Association of genitourinary infections and cervical length with preterm childbirth

F.M.M Bernardo,M.T.S.S.B Alves,V.C Cardoso,F.J.A Camayo,R.C Cavalli,M.A Barbieri,H Bettiol,R.F.L Batista,E.C.A Veiga,S.M Quintana

doi:10.1590/1414-431x202010235

F.M.M Bernardo, M.T.S.S.B Alves + Show 8 more

Open Access

https://doi.org/10.1590/1414-431x202010235

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Abstract

A prospective cohort study was conducted on a convenience sample of 1370 pregnant women with a gestational age of 20 to 25 weeks in the city of Ribeirão Preto. Data on obstetrical history, maternal age, parity, smoking habit, and a history of preterm delivery was collected with the application of a sociodemographic questionnaire. Cervical length was determined by endovaginal ultrasound, and urine and vaginal content samples were obtained to determine urinary tract infection (UTI) and bacterial vaginosis (BV), respectively. The aim of this study was to verify the association of cervical length and genitourinary infections with preterm birth (PTB). Ultrasound showed no association of UTI or BV with short cervical length. PTB rate was 9.63%. Among the women with PTB, 15 showed UTI (RR: 1.55, 95%CI: 0.93–2.58), 19 had BV (RR: 1.22, 95%CI: 0.77–1.94), and one had both UTI and BV (RR: 0.85, 95%CI: 0.13–5.62). Nineteen (14.4%) PTB occurred in women with a cervical length ≤2.5 cm (RR: 2.89, 95%CI: 1.89–4.43). Among the 75 patients with PTB stratified as spontaneous, 10 showed UTI (RR: 2.02, 95%CI: 1.05–3.86) and 14 had a diagnosis of BV (RR: 1.72, 95%CI: 0.97–3.04). A short cervical length between 20 and 25 weeks of pregnancy was associated with PTB, whereas UTI and BV determined at this age were not associated with short cervical length or with PTB, although UTI, even if asymptomatic, was related to spontaneous PTB.

Highlights

Preterm birth (PTB) is an important public health problem due to its high incidence and perinatal morbiditymortality [1]
Studies have demonstrated that infections such as bacterial vaginosis (BV) and urinary tract infections (UTI) may be associated with a higher risk of PTB and low birth weight [5,6], since these processes are related to the inflammatory response present in infections
Of the 74 women with spontaneous PTB, 10 had UTI and 14 had BV

Summary

Introduction

Preterm birth (PTB) is an important public health problem due to its high incidence and perinatal morbiditymortality [1]. Studies have demonstrated that infections such as bacterial vaginosis (BV) and urinary tract infections (UTI) may be associated with a higher risk of PTB and low birth weight [5,6], since these processes are related to the inflammatory response present in infections. These conditions are fundamentally involved in the physiopathology of PTB since cytokines (TNF-a, interleukins, and prostaglandins - PGE2, PGD2, and PGF2a, in particular) resulting from the cascade of inflammatory events that directly participate in the triggering of uterine contractions [7,8]. The identification of cervical shortening at early gestational ages represents an important risk factor for PTB [11,12,13] and its evaluation by transvaginal ultrasound is one of the parameters showing a good correlation with the risk for PTB [14]

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