[Bacterial vaginosis: what risks for the mother and child?]

Bacterial vaginosis are characterized by a polymicrobial proliferation of anaerobic organisms and the disappearance of the commensal lactobacilli, which can cause ascending utero-adnexitis and endanger ongoing pregnancy. The role of anaerobes in utero-adnexitis and tubal abscess was first raised in 1973 par Eschenbach. Several authors have since established correlations between bacterial vaginosis and both pain from the uterine appendages and gynecologic infections, particularly post-abortum. Bacterial vaginosis is a major problem in pregnant women, given its high prevalence (15-20 p. cent) and significant relationship with premature delivery and premature rupture of the membranes (at less than 37 weeks of amenorrhea) in epidemiological case-control and cohort studies taking into account demographic and concomitant obstetric characteristics. In particular, histological lesions indicative of chorioamniotitis have been correlated with prematurity and with the presence of bacteria (usually those involved in vaginosis) in the amniochorial space. Bacterial vaginosis can give rise to ascending infections which reach the amniochorial space and cause uterine contractions or alter the amniochorial membrane, leading to premature rupture of the membranes. These epidemiological data must, however, be confirmed by controlled trials of antibiotics active in bacterial vaginosis and their preventive effect on prematurity and premature rupture of the membranes. Finally, bacterial vaginosis can play a role in endometritis following both natural and caesarean delivery; this has been shown in multivariate analyses with adjustment for maternal age, duration of labor and rupture of the membranes, and isolation of bacteria associated with bacterial vaginosis from the endometrium.