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ID naloge: 17 Letnik: 1997 Predmet: ginekologija in porodništvo
Pogostnost bakterijske vaginoze in povezava s prezgodnjim porodom
Avtor: Mojca Novak, Barbara Prosen
Mentor: prof. dr. Živa Novak-Antolic
IZHODIŠCA: V Sloveniji se v zadnjem desetletju delež prezgodnjih porodov giblje okrog 6%, ti pa prispevajo k približno 70% perinatalne umrljivosti. Nosecnice s povecanim tveganjem za prezgodnji porod je težko prepoznati, ker ne poznamo vseh vzrokov, ki ga sprožijo. Bakterijska vaginoza (BV) je možen vzrok za prezgodnji porod. BV je stanje v nožnici, ko normalno prisotne laktobacile zamenjajo mocno pomnožene anaerobne bakterije, Gardnerella vaginalis in Mycoplasma hominis. Dolociti jo je mogoce klinicno ali mikrobiološko.
NAMEN: Ugotoviti, kakšna je pogostnost BV pri nas, kakšne so posebnosti žensk z BV, dolociti dejavnike tveganja za njen pojav, ter ugotoviti ali obstaja povezava s pojavom prezgodnjega poroda. Izbrati najzanesljivejši in najprimemejši nacin dolocanja BV.
PREISKOVANKE IN METODE: V raziskavo smo prospektivno vkljucevali ženske:
1) iz Ambulante za patološko nosecnost,
2) iz Dnevne klinike (umetna prekinitev nosecnosti), in
3) iz Ambulante za spolno prenosljive bolezni.
Vseh skupaj je bilo 201, od teh 175 nosecih in 26 nenosecih. Vsaki ženski smo odvzeli bris nožnicnega izcedka. BV smo dolocali na podlagi klinicnih kriterijev (videz, vonj, pH nožnicnega izcedka, prisotnost 'clue' celic v razmazu) in z metodo barvanja razmaza po Gramu. Podatke v zvezi z osebno, socialno, spolno in porodniško anamnezo smo dobili z vprašalnikom.
REZULTATI: Med skupinami preiskovank iz razlicnih oddelkov Ginekološke klinike ni bilo statisticno pomembnih razlik v pogostnosti BV dolocene z metodo barvanja po Gramu (p = 0,181 ). Pogostnost pri vseh preiskovankah skupaj znaša 11,9%. Ženske z BV so, v primerjavi z ženskami brez nje, pogosteje imele prvi spolni odnos pred 17. letom (p = 0,003). Dejavnika tveganja za pojav BV sta kajenje (> 15 cigaret na dan) (razmerje obetov (RO) 7,15; 95% interval zaupanja (IZ) od 1,9 do 26,0) in starost pri prvem spolnem odnosu nižja od 17 let (RO 3,64; IZ od 2,2 do 7,1); pri nenosecih je BV pogostejša kot pri nosecih (RO 3,22; IZ od 1,5 do 6,8). Od 44 preiskovank, ki so rodile v casu raziskave, jih je 5 imelo prezgodnji porod. Ena od treh porodnic s spontanim prezgodnjim porodom je imela BV. KIinicni kriteriji so v primerjavi z metodo barvanja razmaza nožnicnega izcedka po Gramu za dolocanje BV dovolj zanesljivi.
ZAKLJUCKI: Pogostnost BV v Sloveniji je podobna pogostnosti, ki jo navajajo v drugih državah. Povezava med BV in spolnim vedenjem, ter kajenjem verjetno obstaja; nosecnost ugodno vpliva na zmanjšanje njene pojavnosti. Kot presejalni test so klinicni kriteriji dovolj zanesljivi, za dokoncno potrditev BV pa je primernejše barvanje razmaza nožnicnega izcedka po Gramu. Povezave med prisotnostjo BV in pojavom prezgodnjega poroda nismo mogli dokazati zaradi premajhnega števila preiskovank.
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[Abstract / English version]
Incidence of bacterial vaginosis and its relation to preterm delivery
Author: Mojca Novak, Barbara Prosen
Mentor: prof. dr. Živa Novak-Antolic
BACKGROUND: In Slovenia the rate of premature delivery in the last decade has been around 6%, they account for about 70 % of all perinatal mortality. It is difficult to recognise women at high risk for preterm delivery for only some causes are known. Bacterial vaginosis (BV) is a possible cause of preterm delivery. BV is a condition, where normally present Lactobacilli in the vagina are replaced by enormous amounts of anaerobic bacteria, Gardnerella vaginalis and Mycoplasma hominis. It can be detected clinically or microbiologically.
OBJECTIVES: To define the incidence of BV at Gynecology Clinic in Ljubjana as well as to find the characteristics of women with BV that could predispose to its occurrence. Our interest was also to find out its relation to preterm delivery. The most reliable and suitable way of BV was sought.
SUBJECTS AND METHODS: Women from three different populations have prospectively entered in our research:
1) from Clinic for Pathologic Pregnancy,
2) from Day Clinic (artificial abortion), and
3) from Clinic for Sexually Transmitted Diseases.
Altogether 201 women were enrolled in the study: 175 pregnant and 26 nonpregnant. For each one a vaginal smear was obtained and a questionnaire filled in. The presence of BV was determined by clinical criteria and by Gram stain criteria.
RESULTS: There was no statistically significant difference in incidence of BV among the groups of women from different clinics (p = 0,181 ). The collective incidence was 11,9%. Proportion of women who became sexually active before age of 17 was significantly greater among those found positive for BV by Gram stain criteria (p = 0,003). An increased incidence of BV was found among women: ( 1 ) who smoke more than 15 cigarettes per day (odds ratio (OR) 7, 15; confidence interval (CI) from 1,9 to 26,0), (2) who became sexually active before the age of 17 (OR 3,64; CI from 2,2 to 7,1) and (3) among nonpregnant women (OR 3,33; CI from 1,5 to 6,8) compared to pregnant ones. 44 women already gave birth, 5 of them preterm. One pregnant woman out of three who experienced spontaneous preterm delivery was found positive for BV. Compared to Gram stain criteria clinical criteria are equally reliable.
CONCLUSIONS: The incidence of BV in Slovenia is probably very similar to the incidence in other countries. Sexual habits and smoking are possibly the predisposing factors for BV. BV might resolve during pregnancy. As a screening test clinical criteria seem to be reliable enough while Gram stain criteria could be used for a definite diagnosing. Because of the small size of groups we were not able to prove the relation of BV to preterm delivery.
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