For the purpose of this study, grade I or Lactobacillus-dominated vaginal microflora is designated as ‘normal vaginal microflora’ and all other grades as ‘abnormal vaginal microflora’. Table 2 Overview of microflora patterns on Gram stain on follow-up for patients who displayed an abnormal microflora in the first trimester (n = 23) patient number trimester I trimester II trimester III PB2003/070 MEK inhibitor I-like Ib Ia PB2003/106

I-like Ib Ib PB2003/120 I-like III Ia PB2003/117 Tucidinostat cost I-like I-like I-like PB2003/088 I-like I-like IV PB2003/121 II Ia Ia PB2003/123 II Iab Ia PB2003/012 II Ib Ib PB2003/108 II I-like Ia PB2003/063 II I-like I-like PB2003/076 II II Ib PB2003/017 II III Ib PB2003/080 II I-like IV PB2003/044 II II I-like PB2003/046 II II II PB2003/105 II II II PB2003/078 III Ib Ib PB2003/079 III Ib Ib PB2003/094 III I-like Ia PB2003/132 III III III PB2003/144 Angiogenesis inhibitor IV I-like Ib PB2003/025 IV I-like I-like PB2003/008 IV IV IV Gram stained vaginal smears were scored

according to the criteria previously described by Verhelst et al [7]. Briefly, Gram-stained vaginal smears were categorized as grade I (normal) when only Lactobacillus cell types were present, as grade II (intermediate) when both Lactobacillus and bacterial vaginosis-associated cell types were present, as grade III (bacterial vaginosis) when bacterial vaginosis-associated cell types were abundant in the absence of lactobacilli, as grade IV when only gram-positive cocci mafosfamide were observed, and as grade I-like when irregularly shaped or curved gram-positive rods were predominant [7]. For the purpose of this study, grade I or Lactobacillus-dominated vaginal microflora is designated as ‘normal vaginal microflora’ and all other grades as ‘abnormal vaginal microflora’. Among

the 13 women with grade I VMF during the first trimester and who converted in the second or third trimester to abnormal VMF (Table 1), the transition involved once a transition from grade Ia VMF to abnormal VMF (grade I-like) (1/18 or 5.6%), twelve times a transition from grade Ib VMF to abnormal VMF (grade I-like (4), grade II (7), and grade III (1)) (12/43 or 27.9%), while none of the 16 women with grade Iab VMF converted to abnormal VMF (Table 1). Accordingly, compared to grade Ia and grade Iab VMF, grade Ib VMF were about 10 times (RR = 9.49, 95% CI 1.30 – 69.40) more likely to convert from normal to abnormal VMF (p = 0.009). Prevalence of Lactobacillus species according to tRFLP and culture at baseline and on follow-up We further elaborated on the above findings through the study of the prevalence over time of the distinct Lactobacillus species as determined through tRFLP and culture. Through tRFLP and culture, the vaginal lactobacilli comprising the grade I VMF were identified to be predominantly one or more of four different Lactobacillus species, i.e., L. crispatus, L. jensenii, L. gasseri and L.