Bacterial vaginosis in Pregnant Women: A diagnostic approach

Objective: To determine the prevalence of Bacterial Vaginosis (BV) in pregnant women using a simple clinical diagnostic approach. Method: The clinical criteria developed by Amsel`s and colleagues were used as a reference standard for accurate diagnosis of Bacterial vaginosis (BV) infection. This is based on the presence of the following clinical signs 1) Homogeneous thin, white vaginal discharge 2) Presence of clue cells (greater than 20%). 3) Positive amine (whiff) test. 4) Vaginal pH > than 4.5. The presence of any three of the four clinical criteria was considered diagnostic for BV. Samples were collected from 75 pregnant females, irrespective of their gestational duration, presenting with vaginal discharge at the antenatal clinic of Jinnah Hospital, Lahore. Results: BV was diagnosed in 14 females giving an incidence of 18.7%. The, most common symptom was a thin white homogeneous vaginal discharge seen in 27(36%) women. The other diagnostic clinical signs observed were the presence of clue cells on wet mount 9(12%), positive `whiff` test 13(17.3%), and elevated pH>4.5 in 18(24%) women. Microscopic analysis of vaginal secretion revealed diminished polymorph epithelial ratio 19(25.3%) and loss of normal vaginal Lactobaclli 22(29.3%). The other associated findings were candidiasis seen in 16(21.3%) women, while Trichomonas infection in only one woman. These findings were confirmed on Gram staining. Gardnerella vaginalis 9(12%) and Gram variable organisms (Mobiluncus) 11(14.7%) were also identified by Gram smear of vaginal discharge. Conclusion: The clinical diagnosis of BV infection can be established by identifying three of Amsel`s four clinical criteria. In most cases it provides a rapid inexpensive and accurate diagnosis. Strategies should be planned to screen and treat women with BV so as to prevent adverse Obstetric outcome associated with it.