ASSESSMENT OF VAGINAL INFECTION AND IDENTIFICATION OF MICROBES ASSOCIATED WITH UNEXPLAINED PRETERM LABOUR

Background: Preterm birth (< 37 completed gestation weeks) is a leading contributor to neonatal morbidity and mortality. Despite advances in perinatal medicine in recent decades, preterm delivery continues to pose a challenge to both the obstetricians and the neonatologists. Among many factors that trigger preterm labour, infection is a possible cause. The present study deals with the demographic and baseline characteristics of preterm labour patients, identification of vaginal flora and their relationship with unexplained preterm labour. Material and methods: For the present prospective observational study, 350 cases of preterm labour were included. All the pregnant women in the present study were enrolled after excluding all exclusion criteria. A thorough systemic and obstetric examination was done along with detailed history of each patient. Vaginal swab samples were taken from the posterior fornix of the vagina. Samples were examined microscopically and also inoculated onto appropriate culture media to identify vaginal flora and degree of infection. Results: Maximum cases of preterm labour were reported in females of the 20-25 years age group. Females of primigravida showed the highest number of preterm labour as well as infections. Concerning the gestation period (weeks), 34-36 weeks showed a higher frequency of preterm labour as well as infections.Incidence of preterm labour was higher in females who had a previous history of two preterm deliveries and who had a previous history of one abortion. Vaginal infection and urinary tract infection were reported in 34.57% and 24% of total cases studied, respectively. In vaginal swabs Lactobacillus, Gardnerella vaginalis, fungi(yeast), Candida, Gram positive Cocci, Escherichia coli and mixed microbes were the prevalent microorganisms identified. Gram staining results of vaginal swabs revealed the presence of Lactobacillus,Gardnerella vaginalis,Mobiluncus, Fungi(yeast),Gram positive bacilli,Gram negative cocci. Among these Lactobacillus and Gardnerella were the most common.In vaginal swab culture Enterococusspp,Streptococcusaureus,Escherichiacoli,Proteus mirabilis,Pseudomonas,Staphylococcus coagulase,Candida,Acetinobacter,Klebseillaand mixed microbes were isolated and identified.Among these Candida,Escherichia coliand mixed microbes were the most commonly isolated micro-organisms. Conclusion: Vaginal infection significantly contributes to the cause of preterm labour. It indicates the need to screen, all antenatal women for the precipitating cause of PTL, especially asymptomatic genitourinary infections. There should be measures to manage them as early recognition and timely and prompt treatment can help to reduce preterm labour cases and associated neonatal morbidity and mortality of premature newborns.