Effect of the pattern of colonization of the maternal genital tract at the time of delivery on early onset neonatal sepsis

Early onset neonatal sepsis increases significantly in the presence of vaginal and cervical colonization with pathogenic organisms. The aim of this study was to study the effect of the pattern of colonization of the maternal genital tract at the time of delivery on early onset neonatal sepsis. A prospective clinical study was conducted in Cairo University Hospitals on 352 pregnant women coming for delivery and their newborns. Vaginal swabs were taken from the mothers before first vaginal examination [PV] and just before delivery. Surface swabs from the body of babies were taken. The neonates were clinically evaluated and prospectively followed up in the first week of their life for clinical evidence of sepsis and blood cultures were done for clinically septic neonates. Swabs were taken from different environmental sources in the Obstetric and Neonatology wards. Microbiological typing was conducted by biotyping and antibiogram to prove the similarity between microorganisms isolated from maternal or environmental sources and the corresponding neonates. Pulsed field gel electrophoresis was used for genotyping of phenotypically similar isolates. Microbiological similarity between culture results of mothers and their newborns was proven in 86% of cases. The correlation between clinical sepsis and microbiological agreement was also highly significant [p value=0.001]. Positive vaginal swab cultures were highly predictive of positive blood culture [p-value=0.09]. We found that, multiple vaginal examinations [more than 3 times] was the most frequent maternal risk factor of neonatal bacteremia [p-value=0.049]. Contamination of environment [gel and gloves] and equipment [suction sets] used for mothers and their babies during delivery was probably an important source of microorganisms. Maternal colonization and the contaminated environment were important risk factors for neonatal sepsis. Hence, limitation of PV and strict infection control measures should be followed in delivery room

Sonographic and bacteriological evaluation of cases likely to progress to preterm labor

The aim of the work is evaluation of bacteriological and sonographic role in the assessment of cases likely to progress to preterm labour and setting the management plan. This study included 30 pregnant ladies selected from the Shatby Maternity University Hospital between 20-30 years, primigravida or multigravida, and pregnant between 26 to 34. Presenting with threatening preterm labor, with intact membrane, with two or more of the following criteria: persistent menstrual like cramps and low dull backache, persistent heaviness, abdominal cramping, increase or change in vaginal discharge. All cases were subjected] 1-Complete history taking 2-Complete physical and obstetrical examination included a] inspection of the vulva, urethra, and perineum to detect the presence of any discharge or local inflammatory signs b] Speculum examination: for the presence of any pathological lesion and the type and character of any discharge [amount, color, and odor] c] Digital vaginal examination is performed with sterile glove if established preterm labour is suspected.3-Investigations:-1] Vaginal specimens: Sterile cotton-tipped swabs were used, inserted into the upper part of the vagina and rotated there before withdrawing it. For each case, two swabs were collected: one was placed in a transport medium for culture of aerobes and anaerobes; the other was rolled into a clean glass slide to make a smear.2] Specimens of urine were collected to detect and treat urinary tract infection if present.3] Detailed abdominal ultrasonography.4] Trans-vaginal ultrasound to determine: i] Cervical length. ii] Cervical width iii] The presence of funneling iv] Condition of the membranes. Cases were followeA up till either labor or complete 34 weeks was reached. The study -started with 54 cases, 24 cases dropped out, while 30 cases completed the study till the end-point. Initial pregnancy duration of the selected cases ranged between 26 - 33 weeks with a mean of 28.8 +/- 2.1. Culturing vaginal swabs recovered pathogens in a total of 18 of the studied 30 cases [60%]. Gardnerella virginals was found in 9 cases [30%], Klebsiella spp.5 cases [16.6%] and anaerobic streptococci spp. in 3 cases [10%] and pseudomonas spp.1 case [3.3%]. In the remaining 12 cases [40%], the recovered organisms were encountered as vaginal flora. Six cases with positive vaginal swabs showed clinical manifestations of vaginal infection mainly itching and vaginal discharge, while the remaining 12 cases are asymptomatic. Urine culture showed 3 cases of the study to have urinary tract infection [UTI], one of t em had Escherichia Coli [E.coli], and the other 2 cases had asymptomatic bacteriuria. All cases with viable singleton pregnancy between 26 -33 weeks, with adequate amount of liquor, placenta was fundal anterior in 25 cases and fundal posterior in the remaining 5 cases. Cephalic presentation in [16] cases, breech in [6] cases, and the remaining [8] cases with unstable lie. Ten cases out of 30 [33.3%] showed positive cervical changes on ultrasonography [cervical length<27 mm and diameter >17 mm], while 20 cases [66.7%] showed no changes.18 cases out of 30 showed positive vaginal infection, the cases with mean gestational age 27.09 +/- 1.30 weeks at the beginning of the study [11 cases], they continued their pregnancy till the end-point of the study[completed 34 weeks,] while cases with mean gestational age of 29.71 +/- 2.14 weeks at the beginning of the study [7 cases], they progressed to preterm labour, in spite of the same management plan. This difference showed a statistical significance [X[2] 6.744, P>0.05]. Positive correlation was found between the presence of vaginal infection and the occurrence of cervical changes and between cervical changes as detected by ultrasonography [decreased cervical length less than 27 mm and dilatation of the internal os more than 17 mm] and the occurrence of preterm labor

