Verstraelen Hans, Verhelst Rita, Roelens Kristien, Claeys Geert, Weyers Steven, De Backer Ellen, Vaneechoutte Mario, Temmerman Marleen
Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Am J Obstet Gynecol. 2007 Jun;196(6):528.e1-6. doi: 10.1016/j.ajog.2006.12.026.
The purpose of this study was to identify women at risk of spontaneous preterm birth through a 4-category Gram-stained vaginal smear method, not restricted to bacterial vaginosis.
This was a prospective cohort study correlating Gram-stained vaginal smears in early pregnancy with spontaneous preterm birth. Smears were categorized as 'normal,' 'bacterial vaginosis-like,' 'grade I-like' (atypical gram-positive rods) or 'purulent grade I' (lactobacilli-dominated smears showing heavy leukorrhea of unknown cause).
Normal microflora were associated with a 4-fold decreased risk (95%CI 0.1-0.6, P < .001) of spontaneous preterm birth and an abnormal Gram stain with an overall adjusted odds ratio of 5.2 (95%CI 1.8-14.5, P < .001). The sensitivity of vaginal smear diagnosis for preterm birth increased from 25% with conventional scoring up to 70% with these modified criteria.
Accounting for atypical gram-positive bacteria and neutrophils on Gram-stained vaginal smears may identify a larger proportion of women at risk of preterm birth compared to diagnosis of bacterial vaginosis alone.
本研究旨在通过一种四类革兰氏染色阴道涂片法识别有自发早产风险的女性，该方法不限于细菌性阴道病。
这是一项前瞻性队列研究，将妊娠早期的革兰氏染色阴道涂片与自发早产相关联。涂片被分类为“正常”、“细菌性阴道病样”、“I级样”（非典型革兰氏阳性杆菌）或“脓性I级”（以乳酸杆菌为主的涂片显示原因不明的大量白带）。
正常微生物群与自发早产风险降低4倍相关（95%可信区间0.1 - 0.6，P <.001），革兰氏染色异常与总体调整后的优势比为5.2（95%可信区间1.8 - 14.5，P <.001）。阴道涂片诊断早产的敏感性从传统评分的25%提高到这些改良标准下的70%。
与仅诊断细菌性阴道病相比，考虑革兰氏染色阴道涂片上的非典型革兰氏阳性细菌和中性粒细胞可能会识别出更大比例的有早产风险的女性。
