Objective: The purpose of this prospective investigation was to determine if the presence of bacterial
vaginosis (BV) at the time of delivery was associated with the development of maternal and neonatal
Methods: Vaginal fluid was collected from 390 laboring patients. Smears of the vaginal secretions
were gram stained, and slides were scored and interpreted as normal, intermediate, and BV based on
Gram's stain criteria. Results of the Gram's stains were correlated with the clinical diagnoses of
chorioamnionitis, endometritis, and neonatal sepsis.
Results: Eighty-eight percent of patients were term and 12% were preterm. The overall prevalence of BV was 30%. The frequency of BV was similar in both term and preterm women. BV was
significantly more prevalent among nonwhites than whites (37% vs. 25%, P = 0.005). Maternal
characteristics such as mean age, parity, status of the membranes, mean duration of labor, mean
duration of ruptured membranes, mean length of fetal monitoring, mean number of vaginal examinations,
and mode of delivery were similar in patients with BV, intermediate, and normal Gram's
stains. Forty-seven (12%) women developed peripartum infection. The frequencies of chorioamnionitis
or endometritis in women with BV or intermediate Gram's stains were 19/116 (16.4%) and
11/63 (17.5%), respectively. The frequency in each of the 2 groups was significantly increased
compared with the rate in women with normal Gram's stains: 17/211 (8.1%), [P = 0.034, OR = 2.0
(95% CI, 1.07–3.73) for BV and P = 0.054, OR = 2.1 (95% CI, 1.12–3.94) for intermediate Gram's
stain]. The incidence of suspected or confirmed neonatal infection was significantly higher in mothers
with intermediate Gram's stains compared with mothers with normal Gram's stains (P = 0.02,
OR = 2.18, 95% CI, 1.12–3.94), while no difference in incidence was observed between mothers
with BV and normal Gram's stains (P > 0.05). The rate of neonatal infection directly correlated
with maternal group B streptococcal colonization rather than with BV.
Conclusions: In this population, patients with BV and intermediate Gram's stains had an increased
frequency of peripartum infection.