Bacterial Colonization of Vagina in Indian Women During Labor and Its Association With Puerperal and Neonatal Sepsis: A Tertiary Hospital Study.

Sabeena Elliyas,Sugandha Arya,Sandeep Kumar Kanwal,Rajni Gaind,Sarita Singh

doi:10.7759/cureus.13943

Sabeena Elliyas, Sugandha Arya + Show 3 more

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https://doi.org/10.7759/cureus.13943

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Abstract

ObjectiveThe aim was to find the prevalence of colonization of vagina with aerobic bacteria among low-risk Indian women in active labor and its association with early-onset neonatal sepsis (EONS) and puerperal sepsis.MethodsThe study was conducted prospectively from October 2018 to March 2020 in a tertiary hospital in New Delhi, India. Low-risk pregnant women (N=920) in active labor with intact membranes were recruited. High vaginal swabs were collected, cultured by standard methods to detect aerobic bacteria. The primary outcomes were the development of puerperal sepsis and EONS.ResultsIn a total of 920 low-risk subjects, vaginal colonization was found in 484 (52.6%), coagulase-negative Staphylococcus being the predominant colonizer (13.2%) followed by Escherichia coli (8.9%). Multigravida women were at 1.4 times higher risk of colonization than primigravida (odds ratio [OR] 1.399; 95% CI 1.064, 1.84). Women whose sample was collected at the first vaginal examination were at 0.34 times lower risk of colonization as compared to women with more than one vaginal examination (OR 0.34; 95% CI 0.241, 0.481). The incidence of colonization increased with progressive vaginal examinations (p<0.001). None of the colonized women and their neonates developed puerperal sepsis or EONS, respectively.ConclusionVaginal colonization of aerobic bacteria in active labor is not associated with an increased risk of puerperal sepsis or EONS.

Highlights

World Health Organization reports that more than 500,000 women die every year worldwide due to complications of pregnancy and childbirth [1]
Multigravida women were at 1.4 times higher risk of colonization than primigravida
Women whose sample was collected at the first vaginal examination were at 0.34 times lower risk of colonization as compared to women with more than one vaginal examination

Summary

Introduction

World Health Organization reports that more than 500,000 women die every year worldwide due to complications of pregnancy and childbirth [1]. It is known that sepsis, hemorrhage, and prolonged and obstructed labor are some of the factors at delivery that are responsible for increased maternal and neonatal morbidity [2,3]. Puerperal sepsis is the third most common cause of maternal mortality worldwide [4]. Puerperal sepsis can be caused by endogenous or exogenous bacterial inoculation of the uterine cavity. Endogenous bacteria are normal commensals in the vagina and rectum but can get carried into the uterus from the vagina by examining fingers or instruments during pelvic examinations following prolonged rupture of membranes, obstructed labor, and traumatic vaginal delivery. Postpartum puerperal sepsis leads to acute morbidity in women and long-term morbidities like pelvic inflammatory disease and infertility. Postpartum puerperal sepsis was significantly associated with the occurrence of early neonatal mortality due to early-onset neonatal sepsis (EONS) [6]

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