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Infectious Diseases in Obstetrics and Gynecology - Volume 4 1996, Issue 1, Pages 2-6

Clinical Study

Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49, Leuven 3300, Belgium

Laboratory of Clinical Pathology, Division of Microbiology, Tolstraat, Antwerp, Belgium

Department of Gynecology, Erasmus Hospital, Antwerp, Belgium

Received 15 January 1996; Accepted 6 May 1996

Copyright © 1996 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective: The assessment of the vaginal lactobacillary flora helps to direct further diagnostic microbiologicinvestigations in genital infectious disease and seems to represent a powerful tool in predictinginfectious morbidity and preterm labor during pregnancy. In the absence of a “gold standard,” westudied the variations in assessing lactobacillary morphotypes according to the method used.

Methods: The lactobacillary flora from 183 pregnant women was classified according to 3 groups:normal, intermediate, and abnormal. This grading of lactobacilli was appled to vaginal and cervicalspecimens by means of 1 immediate wet-smear microscopy, 2 Gram's stain on a fresh, air-dried specimen,and 3delayed Gram's stain after specimen transportation in Stuart's growth medium for 3–6 h.

Results: The assignment of intermediate or abnormal flora grade II or grade III showed highconcordance rates among the different preparatory techniques, but the assignment of grade I normalflora did not. Fewer lactobacilli were found 2.6 times more often after Gram's stains of freshspecimens [Relative Risk RR 2.6, 95% confidence interval CI 1.7–4.1] and 6 times more oftenwhen the Gram%s stain was performed in a delayed examination after transport than in a freshwet-mount specimen RR 6.2, 95% CI 2.5–15.6. Disturbed lactobacillary grades were also foundmore frequently in specimens from the cervix than those from the vagina RR 4.0, 95% CI, 1.5–10.4.

Conclusions: There are discrepancies in the diagnosis of lactobacillary grades between gram-stainedand fresh vaginal specimens. The evidence is ambiguous as to which of the 2 methods isresponsible. If an evaluation is to be done on a gram-stained specimen, then the storage of thesample in Stuart transport medium before staining should be avoided.

Autor: Gilbert G. G. Donders, Annie Vereecken, Geert Salembier, Ben Van Bulck, and Bernard Spitz



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