Vaginal infections and its relation to preterm labour, PPROM, PROM and its outcome

Pradeep Shivaraju, Pallavi Purra, Navatha Bheemagani, Krishna Lingegowda


Background: Prematurity is the cause of 85% of neonatal morbidity and mortality. Recently, vaginal infection has been associated with increased risks for prematurity and premature rupture of membranes (PROM). Since preventive measures can prevent preterm labour and neonatal morbidity and mortality taking these facts into consideration the present study was undertaken to study the role of vaginal infection in preterm labour, PPROM, PROM.

Methods: A prospective observational study was done in PESIMR, Kuppam, Andhra Pradesh.  The aim was to study the role of vaginal infections in preterm labour, preterm premature rupture of membranes (PPROM) and premature rupture of membranes (PROM). Objectives of the study were to diagnose vaginal infection by taking high vaginal swab, to study the relation of vaginal infection and preterm labour, PPROM, PROM, to evaluate maternal morbidity, mortality and neonatal outcome. The another objective was to select an appropriate antibiotic therapy. The study was done on 80 patients of preterm labour, PPROM and PROM. Vaginal infection was confirmed by high vaginal swab and neonatal outcome was noted.

Results: Out of 80, high vaginal swab had growth in 40 patients and 40 were sterile. CONS were the commonest isolated organism grown followed by candida. RDS was the commonest neonatal complication seen in mothers with vaginal infection who delivered prematurely, thus vaginal infection being a common cause of preterm labour, PPROM and PROM, timely detection and treatment is important to avoid prematurity, associated neonatal morbidity and mortality.

Conclusions: study provides important data about microbiological correlate of threatened preterm, preterm labour, PROM, PPROM in our pregnant women and most of pathological isolates were sensitive to ampicillin, taxim and gentamicin.


Vaginal infection, Prematurity, Threatened preterm, Preterm labour, Premature rupture of membranes, Preterm premature rupture of membranes, Antibiotics

Full Text:



Gynecol Obstet Invest. 2006; 61(3):135-8. E pub 2005 Dec 5.

Eschenbach, D. A., M. G. Gravett, K. C. S. Chen, U. B. Hoyme et al 1984. Bacterial vaginosis during pregnancy. An association with prematurity and postpartum complications, p. 213-222. Statistics with confidence. Br. Med. J.

Gravett MG, Hummel D, Eschenbach DA, Holmes KK. Preterm labor associated with subclinical amniotic Fluid infection and with bacterial vaginosis. Obstet. Gynecol. 1986;67:229-37.

Gravett MG, Nelson HP, DeRouen T, Critchlow CC, et al. Independent association of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome. Jama. 1986;256:1899-903.

Martius J, Krohn MA, Hillier SL, Stamm WE, et al. Relationships of vaginal Lactobacillus species, cervical Chlamydia trachomatis, and bacterial vaginosis to preterm birth. Obstet Gynecol. 1988;71:89-95.

McGregor JA, French JI, Richter R, et al. Antenatal microbiologic and maternal risk factors associated with prematurity. Am J Obstet Gynecol. 1990;163:1465-73.

Goldenberg RL, Culhane JF, Iams JD. et al. Epidemiology and causes of preterm birth. Lancet.2008;371:75–84.

Romero R, Baumann P, Gomez R. et al. The relationship between spontaneous rupture of membranes, labor, and microbial invasion of the amniotic cavity and amniotic fluid concentrations of prostaglandins and thromboxane B2 in term pregnancy. Am J Obstet Gynecol. 1993;168:1654–1664.

Mercer B M, Goldenberg R L, Das A F. et al. What we have learned regarding antibiotic therapy for the reduction of infant morbidity after preterm premature rupture of the membranes. Semin Perinatol.2003;27:217–230.

Mercer B M. Preterm premature rupture of the membranes. Obstet Gynecol. 2003;1101:178–193.

McGregor JA, French JI, Lawellin D et al Bacterial protease-induced reduction of chorioamniotic membrane strength and elasticity. Obstet Gynecol 1987; 69:167-74.

Draper D, Jones W, Heine RP et al. Trichomonas vaginalis weakens human amniochorion in an in vitro model of premature membrane rupture. Infectious Disease Obstet Gynecol. 1995;2:267-74.

DiGiulio DB, Romero R, Kusanovic JP. et al. Prevalence and diversity of microbes in the amniotic fluid, the fetal inflammatory response, and pregnancy outcome in women with preterm pre-labor rupture of membranes. Am J Reprod Immunol. 2010;64:38–57.

Mehta A. prematurity –A Review. J of obst gyn India. 1971;21:453-61.

Naeye RL, Dellinger WS, Blac WA. Fetal and maternal features of antenatal bacterial infection. Am J. Pediatrics 1978; 61:171.

McDonald HM, O’ Loughlin JA, Jolly P, et al. Br J Obstet Gynecol. 1991;98(5):427-35.

Das C. R, Pattnaik PL, Sahoo PK. Prevalence of vaginal infection in preterm labour. Antiseptic 1996 April;93(4):140-43.

Sharma JB, Prevalence of pathogenic Bacteria in Genital tract in preterm labour. J Obstet Gynecol India. 1989;229.

Raunt M. D, Dora H, Premature rupture of membrane – A clinical and bacteriological study. J of Obst Gyn 1988;38(1-6);184-7.

Agarwal SK, Rathi AK, Asha Awasthi, et al. J of Obst Gyn of India 1979:40-44.

Lanier RL Jr, Carbraugh RW et al Incidence of maternal and foetal complications associated with rupture of membranes before onset of labour. Am J Obstet Gynecol. 1965;93:398.

Swati Pandey, Anupama Dave, Bandi S. Maternal and foetal outcome in cases of PROM J. Obstet Gynecol Ind. 2000;50(1):63-5.

Dudley J, Malcolm G and Ellwood D. Amniocentesis in the management of preterm labour J of Obst Gyn 1988;38(1-6);184-7.

Mathew R, Kalyani J, Bibi R, Mallika M. Prevalence of bacterial vaginosis in antenatal women. Indian J Pathol Microbiol. 2001;44(2):113-6.

ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician gynecologists. Obstet Gynecol. 2007;109(4):1007-19.