title: High vaginal concentrations of Atopobium vaginae and Gardnerella vaginalis in women undergoing preterm labor.
abstract: OBJECTIVE
  To estimate the relationship between vaginal quantification of the main microorganisms related with bacterial vaginosis and the risk of preterm delivery among women with preterm labor.
  
  
  METHODS
  Molecular methods were used to prospectively quantify Lactobacillus species, Gardnerella vaginalis, Atopobium vaginae, and Mycoplasma hominis in vaginal fluid samples from women admitted for spontaneous preterm labor with intact membranes from July 2007 through July 2008. The primary outcome measure was the relationship between bacterial concentration at admission and preterm delivery, before 37 weeks of gestation. Sensitivity and specificity of molecular cutoff values and 95% confidence intervals (CIs) were calculated using the University of British Columbia Bayesian Calculator type 2.
  
  
  RESULTS
  Of the 90 women included, 36 delivered before 37 weeks of gestation (40%). Preterm delivery was not associated with the presence of Lactobacillus species, G vaginalis, A vaginae, or M hominis. In contrast, molecular quantification detected high concentrations of A vaginae (10(6)/mL or more: 25.0% in the preterm group and 9.3% in the term group, P=.04) and G vaginalis (10(7)/mL or more: 16.7% and 3.7%, P=.03) more often in women with preterm deliveries compared with term deliveries. Moreover, high vaginal concentrations of these two microorganisms together were associated with a significantly (P=.03) shorter interval between preterm labor and delivery (46 days, 95% CI 30-61) than were lower concentrations (85 days, 95% CI 75-95). The hazard ratio for a short preterm labor-to-delivery interval was three times higher for high vaginal fluid concentrations of A vaginae and G vaginalis than for lower concentrations (hazard ratio 3.3, 95% CI 1.1-9.5, P=.03).
  
  
  CONCLUSIONS
  The risk of preterm delivery is significantly associated with high vaginal concentrations of A vaginae and G vaginalis in women with preterm labor.
  
  
  BACKGROUND
  ClinicalTrials.gov, www.clinicaltrials.gov, NCT00484653.
  
  
  METHODS
  III.
authors.affiliation: From the Department of Obstetrics and Gynecology, Marseille Public Hospital System (APHM); Unité des rickettsies, IFR 48, CNRS-IRD UMR 6236, Faculté de Médecine, Université de la Méditerranée; and Centre d'investigation clinique 9502, Marseille, France.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Menard
authors.forename: Chafika
authors.initials: C
authors.lastname: Mazouni
authors.forename: Inesse
authors.initials: I
authors.lastname: Salem-Cherif
authors.forename: Florence
authors.initials: F
authors.lastname: Fenollar
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Léon
authors.initials: L
authors.lastname: Boubli
authors.forename: Marc
authors.initials: M
authors.lastname: Gamerre
authors.forename: Florence
authors.initials: F
authors.lastname: Bretelle
mesh_terms: D039903:Actinobacteria / Q000302:isolation & purification*; D015169:Colony Count, Microbial; D005260:Female; D006194:Gardnerella vaginalis / Q000302:isolation & purification*; D006801:Humans; D007752:Obstetric Labor, Premature / Q000382:microbiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology*; D016016:Proportional Hazards Models; D012680:Sensitivity and Specificity; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000382:microbiology*