Lower uro-genital tract infections in pregnancy : research article

Abstract

Aim: To examine the effectiveness of a new protocol for investigating women with lower abdominal pain, uterine tenderness and intact membranes, but who were not in labour or pyrexial and did not have symphysis pubis diastasia in identifying the cause of the symptom complex. Setting: Indigent South African urban population. Method: An audit of women presenting with lower abdominal pain, uterine tenderness and intact membranes but who were not in labour or pyrexial was performed. A mid-stream urine culture, wet vaginal smear, amniocentesis for amniotic fluid glucose, gram stain and culture and where possible, histology of the placenta was performed. Amniotic fluid infection was diagnosed on a positive gram stain (white blood cells or bacteria) of amniotic fluid and an amniotic fluid glucose less than 0.77mmol/l. Urinary tract infection was diagnosed if there were more than 100 000 organisms were cultured; bacterial vaginosis diagnosed on the presence of a positive whiff test and clue cells on microscopy of a wet preparation. Results: Twenty-four patients were included in this protocol audit over a 3-month period. Eleven of the 19 urine samples that were sent for culture had a positive growth (58%). Bacterial vaginosis was diagnosed in 11 out of 15 smears performed (73%). Amniotic fluid infection was diagnosed in 8 of the 24 patients (33%). Three patients had both an amniotic fluid infection and a urinary tract infection. Conclusion: Full investigation of women with lower abdominal pain and uterine tenderness, including invasive testing, revealed a high proportion of severe disease that can cause the death of the fetus/neonate. The protocol was effective in identifying the causes of the symptom complex. Obstetrics and Gynaecology Forum Vol.15(2) 2005: 6-9