Is there a correlation between bacterial vaginosis and preterm labour in women in the Otago region of New Zealand?

CONTEXT: While an association between bacterial vaginosis and preterm labour has been established, the relative contribution of this condition remains controversial. OBJECTIVE: To determine whether bacterial vaginosis is likely to be an important contributing factor in preterm births in Otago, New Zealand, a region with a historically high rate of such births. DESIGN AND SETTING: Women receiving antenatal care from Queen Mary Maternity Services were studied prospectively. Cases were women presenting with preterm labour or premature rupture of membranes. Controls had uncomplicated pregnancies and delivered at term. PATIENTS AND METHODS: Vaginal swabs from 44 cases and 72 controls were examined by amplification of bacterial 16S rRNA genes followed by denaturing gel gradient electrophoresis. Atopobium vaginae, a bacterial vaginosis-associated bacterium, was detected in a separate polymerase chain reaction. Nugent Gram stain scoring of vaginal swabs from 44 cases and 69 controls was also carried out. RESULTS: Denaturing gel gradient electrophoresis revealed three major types of band profiles corresponding to normal, intermediate and bacterial vaginosis microflorae. There were significantly more cases with bacterial vaginosis band profiles compared with controls (P = 0.024). More cases had intermediate or bacterial vaginosis Nugent scores compared with controls (P = 0.022). Conversely, controls were more likely to have normal scores than cases (P = 0.022). Atopobium vaginae was equally distributed between the cases and controls. CONCLUSIONS: Women in the Otago region undergoing preterm labour were approximately twice as likely to have a bacterial vaginosis type vaginal microflora as controls. In preterm labour, the incidence of bacterial vaginosis was comparable with that found elsewhere, suggesting that current guidelines for treatment and detection of this condition are appropriate.

Perspectives of Patients With Rheumatic Diseases in the Early Phase of COVID-19.

OBJECTIVE: To determine health perceptions of patients with rheumatic diseases in the early phase of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Rheumatology patients at a single center received via text message the Australian Rheumatology Association COVID-19 information sheet and an invitation to participate in a deidentified survey. Patient concerns regarding risks conferred by their rheumatologic disease or medications, impact of receiving the information sheet on the likelihood of staying on medication, and acceptance of telehealth were ascertained. RESULTS: A total of 2,630 patients received the text message, and the survey response rate was 21% (n = 550). The mean ± SD age of the participants was 52 ± 15.2 years, and 75.3% were female. Participants' highest ranked concern was that their medications would increase the severity of their COVID-19 symptoms (76.1%). The highest levels of concern were seen in patients taking combination conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and/or a biologic/targeted synthetic DMARD. There was no association between prednisolone dose and concern. While 63% of patients planned to continue their antirheumatic medications, a further 30% were more likely to continue taking their medications because of receiving the information. Telehealth was acceptable to 98.4% of patients, but 28.1% felt this was only appropriate while infection control measures were in place. CONCLUSION: Concerns regarding the risk of COVID-19 among patients taking antirheumatic drugs are common. Proactive dissemination of information is needed to address misconceptions related to medication risk, improve medication adherence, and minimize the risk of flares. Telehealth is acceptable to most patients during the COVID-19 pandemic.