Questions about Bacterial Vaginosis during Pregnancy

QUESTION

Dear Midwife,
My name is Suzanne, age 37, mother of 2 teens, and I am currently 6 1/2 weeks pregnant. This is my third attempt at a pregnancy with my second husband. I lost a pregnancy last year at just short of 6 weeks pregnant and another pregnancy where I miscarried twin boys at about 18 weeks. During both pregnancies, especially the second one, I experienced a lot of bleeding and discharge. Because of my age, the fact that I've had multiple abdominal surgeries, and am a gastric bypass patient, I was seeing a high risk OB/GYN. Until I was in my 17th week, and experiencing heavy bleeding, he had never performed any time of vaginal examination. Even at this point, he never examined the discharge under a microscope.

Shortly after I miscarried the twins, I had a follow-up with another provider who discovered that I had pretty severe symptoms of Bacterial Vaginosis (BV). She treated it with Flagyl, and did a recheck a month later, giving us the green light to attempt to conceive again. She denied that the BV could have caused the miscarriage of the twins, however, both of their placentas showed significant inflammation. Unfortunately, the BV diagnosis came after the placental testing, so we were never able to confirm what caused the inflammation.

I've read a great deal on the subject and have learned that BV may indeed be responsible for placental abruption in second trimester.

I am scheduled this pregnancy to see a different OB/GYN at about the 9 1/2 week mark. This made me very nervous to wait so long, so I basically demanded to see a midwife in the meantime to see if I had BV again. I believe it was the right thing to do, because I do indeed have the beginnings of another BV infection for which I am again taking Flagyl. I've never been diagnosed outside of pregnancy of any type of infection. In addition, I had been diagnosed during my daughter's pregnancy 14 years ago with recurrent yeast infections. I ended up on bedrest during the last 6 weeks of that pregnancy for early labor symptoms.

Is it possible to be prone to BV infections only during pregnancy? How likely is it to have caused my previous miscarriages? Other than antibiotics, are there any other ways I can prevent BV from occurring?

Fortunately, so far, this pregnancy is going well. Some discharge and no bleeding. Thanks for your time in reviewing my questions.

ANSWER

The evidence linking BV and miscarriage is very mixed, with some studies showing an association and others not, so I really couldn't say for sure.

That said, during pregnancy your immune system does not function as well as normal (so it doesn't reject the fetus), and women are more prone to all sorts of infections that they wouldn't even notice when not pregnant. Most of these are easily treated (like BV and yeast).

There is some evidence that BV can be prevented by meticulous hygiene, (both shower before intercourse, wipe from front to back, no baths, only showers) and by using lots of *water-based* lubricant during intercourse. But even with all of these measures, some women are just prone to BV when pregnant, and should be checked regularly for it.

I am SO sorry for your prior losses, and hope this pregnancy results in a healthy pregnancy and delivery!

--Cynthia, CNM

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Cynthia Flynn

Cynthia Flynn, CNM. PhD, is the General Director of the Family Health and Birth Center which provides prenatal, birth, postnatal, gynecological and primary health care to underserved women and their families in Washington, D.C. Recently Cynthia served as Associate Professor of Nursing at Seattle University. There she not only taught, but remained in full scope clinical midwifery practice at Valley Medical Center where she cared for pregnant and birthing women, and practices well-woman gynecology, family planning, and treatment of sexually transmitted diseases.

Cynthia founded Columbia Women's Clinic and Birth Center, where she took care of pregnant women and infants up to two weeks of age and attended both birth center and hospital births. Before Cynthia earned her CNM, she worked as a registered nurse in labor and delivery and postpartum and is a certified Doula and Doula trainer.