Prediction of preterm birth using a modified classification of gram- stained vaginal smears

Document Type : Original Article

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Obstetrics &Gynecology Department Faculty of Medicine, Mansoura University,Egypt

Abstract

Objective: The aim of this study was to identify women at risk of spontaneous preterm birth
through a 4-category Gram-stained vaginal smear method and to examine the diagnostic
accuracy of this classification in relation to the occurrence of preterm delivery.
Patients & Methods: This was a prospective study correlating first trimester Gram-stained
vaginal smears with spontaneous preterm birth. Smears were categorized as normal, bacterial vaginosis-like, grade I-like (atypical gram-positive rods) or purulent grade I (lactobacilli-dominated smears showing heavy leukorrhea of unknown cause).
Results: Abnormal Gram stain vaginal smears were associated with more than 5 fold increase in the odds of having a preterm birth when applying the modified 4 category scoring
system. The presence of bacterial vaginosis (BV) like, Grade I-like and Grade I-PNL were
associated with a significant increase in the odds of preterm labor (4, 7.8 and 6.1, respectively).
Conclusion: Pregnant women with abnormal Gram-stained vaginal smear have a higher
risk of preterm labor. Also, the modified 4-category Gram-stained vaginal smear classification is a useful tool in predicting preterm labor.

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