The Prevalence of Vaginal Microorganisms in Pregnant Women with Preterm Labor and Preterm Birth

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Abstract

Background

To investigate the risk factors for vaginal infections and antimicrobial susceptibilities of vaginal microorganisms among women who experienced preterm birth (PTB), we compared the prevalence of vaginal microorganisms between women who experienced preterm labor (PTL) without preterm delivery and spontaneous PTB.

Methods

Vaginal swab specimens from 126 pregnant women who experienced PTL were tested for group B streptococcus (GBS), Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, Treponema pallidum, herpes simplex virus (HSV) I and II, and bacterial vaginosis. A control group of 91 pregnant women was tested for GBS. Antimicrobial susceptibility tests were performed for GBS, M. hominis, and U. urealyticum.

Results

The overall detection rates for each microorganism were: U. urealyticum, 62.7%; M. hominis, 12.7%; GBS, 7.9%; C. trachomatis, 2.4%; and HSV type II, 0.8%. The colonization rate of GBS in control group was 17.6%. The prevalence of GBS, M. hominis, and U. urealyticum in PTL without preterm delivery and spontaneous PTB were 3.8% and 8.7% (relative risk [RR], 2.26), 3.8% and 17.3% (RR, 4.52), and 53.8% and 60.9% (RR, 1.13), respectively, showing no significant difference between the 2 groups. The detection rate of M. hominis by PCR was higher than that by culture method (11.1% vs. 4.0%, P=0.010). The detection rates of U. urealyticum by PCR and culture method were 16.7% and 57.1%, respectively.

Conclusions

There was no significant difference in the prevalence of GBS, M. hominis, and U. urealyticum between the spontaneous PTB and PTL without preterm delivery groups.

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Most cited references 24

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Classification and heterogeneity of preterm birth.

Jean-Marie Moutquin (2003)

Three main conditions explain preterm birth: medically indicated (iatrogenic) preterm birth (25%; 18.7-35.2%), preterm premature rupture of membranes (PPROM) (25%; 7.1-51.2%) and spontaneous (idiopathic) preterm birth (50%; 23.2-64.1%). The majority of multiple pregnancies (10% of all preterm births) are delivered preterm (50% for medical reasons). Although medical indications relate more to feto-maternal conditions, PPROM to infections and idiopathic preterm birth to lifestyle, these risk factors are identified in any category, emphasising that preterm birth has a multifactorial origin. Still, several incidences of preterm birth are not completely explained with a plausible cause for PPROM or spontaneous preterm labour suggesting that other causes have yet to be identified. In addition, preterm birth is associated with unrecognised severe congenital anomalies. Variability within the main categories may be explained by the studied population, ethnic group, social class and preventive interventions towards reducing spontaneous preterm birth where the proportion of medically-indicated preterm birth is increased. Despite being retrospective a classification according to gestational age at birth is important for neonatal prognosis. Preterm birth is stratified into mild preterm (32-36 weeks), very preterm (28-31 weeks) and extremely preterm (<28 weeks) with increasing neonatal mortality and morbidity. Recent studies suggested that infection was mostly responsible for extreme preterm birth, while stress and lifestyle accounted for mild preterm birth, and a mixture of both conditions contributed to very preterm birth.

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A review of premature birth and subclinical infection.

Frederico Romero, D Eschenbach, Charles R. Sweet … (1992)

Premature birth causes high rates of neonatal morbidity and mortality. There are multiple causes of preterm birth. This article reviews the evidence linking subclinical infection and premature birth. Although maternal genital tract colonization with specific organisms has been inconsistently associated with preterm birth and/or premature rupture of membranes, some infections have been consistently associated with preterm delivery. The association of histologic chorioamnionitis with prematurity is a consistent finding, but the mechanisms require further study. The relationship between histologic chorioamnionitis infection and the chorioamnionitis of prematurity requires additional research. A varying number of patients in "idiopathic" preterm labor have positive amniotic fluid cultures (0% to 30%), but it is not clear whether infection preceded labor or occurred as a result of labor. Evidence of subclinical infection as a cause of preterm labor is raised by finding elevated maternal serum C-reactive protein and abnormal amniotic fluid organic acid levels in some patients in preterm labor. Biochemical mechanisms for preterm labor in the setting of infection are suggested by both in vitro and in vivo studies of prostaglandins and their metabolites, endotoxin and cytokines. Some, but by no means all, antibiotic trials conducted to date have reported decreases in prematurity. These results support the hypothesis that premature birth results in part from infection caused by genital tract bacteria. In the next few years, research efforts must be prioritized to determine the role of infection and the appropriate prevention of this cause of prematurity.

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Preterm birth due to maternal infection: Causative pathogens and modes of prevention.

C Skevaki, M V Pararas, D A Kafetzis (2006)

Preterm birth represents a major problem for modern obstetrics due to its increasing frequency and the accompanying socioeconomic impact. Although several maternal characteristics related to preterm birth have been identified, the etiology in most cases remains inadequately understood. Various microorganisms have been linked to the pathogenesis of preterm birth. Microbes may reach the amniotic cavity and fetus by ascending from the vagina and cervix, by hematogenous distribution through the placenta, by migration from the abdominal cavity through the fallopian tubes, or through invasive medical procedures. Organisms commonly cultured from the amniotic cavity following preterm delivery include Ureaplasma urealyticum, Mycoplasma hominis, Bacteroides spp., Gardnerella vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and group B hemolytic streptococci. Several trials have examined the effect of antibiotic administration to patients with preterm labor and intact membranes, preterm premature rupture of the membranes, genital mycoplasmal infection, asymptomatic bacteriuria, and bacterial vaginosis. The results of such studies, which were variable and often conflicting, are discussed here.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Lab Med

Journal ID (iso-abbrev): Ann Lab Med

Journal ID (publisher-id): ALM

Title: Annals of Laboratory Medicine

Publisher: The Korean Society for Laboratory Medicine

ISSN (Print): 2234-3806

ISSN (Electronic): 2234-3814

Publication date (Print): May 2012

Publication date (Electronic): 18 April 2012

Volume: 32

Issue: 3

Pages: 194-200

Affiliations

[1 ]Department of Obstetrics & Gynecology, Yonsei University Wonju College of Medicine, Wonju, Korea.

[2 ]Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

[3 ]Department of Laboratory Medicine, Seoul Medical Science Institute, Seoul, Korea.

Author notes

Corresponding author: Young Uh. Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju 220-701, Korea. Tel: +82-33-741-1592, Fax: +82-33-731-0506, u931018@ 123456yonsei.ac.kr

Article

DOI: 10.3343/alm.2012.32.3.194

PMC ID: 3339299

PubMed ID: 22563554

SO-VID: 027fa2fe-1092-4e29-827f-6a9512f5dfb1

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 17 October 2011

Date revision received : 11 December 2011

Date accepted : 08 February 2012

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The Prevalence of Vaginal Microorganisms in Pregnant Women with Preterm Labor and Preterm Birth

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Abstract

Background

Methods

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Conclusions

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Journal of Circulating Biomarkers

Most cited references 24

Classification and heterogeneity of preterm birth.

A review of premature birth and subclinical infection.

Preterm birth due to maternal infection: Causative pathogens and modes of prevention.

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