日本性感染症学会誌 Journal of Japanese Society for Sexually Transmitted Infections

[Introduction] Bacterial vaginosis (BV) is diagnosed based on the Nugent score (NS). Although ideally NS is an objective reference, discrepancies may arise, depending on the expertise of the clinical technologist who performs the test. We tested a method of diagnosing BV that was effective in predicting premature delivery. [Methods] Among the 2,454 deliveries that occurred over a 4-year period between April 2012 and March 2016 at our institution, we retrospectively investigated the medical records of 741 patients who underwent early prenatal (before 20 weeks of gestation) vaginal discharge bacterial testing. The patients were divided into the BV or Non-BV group as per the NS or the results of the culture tests. Univariate and multivariate analyses were used for the perinatal prognosis and, in particular, for the risk of premature birth at <28 weeks of gestation (extremely preterm birth) according to each form of testing. [Results] One patient in the BV group who was diagnosed with NS (1.3%, p=0.542) experienced extremely preterm birth, and five patients in the BV group diagnosed with culture results (4.3%, p=0.0015) experienced extremely preterm birth. [Conclusions] The presence of Gardnerella vaginalis and hypertension disorder in pregnancy were significantly related to the risk of extremely preterm birth, with hazard ratio of 20.1 (95% confidence interval [CI], 2.54–165; p=0.0046) and 17.2 (95%CI, 1.32–224; p=0.0298), respectively, in the multivariate analysis. BV diagnosis with culture test may be more accurate for the prediction of severe premature birth than that with NS.