Risk Factors for Vaginal Colonization and Relationship between Bacterial Vaginal Colonization and In-Hospital Outcomes in Women with Obstructed Labor in a Ugandan Regional Referral Hospital.

Jean-Pierre Van Geertruyden,Joel Bazira,Lisa M Bebell,Yves Jacquemyn,Laura E Riley,Dan Nyehangane,Adeline Boatin,Jerome Kabakyenga,Yap Boum,Yarine Fajardo,Joseph Ngonzi,Deborah Nanjebe

doi:10.1155/2018/6579139

Abstract

Introduction The proportion of women with severe maternal morbidity from obstructed labor is between 2 and 12% in resource-limited settings. Maternal vaginal colonization with group B streptococcus (GBS), Escherichia coli, and Enterococcus spp. is associated with maternal and neonatal morbidity. It is unknown if vaginal colonization with these organisms in obstructed labor women is associated with poor outcomes. Objectives To determine whether vaginal colonization with GBS, E. coli, or Enterococcus is associated with increased morbidity among women with obstructed labor and to determine the risk factors for colonization and antibiotic susceptibility patterns. Methods We screened all women presenting in labor to Uganda's Mbarara Regional Referral Hospital maternity ward from April to October 2015 for obstructed labor. Those meeting criteria had vaginal swabs collected prior to Cesarean delivery and surgical antibiotic prophylaxis. Swabs were inoculated onto sterile media for routine bacterial culture and antimicrobial susceptibility testing. Results Overall, 2,168 women were screened and 276 (13%) women met criteria for obstructed labor. Vaginal swabs were collected from 272 women (99%), and 170 (64%) were colonized with a potential pathogen: 49% with E. coli, 5% with GBS, and 8% with Enterococcus. There was no difference in maternal and fetal clinical outcomes between those colonized and not colonized. The number of hours in labor was a significant independent risk factor for vaginal colonization (aOR 1.02, 95% CI 1.00–1.03, P=0.04). Overall, 38% of GBS was resistant to penicillin; 61% of E. coli was resistant to ampicillin, 4% to gentamicin, and 5% to ceftriaxone and cefepime. All enterococci were ampicillin and vancomycin susceptible. Conclusion There was no difference in maternal or neonatal morbidity between women with vaginal colonization with E. coli, GBS, and Enterococcus and those who were not colonized. Duration of labor was associated with increased risk of vaginal colonization in women with obstructed labor.

Highlights

Obstructed labor is diagnosed in women presenting with features of prolonged or complicated labor, such as labor duration >24 hours, distended bladder, Bandl’s ring in the lower uterine segment, fetal distress or death, edematous vulva or cervix, fetal caput or significant skull molding, and foul smelling vaginal discharge or amniotic fluid [1]
We hypothesized that vaginal colonization with one or more of these known bacterial pathogens (GBS, E. coli, or Enterococcus spp.) is associated with poor maternal and newborn outcomes in women with obstructed labor versus those who are not colonized with those pathogens
All women presenting to Mbarara Regional Referral Hospital (MRRH) maternity ward for delivery or postpartum care were enrolled in a larger prospective cohort study of postpartum infection at MRRH [10, 11] from which a nested substudy of women with obstructed labor were recruited between April and October 2015

Summary

Introduction

Obstructed labor is diagnosed in women presenting with features of prolonged or complicated labor, such as labor duration >24 hours, distended bladder, Bandl’s ring in the lower uterine segment, fetal distress or death, edematous vulva or cervix, fetal caput or significant skull molding, and foul smelling vaginal discharge or amniotic fluid [1]. Is may include maternal sepsis, uterine rupture, postpartum endometritis, or maternal death, whereas perinatal morbidity may include neonatal sepsis, encephalopathy, or fetal or neonatal demise [2,3,4,5] Several bacterial pathogens such as group B Streptococcus (Streptococcus agalactiae, GBS), Enterococcus spp., and Escherichia coli are known to be associated with poor obstetric and neonatal outcomes, even in women with uncomplicated labor [6,7,8,9]. We hypothesized that vaginal colonization with one or more of these known bacterial pathogens (GBS, E. coli, or Enterococcus spp.) is associated with poor maternal and newborn outcomes in women with obstructed labor versus those who are not colonized with those pathogens. We set out to determine risk factors for bacterial vaginal colonization with a potential pathogen and the relationship between colonization and inhospital outcomes among women with obstructed labor

Methods

Results

Conclusion