Characteristics of three vaginal flora patterns assessed Gram stain among pregnant women*,**

https://doi.org/10.1016/0002-9378(92)91368-KGet rights and content

This study was undertaken to define the characteristics and persistence of vaginal flora in 7918 pregnant women at 23 to 26 weeks' gestation. Vaginal smears were categorized as normal (predominant lactobacilli), intermediate (reduced lactobacilli), or positive for bacterial vaginosis. The women with normal flora were least likely to have elevated vaginal pH, amine odor, milky discharge, or colonization by Gardnerella, Bacteroides, or genital mycoplasmas. Women with intermediate vaginal flora had intermediate frequencies of these clinical signs and microorganisms. Group B streptococci and yeast were associated with normal or intermediate flora, whereas Neisseria gonorrhoeae and Chlamydia trachomatis were recovered more frequently from women with intermediate flora or bacterial vaginosis. Trichomonas vaginalis was most associated with intermediate flora. At follow-up, 81% of the women with normal flora had remained normal. Of the women with intermediate flora, 32% acquired bacterial vaginosis and 30% shifted to normal flora. Only 12% of the women with bacterial vaginosis had shifted to normal flora. We conclude that there are two primary stable vaginal flora patterns (normal flora or bacterial vaginosis) and a third less distinct transitional flora pattern between these two.

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    *

    Members of the Vaginal Infections and Prematurity Study Group and their affiliations are listed at the end of the article.

    **

    Supported by contracts HD-3-2832, HD-3-2833, HD-3-2834, HD-3-2835, HD-3-2836, and AI-4-2532 from the National Institute of Child Health and Human Development and the National Institute of Allergy and Infectious Diseases.

    a

    From the Department of Obstetrics and Gynecology, University of Washington

    b

    From the Department of Epidemiology, University of Washington

    c

    National Institute of Child Health and Human Development, University of Colorado Health Science Center.

    d

    Department of Obstetrics and Gynecology, University of Colorado Health Science Center.

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