title: Screening of vulvovaginal infections during pregnancy in resource constrained settings: Implications on preterm delivery.
abstract: The present study was undertaken to evaluate the efficacy of clinical and microbiological investigations available in limited resource settings for an effective diagnosis of vaginal infections/abnormal vaginal microbiota among pregnant women. As an outcome of the study we intended to find the association of various vaginal infections during pregnancy with preterm delivery. Pregnant women presenting for routine antenatal care at an antenatal clinic in south India were enrolled in the study. Each participant underwent clinical and microbiological examinations for the diagnosis of vaginal infections such as bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomoniasis. In addition, Gram's stained high-vaginal smears were evaluated for the presence of partial BV and vaginitis. Diagnostic accuracies of clinical diagnosis for the aforementioned infections was determined in comparison with gold standard microbiological diagnosis. Proportion of women with vulvovaginal infections were estimated using descriptive statistics and incidence risk ratio for preterm delivery with each form of the infection was estimated using univariate analysis. A total of 790 pregnant women were recruited in the study. Positive predictive values of clinical diagnosis for BV, VVC and Trichomoniasis in comparison with reference method were 72.7, 33.5 and 37.6% respectively. Partial BV (3.2%) and vaginitis due to mixed bacterial etiology (9.4%) were per exclusionem diagnosed using the microbiological smear examination. Microbiological diagnosis of BV and vaginitis were found to have a statistically significant association with preterm delivery. Effective diagnosis of vaginal infections/abnormal vaginal microbiota associated with preterm delivery can be achieved by the adjunct of microbiological smear examination of the vaginal smears to the clinical examination in limited resource settings.
authors.affiliation: Directorate of Research (Health Sciences), Manipal University, Manipal, Karnataka 576014, India.
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Tellapragada
authors.affiliation: Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India. Electronic address: vandanake@gmail.com.
authors.forename: Vandana K
authors.initials: VK
authors.lastname: Eshwara
authors.affiliation: Department of Obstetrics and Gynecology, Melaka Manipal Medical College, Manipal University, Manipal, Karnataka 576104, India.
authors.forename: Parvati
authors.initials: P
authors.lastname: Bhat
authors.affiliation: Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India.
authors.forename: Asha
authors.initials: A
authors.lastname: Kamath
authors.affiliation: Department of Obstetrics and Gynecology, Melaka Manipal Medical College, Manipal University, Manipal, Karnataka 576104, India.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Aletty
authors.affiliation: Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India.
authors.forename: Chiranjay
authors.initials: C
authors.lastname: Mukhopadhyay
mesh_terms: D000293:Adolescent; D000328:Adult; D002181:Candidiasis, Vulvovaginal / Q000150:complications / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008403:Mass Screening; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D014247:Trichomonas Vaginitis / Q000150:complications / Q000453:epidemiology*; D016585:Vaginosis, Bacterial / Q000150:complications / Q000453:epidemiology*; D055815:Young Adult
keywords: Abnormal vaginal microbiota; Bacterial vaginosis; Preterm delivery; Vaginitis; Vulvovaginal infections