Objective: Critically review obstetric, epidemiologic, microbiologic, and pathophysiologic information regarding the possible casual associations of bacterial vaginosis with premature rupture of membranes.
Methods: Observational and experimental studies are reviewed and correlated with in vitro and clinical, microbiologic, and pathophysiologic experiments in an effort to define possibly casual relationships with bacterial vaginosis and premature rupture of membranes and its maternal and perinatal sequelae.
Results: Considerable information shows that bacterial vaginosis, a common vaginal microbe-associated condition of reproductive age women, can be strongly (risk ratios up to 7.3, confidence interval 95%, 1.8 to 29.4) associated with preterm premature rupture of membranes as well as preterm labor and birth. Microorganisms of bacterial vaginosis produce factors including proteases (IgAse, collagenase, etc.) that can facilitate transport of bacteria to fetal membranes and impair fetal membrane integrity in experimental models.
Conclusions: Controlled investigations are required to evaluate if treatment of bacterial vaginosis is associated with reduction of premature rupture of membranes and preterm birth.