Clinical Medicine Reviews in Women's Health

Bacterial vaginosis (BV) has been shown to double the risk of preterm delivery in pregnant women. But trials of antibiotic treatment of BV in pregnant women to prevent preterm delivery have been inconclusive. Without a good understanding of the etiology of BV, interpretation of these results has been challenging. As currently diagnosed, BV appears to be a heterogeneous condition and women with BV might have different risk profiles for preterm delivery depending on the presence of certain bacteria. Additionally, current diagnostic approaches may not adequately discriminate BV from other abnormal vaginal flora associated with mild inflammation. Finally, BV associated bacteria appear to ascend into the uterus very early in pregnancy resulting in early pregnancy losses and very early preterm delivery. In future trials efforts should be made to differentiate abnormal vaginal flora that might be associated with mild inflammation from BV and women should be screened and treated as early as possible, preferably before 20 weeks of gestation.