Vaginal inflammatory status in pregnant women with normal and pathogenic microbiota in lower genital tract.

Objective. To assess the vaginal inflammatory status (VIS) in pregnant women, whether symptomatic or asymptomatic, by leukocyte quantification in relation to the microbiota during each pregnancy trimester (T). Materials and Methods. A thousand two hundred and forty eight vaginal exudates from pregnant women were prospectively examined. All the patients underwent a clinical and colposcopic examination and a microbiological study of vaginal exudates. Leukocyte quantification was determined by May-Grunwald Giemsa staining as LNR per field (400X). Results. Statistically significant differences (SSD) in LNR were observed in the VIS of asymptomatic patients (AP) compared with that of symptomatic ones (SP) with normal microbiota: 10-15 for the 1st T, <10, 20 to 25 and >25 for the 2nd T and >25 for the 3rd; with candidiasis: <10 for the 1st T, <10, 15 to 20 and >25 for the 2nd T and <10 and >25 for the 3rd T. In women with trichomoniasis, SSD in the LNR were observed between SP with LNR ≥ 10 and AP with NLR < 10 in the three trimesters altogether. In women with BV, no SSD were observed in the LNR of any AP with respect to SP for the three T. Conclusion. The VIS is influenced by vaginal microbiota and depends on the state of pregnancy and also, on gestational age. The pronounced leukocyte increase in asymptomatic patients in the absence of lower genital tract infection during the third trimester of pregnancy should be highlighted.

Diagnosis of bacterial vaginosis during pregnancy.

OBJECTIVE.: To evaluate the sensitivity and specificity of the score and each one of the clinical criteria (pH, potassium hydroxide (KOH) test for amines, and clue cells) in relation to the Amsel's method. MATERIALS AND METHODS.: One hundred ninety vaginal exudates from pregnant women were studied from April to August 1997. The patients were examined in the Lower Genital Tract and Colposcopy Clinics of the Obstetrics Division at the University Hospital de Clínicas at the University of Buenos Aires, Argentina.The diagnosis of bacterial vaginosis (BV) was made by the presence of three or more of the following criteria: homogeneous vaginal discharge, pH >/= 4.5, positive KOH test for amines, and microscopic presence of clue cells. We also used the microscopic observation of coccobacilli forms in Gram stain (Nugent's method), diagnosing BV with a score >/= 7. RESULTS.: Nugent's method showed a sensitivity of 97% and specificity of 98%. The presence of clue cells showed a sensitivity of 92% and specificity of 97%. The sensitivity of the pH and KOH test for amines was 87% and 81%, whereas the respective specificity was 45% and 99%. CONCLUSIONS.: Because Nugent's method showed a very good specificity and sensitivity, it can be used as another method in the diagnosis of BV. The presence of clue cells diagnosed BV with better sensitivity and specificity than the other clinical criteria. In this way, we recommend the microscopic exam by Gram stain, using Nugent's method or the presence of clue cells, for diagnosing BV.