Multimodality screening for lower genital tract infections between 18 and 24 weeks of pregnancy and its efficacy in predicting spontaneous preterm delivery

Poojari, Vidyashree G and Dawson, Samantha and Vasudeva, Akhila and Hegde, Nivedita and Kaipa, Geetha and Eshwara, Vandana Kalwaje and Tellapragada, Chaitanya and Kumar, Pratap (2020) Multimodality screening for lower genital tract infections between 18 and 24 weeks of pregnancy and its efficacy in predicting spontaneous preterm delivery. The Journal of Obstetrics and Gynecology of India, 70 (1). pp. 36-43. ISSN 0971-9202

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Abstract

Background Predicting spontaneous preterm birth (SPTB) during mid-trimester would be very useful. We used a multimodality screening approach mainly focusing on urogenital infections among unselected obstetric population between 18 and 24 weeks in a tertiary center. Method Diagnosis of lower genital tract infection (LGTI) was attempted among 228 pregnant women using several factors— symptom of vaginal discharge, characteristic appearance of discharge on speculum, point of care tests using Amsel’s criteria and gram staining of vaginal swab. Nugent’s scoring was taken as gold standard. Urine microscopy/culture was obtained. Serum infammatory markers were done. Total leukocyte count, neutrophil/lymphocyte ratio and C-reactive protein were obtained. Data on cervical length were obtained from mid-trimester scan. Results Thirty patients complained of vaginal discharge. Speculum examination revealed discharge in 221 (96.92%), appearing pathological in 192 (86.87%). Amsel’s criteria showed poor sensitivity to detect full (57%) and partial (24%) bacterial vaginosis (BV). On gram staining, 104 (45.61%) showed evidence of LGTI; 14 full BV (6.1%); 45 partial BV (19.5%); 40 candidiasis (17.5%); and two each of trichomoniasis and aerobic vaginitis. Appearance of vaginal discharge and microscopic diagnosis of LGTI were poorly correlated. Forty women (17.5%) had SPTB, 24 following membrane rupture and 16 following spontaneous labor. The presence of BV (specifcally partial) increased the likelihood of SPTB with OR of 3.347 (CI 1.642, 6.823). Three of seven women with short cervix delivered preterm. No other screening modality was associated with SPTB. Conclusion Active screening for LGTI between 18 and 24 weeks shows high prevalence of BV in Indian setting. There is a strong link between partial BV and SPTB.

Item Type: Article
Uncontrolled Keywords: Screening for preterm delivery ; Lower genital tract infection ; Bacterial vaginosis ; Vaginal discharge ; Screening ; Amsel’s criteria ; Nugent’s criteria.
Subjects: Departments at MU > Manipal Centre for Virus Research
Medicine > KMC Manipal > Microbiology
Medicine > KMC Manipal > Obstetrics & Gynaecology
Depositing User: KMC Library
Date Deposited: 02 Jul 2020 04:19
Last Modified: 02 Jul 2020 04:19
URI: http://eprints.manipal.edu/id/eprint/155213

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