Cervicovaginal Infection during Pregnancy and Its Relation to Preterm Pre-Labour Rupture Of Membranes

Abstract

Preterm premature rupture of the membranes (pPROM) is the rupture of membranes during pregnancy before 37 weeks of gestation. This study aimed to determine the aerobic microorganisms related to preterm pre-labor rupture of membranes. This retrospective case-control study was carried out at the labor ward of the women's Health Center in Assiut. It included 250 pregnant women with pPROM (cases) and 250 no pPROM (controls). Data were collected using structured interview and physical assessment sheets. The results revealed that more study group women reported carrying heavy objects (p=0.04), using daily transportation (p=0.006), and total physical activity (p=0.04), more history of PROM (p<0.001), complaints (p<0.001), and sexual intercourse during third trimester (p=0.03). They had more vaginal discharge with red-brownish color (p<0.001), offensive odor (p=0.02), and pH>7 (p<0.001). Positive culture was higher in the study group (39.6%), compared to control group (29.2%), p=0.01, with more staphylococci (p=0.004). No statistically significant relations could be detected between culture and women's socio-demographic characteristics, obstetric history, current pregnancy problems, characteristics of membrane rupture and vaginal discharge among women in the study group. In the control group, more women with positive culture had a crowding index 2+ (p=0.04), and had yellowish-greenish discharge (p=0.001), with offensive odor (p<0.001). It is concluded that the risk factors of pPROM include woman's job status, residence, level of activity, previous history of PROM, having complaints during pregnancy, and having sexual intercourse during the third trimester. There is an association between the presence of inflammatory vaginal discharge and pPROM, with higher probability of positive culture. It is recommended that the management of pPROM include a cervical swab with culture sensitivity. The management protocol should be improved, and strictly followed, with training of health care providers in following it. Further research is proposed to investigate the effectiveness of nursing interventions aimed at reducing the risk factors of pPROM on its occurrence.