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Proceedings S.Z.M.C. Vol: 35(3): pp. 50-53, 2021.    PSZMC-808-35-3-2021 
 

Prevalence of Bacterial Vaginosis During Pregnancy  
in Tertiary Care Hospital, Lahore 
1Amna Javed, 1Muhammad Ikram, 1Shafqat Mukhtar, 3Saulat Sarfraz, 1Ayesha Shahid, 
2Aman Ur Rehman 
1Department of Obstetrics and Gynecology, Shaikh Zayed Medical Complex, Lahore 
2Department of Histopathology, Shaikh Zayed Medical Complex, Lahore 
3Department of Radiology, Shaikh Zayed Medical Complex, Lahore 

 

ABSTRACT 

Introduction: Pregnancy is a condition usually associated with increased vaginal discharge including vaginal infections 
like bacterial vaginosis, leading to adverse perinatal outcomes due to disturbance in vaginal ecosystem that warrants 
further evaluation and timely management. 
Aims & Objectives: The study was conducted to determine the prevalence of bacterial vaginosis in pregnancy and its 
contributing factors. 
Place and duration of study: Out Patient Department of Obstetrics & Gynecology, Shaikh Zayed Hospital, Lahore. 
Duration of the study was six months. 
Material & Methods: 120 pregnant females with age 20-40 years with singleton pregnancy of more than 12 weeks’ 
gestation were included. Women who were immunosuppressed and history of diabetes and hypertension and recent 
history of use of antibiotics were excluded. Vaginal swab specimen was taken & bacterial vaginosis was labelled after 
fulfilling Amsel criteria. Data was analyzed using SPSS version 21. 
Results: In this study, 120 cases were taken and mean age of participants was 27.55±3.97 years. The mean duration of 
gestation was 18.76±6.14 weeks. Bacterial vaginosis (BV) was seen in 24 (20%) of the cases. BV was seen in 19 
(20.65%) cases with age 20-29 years’ vs 5 (17.86%) cases in age group 20-40 years with p= 1.0. Bacterial vaginosis was 
nearly significantly high in multiparous women where this was seen in 13 (27.65%) cases as compared to 11 (15.06%) 
cases in primiparous women with p= 0.11. Out of 20 cases of bacterial vaginosis, low education was seen in 12 (60%) of 
the cases. 
Conclusion: The prevalence of bacterial vaginosis in pregnancy at local setup is high and is seen nearly in 1 out of 5 
cases. This demands health educational programs to enlighten women regarding screening and early detection & 
treatment to prevent complications during pregnancy. 
 

Key words: Amsel criteria, Bacterial vaginosis, Female Genital Health, Pregnancy, Vaginal Flora. 
 
 

INTRODUCTION 

Normally, vaginal ecosystem is characterized by 
the presence of Gram-positive Lactobacillus which 
plays an important role in maintaining female 
genital health. Disturbance in vaginal ecosystem and 
simultaneous replacement of normal flora with 
anaerobic bacteria leads to bacterial vaginosis 
causing malodorous vaginal discharge.1 Pregnancy 
is a condition usually associated with increased 
vaginal discharge including vaginal infections like 
bacterial vaginosis, leading to adverse perinatal 
outcomes including risk of late miscarriages, 
preterm labor, risk of chorioamnionitis and 
postpartum wound infections or endometritis.2,3 
The prevalence of bacterial vaginosis ranges from 
5% to 58.5% in different population and in 
pregnancy, its prevalence is 11-16% in developed 
countries.2,3 Recent studies showed significant 

reduction in adverse outcomes with the help of 
appropriate screening and treatment.4 Due to   
adverse perinatal outcomes associated with bacterial 
vaginosis especially in pregnancy, pathological 
vaginal discharge warrants further evaluation and 
timely management. In spite of 20% prevalence of 
bacterial vaginosis in pregnancy, evidence of 
epidemiology of BV in pregnancy in developing 
countries is still scarce.5 
This study aims to provide data on prevalence of 
bacterial vaginosis among pregnant females and its 
contributing factors for early screening and 
detection which will be beneficial to prevent 
adverse perinatal outcome and improve quality of 
health. 
 

