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Microbial and Clinical Correlations in Evaluation of Preterm Birth

Microorganisms and the reactions they mediate are increasingly associated with some instances of preterm labor, preterm rupture of membranes, and preterm birth.' Implicated microorganisms include normal cervico/ vaginal microflora as well as recognized pathogens. Quantitative as well as qualitative aspects of cervical /vaginal microflora are likely important as microorganisms may act singly, additively, or synergistically. To evaluate possible influences of selected cervico/vaginal microflora and host responses in preterm birth, 202 women (x = 24.2 weeks gestation) were examined and both mother and perinates prospectively evaluated through the puerperium. Univariate and multivariate analyses were performed. The presence of bacterial vaginosis ( 18%) and Mobiluncus sps. ( 5 . 8 % ) as identified by gram stain * were significantly associated with preterm labor (p < 0.05). Bacterial vaginosis was also associated with demonstration of Mobiluncus sp., Gardnerella vaginalis. Mycoplasma hominis, vaginal pH 2 5 , semiquantitatively increased vaginal bacteria and white blood cells (WBCs), and positive amine odor. Identification of Mobiluncus sp. was associated with bacterial vaginosis, G. vaginalis, M. hominis, and increased vaginal WBCs. Elevated levels of nonspecific protease ( 2 10 trypsin units) were associated with findings of G. vaginalis and semiquantitatively increased WBCs and bacteria. Identification of Chlamydia trachomatis by both culture and immunofluorescent antibody (IFA) was associated with M. hominis and increased WBCs. Staphylococcus aureus (3.0%) was associated with preterm labor (p < 0.06). Recovery of group B streptococcus (3.5%), S. aureus, Ureaplasma urealyticum (64%), and yeast (42.1%) was not associated with other microbiologic findings (FIGURE 1). Clinical criteria used to diagnose bacterial vaginosis (BV) (quality of discharge and positive amine odor) were weakly associated with positive culture for G. vaginalis (p = 0.07), but these criteria accurately predicted only 40% of the patients who were positive for BV diagnosed by gram stain. Similarly, recovery of G. wagindis by culture accurately identified only 43.2% of the women who were positive for BV (gram stain), Use of clinical criteria associated with BV or recovery of G. vaginalis by culture, even heavy growth, was not associated with preterm labor or birth. Overall, 18.8% of the study patients were treated for a nonyeast vaginitis during antepartum care. However, of the women who experienced preterm labor, 82% (27/ 33) had not received any antimicrobials prior to onset of preterm labor.