLUSIONS
Although this was not a cohort study, results suggest that tests for determining the presence of vaginal lactobacilli may be clinically useful tools for identifying women at an increased risk of preterm delivery at < 33 weeks of gestation.
Usui
Rie
R
Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi.
Ohkuchi
Akihide
A
Matsubara
Shigeki
S
Izumi
Akio
A
Watanabe
Takashi
T
Suzuki
Mitsuaki
M
Minakami
Hisanori
H
D000328:Adult; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D005865:Gestational Age; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007778:Lactobacillus / Q000302:isolation & purification*; D009174:Mycoplasma / Q000302:isolation & purification; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014621:Vagina / Q000382:microbiology*