MATERIAL AND METHODS 

A cross sectional study was done in Out Patient 
Department of Obstetrics & Gynecology, Shaikh 
Zayed Hospital, Lahore from 01-04-2019 to 01-10-

 



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Prevalence of Bacterial Vaginosis During Pregnancy in Tertiary Care Hospital, Lahore 

 

2019 enrolling 120 pregnant females with age 20-40 
years with singleton pregnancy of more than 12 
weeks gestation via non probability consecutive 
sampling technique. Women who were 
immunosuppressed and history of diabetes and 
hypertension and recent history of use of antibiotics 
(within 4 weeks) were excluded.  
After the approval of Ethical Committee of Shaikh 
Zayed Hospital (SZH), Lahore an informed consent 
was taken from each patient fulfilling the inclusion 
criteria. Socio demographics and clinical data like 
age, parity, monthly household income, level of 
education and duration of gestation at presentation 
was taken and recorded on a specially designed 
proforma. 
All cases underwent vaginal examination by 
Cusco’s Speculum and a sterile swab specimen was 
taken from vagina and was examined by using 
Amsel criteria: (three of the following four criteria 
must be present)6: presence of homogenous white-
grey vaginal discharge, presence of clue cells under 
microscope & a fishy amine odor of the vaginal 
discharge before and after addition of 10% KOH 
(positive whiff test); a vaginal pH of > 4.5. 
 
Statistical analysis: 
Data was analyzed with the help of SPSS version 
21. Quantitative variables like age and duration of 
gestation at presentation were documented in terms 
of mean ± SD (Standard Deviation). Frequency & 
percentages were calculated for parity, monthly 
household income and bacterial vaginosis. 
Effect modifiers were controlled through 
stratification of age, parity, monthly household 
income, educational status, trimester of pregnancy 
to see the effect on bacterial vaginosis. P-value ≤ 
0.05 was taken as significant. 
 

RESULTS 

In this study there were total 120 cases and the mean 
age of the participants was 27±3.97 years and mean 
duration of gestation was 18 ±6.14 weeks as in 
Table-1. 
Frequency of parity and monthly household income 
is depicted in Table-2. Bacterial vaginosis (BV) was 
seen in 24 (20%) of the cases (Table-2). 
BV was seen in 19 (20.65%) cases with age 20-29 
years vs 5 (17.86%) cases in age group 30-40 years 
with p=1.0. Bacterial vaginosis frequency was 
increased in multiparous women i.e. 13 (27.65%) 
cases as compared to 11 (15.06%) cases in 
primiparous women with p= 0.11. Also it was high 
in women with low education 19 (22.35%) as 
compared to 5 (14.28%) with higher education 

(p=0.34) There was no significant association of BV 
with monthly household income and trimester of 
pregnancy (Table-3). 
 

 Age  (years) 
Duration of 

gestation (weeks) 
Mean 27 18 

Std. Deviation 3.97 6.14 
Table-1: Age & duration of gestation at presentation in 

study subjects (n= 120) 
 

Factors Frequency 
N=120 

Percentage 

Parity 
Primiparous 
Multiparous 

 
73 
47 

 
60.83% 
39.17% 

Monthly household 
Income  
<Rs. 20,000/- 
>Rs. 20,000 

 
 
72 
48 

 
 
60.00% 
40.00% 

Bacterial Vaginosis 
Present 
Absent 

 
24 
96 

 
20.00% 
80.00% 

Table-2: Frequency and percentage of factors in study 
subjects (n=120) 

 
Sociodemographic 

Bacterial Vaginosis Total P value Yes No 
Age 
20-29 
30-40 
Total 

19 (20.65%) 
5 (17.86%) 
24 (20%) 

73 (79.35%) 
23 (82.14%) 
96 (80%) 

92 (100%) 
28 (100%) 
120(100%)

1.0 

Parity 
Primiparous 
Multiparous 
Total 

11 (15.06%) 
13 (27.65%) 
24 (20%) 

62 (84.94%) 
34 (72.35%) 
96 (80%) 

73 (100%) 
47 (100%) 
120(100%

0.11 

Monthly 
household Income 
<Rs 20,000/- 
>Rs. 20,000/- 
Total 

14 (19.44%) 
10 (20.83%) 
24 (20%) 

58 (80.56%) 
38 (79.17%) 
96 (80%) 

72 (100%) 
48 (100%) 
120(100%

1.0 

Educational 
status 
Under-Graduate 
Graduate&Above 
Total 

19 (22.35%) 
5 (14.28%) 
24 (20%) 

66 (77.65%) 
30 (85.72%) 
96 (80%) 

85 (100%) 
35 (100%) 
120(100%

0.34 

Gestational Age 
(Trimester Wise) 
2nd 
3rd 
Total 

14 (17.5%) 
10 (25%) 
24 (20%) 

66 (82.5%) 
30 (75%) 
96 (80%) 

80 (100%) 
40 (100%) 
120(100%

 
0.61 

Table-3: Association of bacterial vaginosis with 
sociodemographic factors. (n= 120) 

