Genital infections and risk of premature rupture of membranes in Mulago Hospital, Uganda: a case control study

Abstract

BackgroundInflammatory mediators that weaken and cause membrane rupture are released during the course of genital infections among pregnant women. We set out to determine the association of common genital infections (Trichomonas vaginalis, syphilis, Neisseria gonorrhea, Chlamydia trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 and candidiasis) and premature rupture of membranes in Mulago hospital, Uganda.MethodsWe conducted an unmatched case–control study among women who were in the third trimester of pregnancy at New Mulago hospital, Uganda. The cases had PROM and the controls had intact membranes during latent phase of labour in the labour ward. We used interviewer-administered questionnaires to collect data on socio-demographic characteristics, obstetric and medical history. Laboratory tests were conducted to identify T. vaginalis, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 (HSV-2) and candidiasis. Logistic regression models were used to estimate the odds ratios (OR) and 95 % CI of the association between genital infections and PROM.ResultsThere was an association between PROM and abnormal vaginal discharge (OR = 2.02, 95 % CI 1.10–3.70 and AOR = 2.30, 95 % CI 1.18–4.47), presence of candidiasis (OR = 0.27, 95 % CI 0.14–0.52 and AOR = 0.22, 95 % CI 0.10–0.46) and T. vaginalis (OR = 2.98, 95 % CI 1.18–7.56 and AOR = 4.22, 95 % CI 1.51–11.80). However, there was no association between PROM and presence of C. trachomatis (OR = 2.05, 95 % CI 0.37–11.49) and HSV-2 serostatus (OR = 1.15, 95 % CI 0.63–2.09). Few or no patients with Bacterial vaginosis, Neisseria gonorrhoea, Group B streptococcus or syphilis were identified among the cases and controls. Co-infection of Trichomoniasis and candidiasis was not associated with PROM (AOR = 1.34, 95 % CI 0.16–11.10). Co infection with T. vaginalis and C. trachomatis was associated with PROM (OR = 3.09, 95 % CI 1.21–7.84 and AOR = 4.22, 95 % CI 1.51–11.83).ConclusionTrichomonas vaginalis alone, T. vaginalis with C. trachomatis co-infection and abnormal per vaginal discharge were found as risk factors for PROM. There was no association of HSV-2 serostatus, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus and Bacterial vaginosis with PROM. Candidiasis seemed to have a protective effect on PROM.

Estimated burden of fungal infections in Kenya

“…Recurrent VVC is an unpleasant problem for women with many psychological consequences as well as being costly in terms of medical consultation time and treatment cost. There are some data consistent with pre-term premature membrane rupture related to vaginal Candida colonization in women during late pregnancy [48][49][50]. Some fluconazole resistance among Candida spp isolated from women with VVC have been identified by recent studies [51].…”

Predictors of Premature Rupture of Membranes among Pregnant Women in Rural Uganda: A Cross-Sectional Study at a Tertiary Teaching Hospital

“…Nevertheless, the efforts of various scholars have continued to demonstrate the association of various obstetric and gynaecologic factors with premature rupture of membranes such as prior history of PROM or preterm labour, genital infections, prior abortions, multiple gestation, polyhydramnios, and prior cervical procedures [11][12][13][14][15] among others. A few available recently conducted studies in central Uganda have only attempted to describe the association of genital infections with PROM [16,17]. There is paucity of information as regards predictors of PROM in western Uganda.…”

Effect of suppressive acyclovir administered to HSV-2 positive mothers from week 28 to 36 weeks of pregnancy on adverse obstetric outcomes: a double-blind randomised placebo-controlled trial

“…In a Nigerian Referral and Teaching Hospital in Enugu, 4.3% of pregnancies were complicated by PROM [9]. In Mulago Hospital, PROM complicates about 12% of women admitted in the labour ward in Mulago Hospital [10]. …”