Citation Information :
Kaje P, Singh B, Pushpalatha K, Gupta A. Evaluation of Endocervical Microbial Colonization in Premature Rupture of Membranes and Pregnancy Outcomes: A Cross-sectional Observational Study. J South Asian Feder Obs Gynae 2024; 16 (3):227-232.
Objective: Premature rupture of membranes (PROMs) is one of the common causes of preterm birth which has a major contribution to maternal and fetal adverse outcomes. Infection may be contributing to premature rupture of membrane or it may be a consequence. The aim of our study was to assess the common pathogens colonizing the endocervix in women with PROM and pregnancy outcomes.
Materials and methods: In this prospective observational study, seventy antenatal women with PROM after 24 weeks of gestation were studied from January 2020 to July 2021. Two swabs were taken from the endocervix. Swabs were subjected to gram staining and culture. The association of endocervical culture positivity with chorioamnionitis, mode of delivery, and neonatal outcome was evaluated.
Results: In the study, 24.2% of endocervical cultures were positive. The pathogens isolated were Escherichia coli in 11.4%, Staphylococcus hemolyticus in 2.9%, budding yeast in 2.9%, 1.4% each with Klebsiella pneumoniae and Methicillin-resistant Staphylococcus aureus (MRSA). The culture was positive in 30.3% of subjects with preterm PROM and 18.9% with PROM (p = 0.40). The incidence of chorioamnionitis was higher with endocervical culture-positive cases as compared to culture-negative women (p = 0.05). There was no association of endocervical culture positivity with the neonatal intensive care unit (NICU) admission, duration of membrane rupture, and mode of delivery.
Conclusion: In our study, the most common bacteria inhabiting the endocervix in PROM was E. coli. There is a definite influence of bacterial endocervical colonization on pregnancy outcomes but further studies are needed to corroborate the findings.
Saghafi N, Pourali L, Ghazvini K, et al. Cervical bacterial colonization in women with preterm premature rupture of membrane and pregnancy outcomes: A cohort study. Int J Reprod Biomed 2018;16(5):341–348. PMID: 30027150.
Zeng LN, Zhang LL, Shi J, et al. The primary microbial pathogens associated with premature rupture of the membranes in China: A systematic review. Taiwan J Obstet Gynecol 2014;53(4):443–451. DOI: 10.1016/j.tjog.2014.02.003.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice bulletin No. 172: Premature rupture of membranes. Obstet Gynecol 2016;128:e165–e77. DOI: 10.1097/AOG.0000000000001712.
Romero R, Miranda J, Chaemsaithong P, et al. Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med 2015;28(12):1394–1409. DOI: 10.3109/14767058.2014.958463.
Tchirikov M, Schlabritz–Loutsevitch N, Maher J, et al. Mid-trimester preterm premature rupture of membranes (PPROM): Etiology, diagnosis, classification, international recommendations of treatment options and outcome. J Perinat Med 2018;46(5):465–488. DOI: 10.1515/jpm-2017-0027.
Weinstein MP, Lewis JS, 2nd. The Clinical and Laboratory Standards Institute Subcommittee on antimicrobial susceptibility testing: Background, organization, functions, and processes. J Clin Microbiol 2020;58(3):e01864–e01919. DOI: 10.1128/JCM.01864-19.
Giuliano C, Patel CR, Kale–Pradhan PB. A guide to bacterial culture identification and results interpretation. P T 2019;44(4):192–200. DOI: PMID: 30930604.
Byonanuwe S, Nzabandora E, Nyongozi B, et al. Predictors of premature rupture of membranes among pregnant women in rural Uganda: A cross-sectional study at a tertiary teaching hospital. Int J Reprod Med 2020;2020:1862786. DOI: 10.1155/2020/1862786.
Assefa NE, Berhe H, Girma F, et al. Risk factors of premature rupture of membranes in public hospitals at Mekele city, Tigray, a case–control study. BMC Pregnancy and Childbirth 2018;18(1):386. DOI: 10.1186/s12884-018-2016-6.
Kerur BM, Vishnu Bhat B, Harish BN, et al. Maternal genital bacteria and surface colonization in early neonatal sepsis. Indian J Pediatr 2006;73(1):29–32. DOI: 10.1007/BF02758256.
Lajos GJ, Junior RP, Nomura ML, et al. Cervical bacterial colonization in women with preterm labor or premature rupture of membranes. Rev Bras Ginecol Obstet 2008;30(8):393–399. DOI: 10.1590/s0100-72032008000800004.
Loeb LJ, Gaither K, Woo KS, et al. Outcomes in gestations between 20 and 25 weeks with preterm premature rupture of membranes. South Med J 2006;99(7):709–712. DOI: 10.1097/01.smj.0000224302.43932.f7.
Dotters–Katz S. Antibiotics for prophylaxis in the setting of preterm prelabor rupture of membranes. Obstet Gynecol Clin North Am 2020;47(4):595–603. DOI: 10.1016/j.ogc.2020.08.005.
Kenyon S, Taylor D, Tarnow–Mordi W, et al. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: The ORACLE I randomised trial. ORACLE Collaborative Group. Lancet 2001;357(9261):979–988. DOI: 10.1016/s0140-6736(00)04233-1.
Arnold KC, Flint CJ. Use of prophylactic antibiotics in labor and delivery. Obstetrics Essentials: Springer; 2017, p. 129–133. DOI: 10.1007/978-3-319-57675-6_20.
Li YY, Kong CW, To WWK. Pathogens in preterm prelabour rupture of membranes and erythromycin for antibiotic prophylaxis: A retrospective analysis. Hong Kong Med J 2019;25(4):287–294. DOI: 10.12809/hkmj197991.
Yu H, Wang X, Gao H, et al. Perinatal outcomes of pregnancies complicated by preterm premature rupture of the membranes before 34 weeks of gestation in a tertiary center in China: A retrospective review. Biosci Trends 2015;9(1):35–41. DOI: 10.5582/bst.2014.01058.
Rzanek–Głowacka J, Pieta–Dolińska A, Zieba K, et al. Is the mother's bacterial vaginosis with PROM a significant factor for intrauterine infection of the fetus in preterm labor before 32 weeks of gestation. Ginekol Pol 2003;74:1262–1268. PMID: 14669428.