 
DISCUSSION 

Globally bacterial vaginosis is an emerging 
gynaecologic concern especially in women of 
childbearing age because this is considered as one of 



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Prevalence of Bacterial Vaginosis During Pregnancy in Tertiary Care Hospital, Lahore 

 

the risk factors for adverse perinatal outcomes 
including risk of miscarriages, preterm labour, 
preterm premature rupture of membranes, and 
postpartum wound infections.7 
The methods for diagnosis of Bacterial Vaginosis 
also have a great impact on the variation of 
Bacterial Vaginosis prevalence. Although the gold 
standard for diagnosis of BV is proposed by Nugent. 
But the clinical criteria by Amsel6 is suitable for 
daily routine as it does not require laboratory 
facilities hence, no delay in reporting. It is arduous 
to evaluate all of these criteria for diagnosis in busy 
practice; and requires the ability of the 
gynaecologist to analyze wet mount microscopy.8,9 
In the present study Bacterial vaginosis (BV) was 
seen in 24 (20%) out of the 120 cases. These results 
were comparable to the findings of the previous 
studies where almost similar burden of the disease 
was found. According to a study done by Ibrahim 
SM et al, the bacterial vaginosis was seen in 17.3% 
of pregnant cases.10 Slightly higher percentages 
were noted by the results of other studies, where 
they revealed this percentage in more than 30% of 
the cases. Romoren M et al. revealed BV in 38% of 
the pregnant ladies.11 while in another study by 
Habib A & Siddiqui I revealed its prevalence as 
35.3% of cases.12 This variability of the results can 
be due to difference in criteria for diagnosis. In 
another study regarding the prevalence and it 
contributing factors this was noted in 19.4%, in their 
study by Mangistie Z et al.13 The incidence of BV is 
30-35% in a study conducted by Ries AJ.14 
However, study by Gul F, et al. showed frequency 
of BV of about 2.5% in women presenting to 
antenatal clinic of a tertiary care hospital in 
Peshawar.15 
Furthermore, regarding various contributing factors 
leading to bacterial vaginosis, Mengistie Z et al. 
found higher number of cases having bacterial 
vaginosis in younger age (21-29 year) where this 
was seen in 21.2%, low educational status (less than 
12 grade) in 23.1% and 3rd trimester pregnancy in 
14% of the cases.13 These results were also 
comparable to the present study findings, where BV 
was seen in 19 (20.65%) cases with age 20-29 
years’ vs 5 (17.86%) cases in age group 20-40 years 
with p= 1.0; though this difference was statistically 
insignificant. And among various contributing 
factors leading to bacterial vaginosis, low education 
was seen in 19 (22.35%) of the cases while 3rd 
trimester of pregnancy had 10 (25 %) cases and 
younger age group was seen in 19 (20.65%) cases 
each. 
In another study conducted by Chaudhury and 
colleagues, the peak age of BV was 25-34 years.16 

In index study the peak age of infection was 20-29 
years. 
There were few limitations of this study as this 
study did not look for concomitant contributing 
factors like urinary tract infection which was an 
important confounder and also did not look for the 
feto -maternal outcomes. 
However, there were many strengthening points as 
well as this study highlighted a very underrated 
entity. 
 

CONCLUSION 
 

The prevalence of bacterial Vaginosis in pregnancy 
at local setup is high and is seen nearly in 1 out of 5 
cases. Among various contributing factors low 
education was the commonest. This demands for 
health educational programs to enlighten women 
regarding screening and early detection & treatment 
to prevent complications during pregnancy. 
 

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The Authors: 
Dr. Amna Javed 
Assistant Professor, 
Department of Obstetrics and Gynecology, 
Shaikh Zayed Medical Complex, Lahore. 
 
Prof. Muhammad Ikram 
Head, Department of Obstetrics and Gynecology, 
Shaikh Zayed Medical Complex, Lahore. 
 
Prof. Shafqat Mukhtar 
Head, Department of Obstetrics and Gynecology, 
Shaikh Zayed Medical Complex, Lahore. 
 
Prof. Aman Ur Rehman 
Head, Department of Histopathology, 
Shaikh Zayed Medical Complex, Lahore. 
 
Dr. Saulat Sarfraz 
Head, Department of Radiology, 
Shaikh Zayed Medical Complex, Lahore. 
 
Dr. Ayesha Shahid 
PG Trainee, 
Department of Obstetrics and Gynecology, 
Shaikh Zayed Medical Complex, Lahore. 
 
Corresponding Author: 
Dr. Amna Javed 
Assistant Professor, 
Department of Obstetrics and Gynecology, 
Shaikh Zayed Medical Complex, Lahore. 
E-mail: amnamuddassar@gmail.com