Gebe Kadınlarda Ürogenital Kültür Pozitifliği ile Erken Doğum Tehdidi İlişkisi

Abstract

Amaç: Erken doğumla sonuçlanan preterm eylem tehdidi (TPL), gebelik komplikasyonları ve yenidoğan morbiditesinin en sık görülen sebeplerinden biri olarak bilinmektedir. Bu çalışmada, TPL olan hastalarda pozitif ürogenital kültür ile erken doğum eylemi arasındaki ilişki araştırılmıştır. Araçlar ve Yöntem: 2018 ile 2022 yılları arasında TPL nedeniyle takip edilen hastaların tıbbi dosyaları değerlendirildi. Demografik verileri, gestasyonel hikayeleri, vaginal swab ve idrar örneklerinin sonuçları kaydedildi. Transvaginal ultrasonografi (TVUS) ile preterm ve term doğum sırasındaki servikal uzunluk ölçümleri yapılarak, <25mm, <20mm ve <15mm olarak derecelendi. İstatistiksel analizler Chi square, Mann Whitney U ve Pearson’s korelasyon (r) testleri ile yapıldı. P<0.05 değeri anlamlı olarak kabul edildi. Bulgular:TPL ile takip edilen 202 hasta çalışmaya dahil edildi. Hastaların yaklaşık yarısında (%40-50) vaginal kültür pozitif bulunurken, bu oran idrar kültüründe çok daha az (%10-15) idi. Erken preterm, geç preterm ve term doğum yapan hastalar arasında hem vaginal hem de idrar kültürleri açısından bir farklılık saptanmadı (p>0.05). Bununla birlikte, erken ve geç preterm doğumlarda, servikal uzunluğun kısalmasına paralel olarak (CL<15mm) pozitif kültür sonuçlarının arttığı tespit edildi (p<0.05). Candida, Staphylococcus ve Escherichia türleri en sık olarak izole edildi. Sonuç: TPL olan hastalarda ürogenital kültür sonuçları preterm ve term doğumlar açısından anlamlı farklılık göstermemekle birlikte (r=0.19), servikal uzunluktaki azalma ile paralel şekilde artış gösteren kültürde üremenin (r=0.74) erken eylemi başlatma potansiyeli göz ardı edilmemelidir.

Keywords

• erken doğum tehdidi
• idrar kültürü
• preterm eylem
• ürogenital infeksiyon
• vaginal kültür

Relationship between Urogenital Culture Positivity and Threatened Preterm Labor in Pregnant Women

Abstract

Purpose: Preterm labor (TPL), which can result in preterm birth, is known as one of the most common causes of pregnancy complications and neonatal morbidities. This study investigates the relationship between positive urogenital culture and preterm labor in patients with TPL. Materials and Methods: Between 2018 and 2022, medical records of patients monitored due to threatened preterm labor (TPL) were reviewed. Demographic data, gestational histories, and results of vaginal swabs and urine samples were recorded. Transvaginal ultrasound was used to measure cervical length during preterm and term births, categorized as <25mm, <20mm, and <15mm. Statistical analyses were conducted using Chi-square, Mann-Whitney U, and Pearson's correlation (r) tests. A significance level of P<0.05 was considered statistically significant. Results: A total of 202 patients monitored for TPL were included. Approximately half of the patients (40-50%) tested positive for vaginal culture, whereas this rate was much lower in urine culture (10-15%). There was no significant difference in terms of both vaginal and urine cultures among patients who had early preterm, late preterm, and term births (p>0.05). However, it was observed that positive culture results increased parallel to cervical length shortening (CL<15mm) in both early and late preterm births (p<0.05). Candida, Staphylococcus, and Escherichia species were the most frequently isolated organisms. Conclusion: In patients with TPL, urogenital culture results did not show significant differences between preterm and term births (r=0.19). However, it is crucial not to overlook the potential of culture positivity (r=0.74) increasing in parallel with cervical length reduction to initiate early labor.

Keywords

• preterm delivery
• threatened preterm labor
• urine culture
• urogenital infection
• vaginal culture

Ethical Statement

Approval for this study was obtained from Istanbul Education and Research Hospitals’ Ethics Committee (IEAH-24.03.2023/82).

References

1. 1. Wen SW, Smith G, Yang Q, Walker M. Epidemiology of preterm birth and neonatal outcome. Semin Fetal Neonatal Med. 2004;9(6):429-435.
2. 2. Khandre V, Potdar J, Keerti A. Preterm birth: An overview. Cureus. 2022;14(12):e33006.
3. 3. Patel SS, Ludmir J. Drugs for the treatment and prevention of preterm labor. Clin Perinatol. 2019;46(2):159-172.
4. 4. Hwang HS, Na SH, Hur SE, et al. Practice patterns in the management of threatened preterm labor in Korea: A multicenter retrospective study. Obstet Gynecol Sci. 2015;58(3):203-209.
5. 5. Hosny AEMS, Fakhry MN, El-Khayat W, Kashef MT. Risk factors associated with preterm labor, with special emphasis on preterm premature rupture of membranes and severe preterm labor. J Chin Med Assoc. 2020;83(3):280-287.
6. 6. Ramos Bde A, Kanninen TT, Sisti G, Witkin SS. Microorganisms in the female genital tract during pregnancy: tolerance versus pathogenesis. Am J Reprod Immunol. 2015;73(5):383-389.
7. 7. Sileo FG, Inversetti A, Bonati F, et al. Screening for low-tract genital infections in women with threatened preterm labor: Which role? Gynecol Obstet Invest. 2022;87(3-4):184-190.
8. 8. Mancuso MS, Figueroa D, Szychowski JM, Paden MM, Owen J. Midtrimester bacterial vaginosis and cervical length in women at risk for preterm birth. Am J Obstet Gynecol. 2011;204(4):342.

9. 9. Verma I, Avasthi K, Berry V. Urogenital infections as a risk factor for preterm labor: a hospital-based case-control study. J Obstet Gynaecol India. 2014;64(4): 274-278.
10. 10. Muzny CA, Schwebke JR. Asymptomatic bacterial vaginosis: To treat or not to treat? Curr Infect Dis Rep. 2020;22(12):32.
11. 11. Yost NP, Cox SM. Infection and preterm labor. Clin Obstet Gynecol. 2000;43(4):759-767.
12. 12. Giraldo PC, Araújo ED, Junior JE, Do Amaral RL, Passos MR, Gonçalves AK. The prevalence of urogenital infections in pregnant women experiencing preterm and full-term labor. Infect Dis Obstet Gynecol. 2012;2012(1):878241.
13. 13. Agrawal V, Hirsch E. Intrauterine infection and preterm labor. Semin Fetal Neonatal Med. 2012;17(1):12-19.
14. 14. Cram LF, Zapata MI, Toy EC, Baker B. Genitourinary infections and their association with preterm labor. Am Fam Physician. 2002;65(2):241-248.
15. 15. Son KA, Kim M, Kim YM, et al. Prevalence of vaginal microorganisms among pregnant women according to trimester and association with preterm birth. Obstet Gynecol Sci. 2018;61(1):38-47.
16. 16. Kaambo E, Africa C, Chambuso R, Passmore JS. Vaginal microbiomes associated with aerobic vaginitis and bacterial vaginosis. Front Public Health. 2018;6:78.
17. 17. Lajos GJ, Passini Junior R, Nomura ML, et al. Colonização do canal cervical em gestantes com trabalho de parto prematuro ou ruptura prematura de membranas [Cervical bacterial colonization in women with preterm labor or premature rupture of membranes]. Rev Bras Ginecol Obstet. 2008;30(8):393-399.