Dr. Sudhamani C,
BACKGROUND Preterm labour is one of the most challenging obstetric complications encountered by obstetricians. Preterm delivery affects one in ten births (11%) and even greater in developing countries. In the United States, preterm birth accounts for approximately 2/3rd of infant deaths. Prematurity is the cause of 80-85% of neonatal morbidity and mortality in developing countries. In India, prematurity is associated with 75% of perinatal mortality. Maternal infections precipitate preterm labour. One of the most important aetiology of preterm labour and preterm premature rupture of membranes is maternal lower genital tract infection and this leads to increased neonatal infections. The objectives of the study were- 1) To find out the prevalence of vaginal infection in preterm labour and preterm premature rupture of membranes. 2) To find out the incidence of neonatal sepsis and its relationship with vaginal swab culture in preterm premature rupture of membranes and preterm labour. 3) To identify common organisms in high vaginal swab culture and its antimicrobial sensitivity. MATERIALS AND METHODS This is a prospective observational study conducted for 12 months from October 2016 to October 2017, in the department of Obstetrics and Gynaecology, Government Medical College, Kottayam. In a previous study by Taralekar Vaishali et al, incidence of genital tract infection in preterm labour was about 59%. For the present study, a conservative estimate of 50% is used in sample size calculation and it is n=105. Statistical analysis is done by using SPSS software. RESULTS Out of the 105 subjects included in this study, 74 were diagnosed with preterm premature rupture of membranes (70.5%), and 31 (29.5%) with spontaneous preterm labour. Majority were in the age group of less than 22 years. Regarding gestational age, 61.9% came under late preterm gestation, majority being primigravidae. Of the 20% positive cultures, most common organism isolated was E.coli (8.6%) and prevalence of genital infection in spontaneous labour and preterm premature rupture of membranes were 16.1% and 21.6% respectively. Most of the isolated organisms were resistant to Ampicillin and sensitive to Cephaperazone-Sulbactum. In this study, 34.3% had neonatal sepsis, 51.4% needed neonatal intensive care and 15.2% succumbed to neonatal death. In 21 positive swab cultures, 88% had neonatal sepsis and 47% died during neonatal period. Relation between the birth weight and neonatal sepsis was statistically significant. CONCLUSION Maternal genital tract infection is one of the causes of preterm labour and preterm premature rupture of membranes. The dictum “prevention is better than cure” applies very well to the management of preterm birth. KEYWORDS
