European Journal of Molecular & Clinical Medicine

Abstract

Background: Upper vaginal tract infection during pregnancy manifesting in the form of Vaginitis, vaginal discharge, has emerged as a major health problem responsible for preterm premature rupture of membranes (PPROM), preterm labour, neonatal and puerperal sepsis. Preterm deliveries come with their own challenges, both for the mother and new-born. High vaginal swab culture positivity during pregnancy for common pathogens, namely Group B Streptococcus, Klebsiella Pneumonia, Escherichia coli, Staphylococcus aureus may predict the predisposition of the mother to PPROM, chorioamnionitis and subsequent neonatal complications.
Methodology: A retrospective study was conducted to analyze feto-maternal outcome of 200 expectant mothers who were admitted for safe confinement after 28 weeks of gestation and were tested for high vaginal swab (HVS) culture & sensitivity, dividing them into two groups, based on the results of their HVS culture i.e., sterile versus nonsterile cases.
Results: 98 patients tested positive for various microorganisms, out of which 60 samples showed mixed flora, 20 Gram positive Cocci, 15 Gram Negative Bacilli, and 3 showed growth of Candida. The most common organisms isolated in high vaginal swabs were Diphtheroids (31%), Coagulase Negative Staphylococcus (8.10%), Escherichia coli (7.10%), Staphylococcus aureus (5.10%) and Candida albicans (3%). The rest 102 samples were sterile. A significant association was found between maternal C-reactive protein (CRP) & increased neonatal morbidity with positive HVS. However, the results of positive HVS culture showed no significant association with other adverse maternal outcomes such as puerperal sepsis and preterm labour.
Conclusion: Ascending intrauterine infections remain an important cause of preterm labour, PPROM, chorioamnionitis, etc. and eventually poor neonatal outcome. Timely treatment with appropriate antibiotics can go a long way in treating the same. But larger studies are needed to prove the same and to make high vaginal swab a useful screening tool for all antenatal patients to prevent complications and overall improvement of feto-maternal outcome.