Search

There appears to be an association between bacterial infections and endometritis. One hundred seventy-eight women with suspected pelvic inflammatory disease were tested for endometritis, salpingitis, Neisseria (N.) gonorrhoeae, and Chlamydia (C.) trachomatis. Tests confirmed endometritis in 65% of the women. Patients with endometritis were 5.7 times more likely to have N. gonorrhoeae and 4.8 times more likely to have C. trachomatis. Of the women with endometritis, 68% also had uterine inflammation while only 23% of the women without endometritis had uterine inflammation.

Bacterial infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Ureaplasma urealyticum, group B streptococci, Gardnerella vaginalis, and Bacteroides species, may cause premature labor, preterm delivery, and preterm rupture of fetal membranes. Most of these infections are sexually transmitted. There is little information about the effects of increased levels of endogenous vaginal bacteria (which normally inhabit the vagina) on preterm labor or preterm delivery. The effects of high amounts of vaginal microorganisms on the incidence (number of new cases) of premature delivery were assessed in 211 women between 22 and 34 weeks of pregnancy, who were experiencing preterm labor. Studies have shown that neonatal death and disability, and inflammation and infection of the fetal membranes occurs most often in pregnancies that are delivered before the 35 week. Samples of vaginal tissue were obtained for culture, a procedure in which the tissue is exposed to conditions that enhance bacterial growth. If bacteria can be identified after culture of the tissue, the patient is considered to be infected. Of 211 pregnancies with preterm labor, 139 ended in preterm delivery. The incidence of preterm delivery was decreased by 40 percent among the women with high levels of facultative lactobacilli in the vaginal fluid, but increased among women with high levels of Bacteroides bivius and B. fragilis. An increased incidence of premature delivery in women experiencing premature labor was not associated with vaginal infection by Gardnerella vaginalis, genital mycoplasmas, group B streptococci, Escherichia coli, and Peptostreptococcus species. (Consumer Summary produced by Reliance Medical Information, Inc.)

The proportion of infants born prematurely has stayed constant at about 7 to 10 percent despite great improvements in the care of pregnant women and their babies. In half the cases of preterm birth, no cause can be identified. Researchers are finding, however, that preterm labor (PTL) may be linked to maternal infections of the vagina and genital tract. The amniotic fluid (which surrounds the fetus in the amniotic sac) of women in PTL has been tested and been found to contain infectious organisms. Also, administration of antibiotics has reduced the rate of premature birth among women with threatened (impending) PTL. But previous studies have been limited in that they typically tested for only one organism, without considering possible interactions among different organisms, and many did not correct for other risk factors for PTL. The current study investigated a range of infectious organisms and other factors thought to predispose to PTL. The subjects were 428 women in PTL, defined as labor before 37 weeks gestation, and 568 women in labor at full term (37 or more weeks gestation). Swabs were used to obtain samples of vaginal secretions, which were then tested for infectious organisms. Data analysis showed that two specific groups of bacteria were significantly associated with PTL. These groups were enteropharyngeal organisms (Escherichia coli, Klebsiella species, Haemophilus species, and Staphylococcus aureus), and the bacterial vaginosis group (normal found populating the vagina) (Gardnerella vaginalis and Bacteroides species). For each of these organisms, the percentage of women who had the organism present was higher for the preterm labor group than the full-term labor group, and the rates of infection were especially high for women in labor before 34 weeks gestation. Infections with some of these organisms produce no symptoms, while colonization with other bacteria leads to inflammation and other effects. More research is needed into sexual practices that may introduce these bacteria into the vagina and predispose to preterm labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bacterial vaginosis (gardnerella vaginalis, non-specific vaginitis), is a common bacterial infection of the vagina. Two organisms, gardnerella vaginalis and mycoplasma hominis, are often found together in vaginal secretions. Bacterial vaginosis has been detected in women having early labor, early delivery, premature rupture of the membrane surrounding the fetus (amniotic membrane) and infections of the amniotic fluid which surrounds the fetus. The role of the two bacterial organisms in causing infections in amniotic fluid was evaluated in 408 patients. It was learned that women with vaginosis infections (69 percent) were more likely to develop amniotic fluid infections than patients without vaginosis infections (46 percent). Those women with infections in the amniotic fluid were more likely to be infected with G. vaginalis and M. hominis bacteria together. Women already at risk for amniotic fluid infection, namely those undergoing invasive internal monitoring and those experiencing premature rupture of membranes, are at an even higher risk if a vaginosis infection is present at the same time. It is suggested that preventive measures be taken in these high risk women.