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Transcript of Journal BV
7/30/2019 Journal BV
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Bacterial Vaginosis in
Pregnancy: Current Findings
and Future Directions
Pembimbing : dr. Eko Krisnarto, Sp.KK
Penyusun : Hernita Ferliyani ( 030.07.107 )
JOURNAL READING
Epidemiologic
Reviews, 2002, Vol. 24
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INRODUCTION
Bacterial vaginosis (BV) is thenumber one cause of vaginitis
among both pregnant andnonpregnant women.
Prevalence of BV among nonpregnant women to range from
15% to 30 %,
Up to 50% of pregnant women
have been found to have BV.
Related to manygynecologic conditionsand complications ofpregnancy includingpelvic inflammatory
disease, endometritis,preterm delivery,
preterm labor, andspontaneous abortion.
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BACKGROUNDBV is a polymicrobial, superficial vaginal infection involving a reduction in theamount of hydrogen-peroxide producing Lactobacillus and an overgrowth
of anaerobic and Gram-negative or Gram-variable bacteria.
Reduced number of Lactobacillus anaerobic bacteria,including Mycoplasma hominis, Gardnerella vaginalis,etc
The most important predictor in subsequent BVdevelopment
No studies pregnant women to describe the changes in vaginal flora or BV prevalence during gestation
The presence of BV at a particular gestational age may be a factor inthe subsequent development of pregnancy complications,
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DIAGNOSIS
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TREATMENT
Metronidazole, given a 7-day,
twice-daily course of 500 mg of
metronidazole ranges from 84% to
96%
Clindamycin reported that a 300-
mg, twice-daily course of
clindamycin for 7 days resulted in a
94% cure rate
Metronidazole during the first trimester ofpregnancy before the completion of
organogenesis no evidence of long-term teratogenic effects.
All of the efficacy studies havebeen conducted amongnonpregnant women, with the
assumption that the cure rate for BV among pregnant woman is
similar.
Oral
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TOPIKAL
Metronidazole0.75% vaginal
gel
Clindamycin 2% vaginal
cream
A twice-daily, 5-daytherapy of vaginal
metronidazole had a
reported cure rate of 75 –
81%
Clindamycin cream wasreported to resolve 82 – 96 %
of cases of BV
These topical treatments result in the resolution of lower genital tract
infection but do not treat BV occurring in the upper genital tract
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EPIDEMIOLOGY : RISK FACTORS
Race
Sexualactivitty
Socio
Economic/Stress
Vaginaldouching
Education
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Reported prevalence of BVamong pregnant women
ranges from 10 to 35 %, withhigher rates occurring amongAfrican-American women, low-
income women, or womenwith prior sexually transmitted
diseases
The Vaginal Infections andPrematurity Study, which
measured BV among pregnant
women between 23 and 26weeks of gestation, found a
2.0- to 2.5-fold increased risk ofBV among African-American
compared with White pregnantwomen.
Numerous studies have confirmed at
least a twofold increased risk of BV
among African-American womenpresumably due to
environmental/behavioral exposures or
stressors
RISKFACTORS
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In recent studies among obstetricspopulations, the reported
prevalence of BV ranged from alow of 10 percent among privatepatient to a high of 35 percentamong women reporting low
monthly incomes and loweducational levels.
Epidemiologic studies have found thatearly sexual activity, a high number of
lifetime sexual partners, women with anew sexual partner, and women with aprior sexually transmitted disease are also
at increased risk of BV.
Some behaviors, such as vaginaldouching, have been examined as
potential risk factors for BV.
Vaginal douching may change thevaginal flora, reduce the amount of
Lactobacillus, and create anenvironment promoting excessive
anaerobic growth
RISKFACTORS
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EPIDEMIOLOGY : ADVERSE PREGNANCY
OUTCOMES
Bacterial Vaginosis Related to :
An increased potential for other vaginal
pathogens to gain access to the upper genital tract
The presence of enzymes that reducethe ability of leukocytes to reduce
infection
An increased level of endotoxinsstimulating cytokine and prostaglandin
production
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EPIDEMIOLOGY : ADVERSE PREGNANCY OUTCOMES
Many studies twofold increased risk of preterm delivery among womendiagnosed with BV in the early second trimester
A recent meta-analysis reviewing studies examining the role of BV and the risk of pretermdelivery reported a summary odds ratio of 1.6, indicating a 60 percent increased risk of
preterm delivery among pregnant women with BV
One study examining several pregnancy outcomes related to BV diagnosed during thefirst trimester of 2.6 fold increased risk of preterm labor, a 6.9-fold increased risk ofpreterm delivery, and a 7.3 fold increased risk of preterm, premature rupture of the
membranes
Studies have reported a three to fivefold increased risk of spontaneous abortion among pregnantwomen with BV in the first trimester
Another study found that BV diagnosed in the second trimester was associated with an increasedrisk of preterm delivery and premature rupture of the membranes and that BV that BV accounted
for 83 percent of the attributable risk for preterm birth
a recent clinical trial did not find a reduction in the occurrence of preterm delivery among either high-risk or low-risk asymptomatic pregnant women following treatment with oral metronidazole
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CONCLUSIONBV is an enormous public health problem,
accounting for the majority of cases of vaginitis andvaginal discharge in the United States. Current studiesrelating BV to adverse pregnancy outcomes have
measured and categorized BV positivity from samples ofthe lower genital tract.
These lower genital tract measurements of BV havebeen moderately related to the risk of adverse events,with the corresponding assumption being the eventualascension of these organisms to the upper genital tract.
Currently, BV is related to many gynecologic conditionsand complications of pregnancy including pelvicinflammatory disease, endometritis, preterm delivery,preterm labor, and spontaneous abortion.
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