Contribution of vaginal infection to preterm premature rupture of membrane and adverse pregnancy outcome

Abstract

Background: Preterm premature rupture of membranes (PPROM) is the cause of approximately one third of preterm deliveries. Objectives: assess the relation of vaginal infections and their antimicrobial profile with PPROM and pregnancy outcome. Methodology: Case control study of 320 females with PPROM (case) and 320 females with normal pregnancy (control) at 28-37 weeks of gestation. Vaginal examination, vaginal pH assessment and Whiff test were done. Vaginal swabs were collected and examined microscopically for diagnosis of different vaginal infections. Swabs were cultivated, identification and antimicrobial susceptibility of revealed bacteria were done. Maternal and neonatal outcomes were assessed. Results: Bacterial vaginosis and aerobic vaginitis were identified in 29.1% and 17.3% of all participants respectively. There was statistically significant difference regarding prevalence of different vaginal infections in case and control groups (p<0.001). Aerobic vaginitis and bacterial vaginosis were risk factors for PPROM. Streptococcus agalactiae was the most prevalent organism. Erythromycin and ampicillin were the least effective antibiotics against Gram positive and Gram-negative isolates respectively. There was significant increase of all maternal and fetal adverse outcomes in cases with aerobic vaginitis. Conclusion: Different vaginal infections carry risk of PPROM and adverse maternal and neonatal outcomes. The variation in prevalence of bacterial isolates in different studies and localities notify the lack of standardized treatment for infected mothers. Accurate diagnosis of vaginal infection, precise medical treatment during pregnancy is essential for maintenance of maternal and neonatal health.