Poojari Vidyashree Ganesh, Dawson Samantha, Vasudeva Akhila, Hegde Nivedita, Kaipa Geetha, Eshwara Vandana, Tellapragada Chaitanya, Kumar Pratap
1Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India.
2Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India.
J Obstet Gynaecol India. 2020 Feb;70(1):36-43. doi: 10.1007/s13224-019-01287-3. Epub 2019 Oct 15.
Predicting spontaneous preterm birth (SPTB) during mid-trimester would be very useful. We used a multimodality screening approach mainly focusing on urogenital infections among unselected obstetric population between 18 and 24 weeks in a tertiary center.
Diagnosis of lower genital tract infection (LGTI) was attempted among 228 pregnant women using several factors-symptom of vaginal discharge, characteristic appearance of discharge on speculum, point of care tests using Amsel's criteria and gram staining of vaginal swab. Nugent's scoring was taken as gold standard. Urine microscopy/culture was obtained. Serum inflammatory markers were done. Total leukocyte count, neutrophil/lymphocyte ratio and C-reactive protein were obtained. Data on cervical length were obtained from mid-trimester scan.
Thirty patients complained of vaginal discharge. Speculum examination revealed discharge in 221 (96.92%), appearing pathological in 192 (86.87%). Amsel's criteria showed poor sensitivity to detect full (57%) and partial (24%) bacterial vaginosis (BV). On gram staining, 104 (45.61%) showed evidence of LGTI; 14 full BV (6.1%); 45 partial BV (19.5%); 40 candidiasis (17.5%); and two each of trichomoniasis and aerobic vaginitis. Appearance of vaginal discharge and microscopic diagnosis of LGTI were poorly correlated. Forty women (17.5%) had SPTB, 24 following membrane rupture and 16 following spontaneous labor. The presence of BV (specifically partial) increased the likelihood of SPTB with OR of 3.347 (CI 1.642, 6.823). Three of seven women with short cervix delivered preterm. No other screening modality was associated with SPTB.
Active screening for LGTI between 18 and 24 weeks shows high prevalence of BV in Indian setting. There is a strong link between partial BV and SPTB.
在孕中期预测自发性早产（SPTB）非常有用。我们采用了一种多模式筛查方法，主要关注一家三级中心18至24周未经过筛选的产科人群中的泌尿生殖系统感染。
在228名孕妇中，通过多种因素尝试诊断下生殖道感染（LGTI），这些因素包括白带症状、窥器检查时白带的特征性外观、使用阿姆斯勒标准的即时检验以及阴道拭子的革兰氏染色。纽金特评分被视为金标准。进行尿液显微镜检查/培养。检测血清炎症标志物。获取白细胞总数、中性粒细胞/淋巴细胞比率和C反应蛋白。通过孕中期扫描获取宫颈长度数据。
30名患者主诉有白带。窥器检查显示221名（96.92%）有白带，其中192名（86.87%）外观呈病理性。阿姆斯勒标准对检测完全（57%）和部分（24%）细菌性阴道病（BV）的敏感性较差。革兰氏染色显示，104名（45.61%）有LGTI证据；14名完全BV（6.1%）；45名部分BV（19.5%）；40名念珠菌病（17.5%）；滴虫病和需氧性阴道炎各2名。白带外观与LGTI的显微镜诊断相关性较差。40名女性（17.5%）发生SPTB，24名在胎膜破裂后，16名在自然发动分娩后。BV（特别是部分BV）的存在增加了SPTB的可能性，比值比为3.347（可信区间1.642，6.823）。7名宫颈短的女性中有3名早产。没有其他筛查方式与SPTB相关。
在印度环境中，对18至24周的LGTI进行主动筛查显示BV的患病率很高。部分BV与SPTB之间存在密切联系。
