Bacterial flora of the genital tract in pregnancy and early labour

  • AO Sule-Odu Department of Obstetrics and Gynaecology, Olabisi Onabanjo University, Sagamu
  • AA Akadiri
  • AA Oluwole
  • OA Osinupebi
  • BA Andu
  • AK Akiseku
  • AI Lawal
  • KS Oritogun
Keywords: Bacterial flora, Early Labour, Early Third Trimester, Foetal Outcome, Genital tract, Sagamu

Abstract

Background: Bacterial infections of the reproductive tract are common during pregnancy and have been associated with some pregnancy-related morbidities. There is limited information on the prevalence of bacterial infection of the reproductive tract during labour.

Objective: To compare the prevalence of bacterial colonisation of the reproductive tract of pregnant women in early third trimester and early labour, and determine the associated foetal outcome.

Methods: High vaginal swabs were collected from 201 pregnant women with gestational age from 26 to 32 weeks at the antenatal clinic of a Nigerian teaching hospital. The samples were processed to isolate bacterial organisms. Repeat samples were collected in early labour. The foetal outcome was assessed and recorded.

Results: The prevalence of bacterial colonisation was 31.3% in early third trimester and 21.9% in early labour (p = 0.032). Staphylococcus aureus was the most prevalent organism isolated. Cefoxitin and imipenem were the most sensitive antibiotics. Women who had positive bacterial cultures in pregnancy had a slightly higher risk of low birth weight babies (RR 1.9, CI 0.9-3.7) and neonatal hospitalization (RR 1.8, CI 0.9-3.4) but without statistical significance (p = 0.05, and p = 0.06 respectively).

Conclusion: The prevalence of bacterial colonisation of the reproductive tract of pregnant women was significantly higher in early third trimester than in early labour. There was no significant difference in pregnancy outcome between women who had positive bacterial cultures and those with negative cultures.

References

Cohen CR, Lingappa JR, Baeten JM, Ngayo MO, Spiegel CA, Hong T, et al. Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples. PLoS Med 2012; 9: e1001251.

Dey BC, Koley AK, Saha D, De SK, Saha A. Different types of vaginal infection in pregnancy and its risk factors- A study in urban Medical College Hospital of India. Sch J App Med Sci 2013; 1: 962-966.

Giraldo PC, Araujo ED, Junior JE, do Amaral RL, Passos MR, Gonҫalves AK. The prevalence of urogenital infections in pregnant women experiencing preterm and full-term labor. Infect Dis Obstet Gynecol 2012; 2012:878241. doi: 10. 1155/2012/878241

Xu F, Du X, Xie L. Vaginitis in pregnancy is related to adverse perinatal outcome. Pak J Med Sci 2015; 31:582-586. http://dx.doi.org/10.12669/pjms.313.6752.

Abdelaziz ZA, Ibrahim ME, Bilal NE, Hamid ME. Vaginal infections among pregnant women at Omdurman Maternity Hospital in Khartoum, Sudan. J Infect Dev Ctries 2014; 8: 490-497. doi:10.3855/jidc.3197.

Svare JA, Schmidt H, Hansen BB, Lose G. Bacterial vaginosis in a cohort of Danish pregnant women: prevalence and relationship with preterm delivery, low birth weight and perinatal infections. British J Obstet Gynecol 2006; 113: 1419-1425.

Sule-Odu AO, Akadri AA, Adeiyi TO, Sotunsa JO, Durojaiye BO, Oluwole AA. Asymptomatic genital infection among pregnant women in Sagamu, Nigeria. Trop J Obstet Gynaecol 2015; 32: 7-13.

Dalzell JE, Lefevre ML. Urinary tract infections during pregnancy. Am Fam Physician 2000; 61: 713–721

Leitich H, Bodner-Adler B, Brunbauer M, Kaider A, Egarter C, Husslein P. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol. 2003; 189: 139-147.

Gibbs RS. The relationship between infections and adverse pregnancy outcomes: an overview. Ann Periodontol 2001; 6: 153–163.

Amalokwu S, Okonta PI, Ebunu E. Prevalence of bacterial vaginosis among antenatal attendees with abnormal vaginal discharge in a secondary health facility in Delta State, Nigeria. Trop J Obstet Gynaecol 2019; 36: 85-88.

Afolabi BB, Moses OE, Oduyebo OO. Bacterial vaginosis and pregnancy outcome in Lagos, Nigeria. Open Forum Infect Dis 2016; 3(1): ofw030. doi: 10.1093/ofid/ofw030.

Barry AL, Thornberry C. Susceptibility tests: Diffusion test procedures. In: Ballows A, Hausler WJ, Herrmann KL, Isenberg HD, Shadomy HJ (Editors). Manual of Clinical Microbiology. 5th Edition. Washington D.C: American Society of Microbiology. 1991: 1117-1125.

Sangkomkamhang US, Lumbiganon P, Prasertcharoensuk W, Laopaiboon M. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery. Cochrane Database Syst Rev. 2015; (2): CD006178. doi: 10.1002/14651858.CD006178.pub3.

van de Wijgert J, Verwijs MC. Lactobacilli-containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review and recommendations for future trial designs. BJOG 2020; 127: 287-299. doi: 10.1111/1471-0528.15870

Akerele J, Abhulimen P, Okonofua F. Prevalence of asymptomatic genital infection among pregnant women in Benin City, Nigeria. Afr J Reprod Health 2002; 6: 93-97.

Rathod S, Vijayalakshmi S. Prevalence of vaginitis during pregnancy and its fetomaternal outcome in the rural setup. Int J Reprod Contracept Obstet Gynecol 2016: 5: 1823-1826.

Sangeetha S, Bendigeri. A study of reproductive tract infections among pregnant women in the reproductive age group, in Urban Field Practice Area in Hubli, Karnataka, India. Ann Trop Med Public Health 2012; 5: 209-213

Mobasheri M, SaeediVarnamkhast N, Karimi A, Banaeiyan S. Prevalence study of genital tract infections in pregnant women referred to health centers in Iran. Turk J Med Sci 2014; 44: 232-236.

Marai W. Lower genital tract infections among pregnant women: a review. East Afr Med J 2001; 78: 581-585.

Adams Waldorf KM, McAdams RM.Influence of infection during pregnancy on fetal development. Reproduction 2013; 146: R151–R162. doi:10.1530/REP-13-0232.

Ngonzi J, Bebell LM, Bazira J, Fajardo Y, Nyehangane D, Boum Y, et al. Risk factors for vaginal colonization and relationship between bacterial vaginal colonization and in-hospital outcomes in women with obstructed labor in a Ugandan regional referral hospital. Int J Microbiol 2018; 2018:6579139. doi: 10.1155/2018/6579139.

Published
2020-08-22
Section
Original Research