Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation.
TLDR
The standardized score facilitates future research concerning bacterial vaginosis because it provides gradations of the disturbance of vaginal flora which may be associated with different levels of risk for pregnancy complications.Abstract:
The purpose of the study was to examine intercenter variability in the interpretation of Gram-stained vaginal smears from pregnant women. The intercenter reliability of individual morphotypes identified on the vaginal smear was evaluated by comparing them with those obtained at a standard center. A new scoring system that uses the most reliable morphotypes from the vaginal smear was proposed for diagnosing bacterial vaginosis. This scoring system was compared with the Spiegel criteria for diagnosing bacterial vaginosis. The scoring system (0 to 10) was described as a weighted combination of the following morphotypes: lactobacilli, Gardnerella vaginalis or bacteroides (small gram-variable rods or gram-negative rods), and curved gram-variable rods. By using the Spearman rank correlation to determine intercenter variability, gram-positive cocci had poor agreement (0.23); lactobacilli (0.65), G. vaginalis (0.69), and bacteroides (0.57) had moderate agreement; and small (0.74) and curved (0.85) gram-variable rods had good agreement. The reliability of the 0 to 10 scoring system was maximized by not using gram-positive cocci, combining G. vaginalis and bacteroides morphotypes, and weighting more heavily curved gram-variable rods. For comparison with the Spiegel criteria, a score of 7 or higher was considered indicative of bacterial vaginosis. The standardized score had improved intercenter reliability (r = 0.82) compared with the Spiegel criteria (r = 0.61). The standardized score also facilitates future research concerning bacterial vaginosis because it provides gradations of the disturbance of vaginal flora which may be associated with different levels of risk for pregnancy complications. Imagesread more
Citations
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Vaginal microbiome of reproductive-age women
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Intrauterine infection and preterm delivery.
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Association between Bacterial Vaginosis and Preterm Delivery of a Low-Birth-Weight Infant
Sharon L. Hillier,Robert P. Nugent,David A. Eschenbach,Marijane A. Krohn,Ronald S. Gibbs,David H. Martin,Mary Frances Cotch,Robert R. Edelman,J G Pastorek nd,A V Rao +9 more
TL;DR: The women with bacterial vaginosis were more likely to be unmarried, to be black, to have low incomes, and to have previously delivered low-birth-weight infants.
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Molecular Identification of Bacteria Associated with Bacterial Vaginosis
TL;DR: Bacterium-specific PCR assays showed that several bacteria that had not been previously described were highly prevalent in subjects with bacterial vaginosis but rare in healthy controls, including three bacteria in the Clostridiales order that were highly specific for bacterialvaginosis.
References
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Journal ArticleDOI
Nonspecific vaginitis: Diagnostic criteria and microbial and epidemiologic associations
Richard Amsel,Patricia A. Totten,Carol A. Spiegel,Kirk C.S. Chen,David A. Eschenbach,King K. Holmes +5 more
TL;DR: Application of practical diagnostic criteria for standard clinical use should assist in clinical management of nonspecific vaginitis and in further study of the microbiologic and biochemical correlates and the pathogenesis of this mild but quite prevalent disease.
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Misinterpretation and misuse of the kappa statistic
Journal ArticleDOI
Haemophilus vaginalis Vaginitis. A Newly Defined Specific Infection previously classified "Nonspecific" Vaginitis.
TL;DR: The clinical manifestations of the newly defined vaginitis have been described and criteria for clinical, microscopic, and bacteriological diagnoses given and the results of treatment by several methods are discussed.
Journal ArticleDOI
A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity.
Sharon L. Hillier,J. Martius,Marijane A. Krohn,Nancy B. Kiviat,King K. Holmes,David A. Eschenbach +5 more
TL;DR: In this article, the role of infection in prematurity was investigated in women who delivered prematurely and compared with those who delivered at term, using demographic and obstetrical characteristics, chorioamnionic cultures, and placental histologic features.
Journal ArticleDOI
Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome.
Michael G. Gravett,H. Preston Nelson,Timothy A. DeRouen,Cathy W. Critchlow,David A. Eschenbach,King K. Holmes +5 more
TL;DR: Pregnancy outcome to bacterial vaginosis, an anaerobic vaginal condition, and to other selected genital pathogens among 534 gravid women was prospectively studied, finding that neonates born to women with bacterialvaginosis had lower mean birth weight than did neonatesBorn to women without bacterial vagInosis.