Mycoplasma hominis and ureaplasma urealyticum vaginosis in pregnant women

The main feature of BV is a change in vaginal flora from predominant Lactobacilli to overgrowth of other microorganisms like; Mycoplasma hominis [M. hominis] and Ureaplasma urealyticum [U. urealyticum]. M. hominis and U. urealyticum vaginosis has been associated with abortion, intraamniotic infection, premature rupture of membranes [PROM] and intrapartum fever in pregnant women. This study was carried out on 100 pregnant women complaining of abnormal vaginal discharge in addition, 50 normal healthy pregnant women were included as a control. Vaginal specimens were collected from all studied women. The incidence of BV among pregnant women was [39%] whereas none of the controls has BV. There was positive correlation between the number of pregnancy but not its duration. M. hominis was detected in BV cases [38.5%] and U. urealyticum in [46.2%]. As regarding the susceptibility, M. hominis was more sensitive to norfioxacin and tetracycline [100% for each] and also, U. urealyticum isolates were more sensitive to norfioxacin and tetracycline [94.4, 88.9%] respectively, but they were resistant to Amoxicillin and Amoxacillin/Culvunate

Isolamento, identificaçäo e sorotipagem de Candida albicans a partir de secreçäo vaginal / Isolation, identification and serotyping of Candida albicans from vaginal secretion

Foram estudadas 104 amostras de secreçäo vaginal de mulheres com suspeita de candidíase segundo observaçöes clínicas, na cidade de Alfenas-MG. Encontrou-se 55,7% de positividade para Candida albicans, prevalecendo maior índice na raça negra (64% de 25 amostras), sendo de 53,1% (79 amostras), a positividade na raça branca. Em 14 gestantes, a pesquisa da levedura mostrou-se positiva na totalidade dos casos. A maior das amostras positivas (93,1%) procedia de mulheres com idade compreendida entre 20-40 anos. O uso de anticoncepcionais, antibióticos e presença de displasias cervicais mostraram-se como fatores que contribuiram para maior incidência do fungo. Das 58 amostras de C. albicans isoladas, 50 (86,2%) pertenciam ao sorotipo "A", sendo 37 (74%) isoladas de mulheres da raça branca e 13 (26%) da raça negra. Apenas 08 amostras (13,8%) pertenciam ao sorotipo "B", sendo 05 (11,9%) isoladas a partir de mulheres da raça branca e 03 (18,75%) da raça negra

Resultados citológicos en pacientes con extendidos inflamatorio / Cytological results in patients with inflammatory smears

Se analiza el material de 300 pacientes que concurrieron al Dpto. de Ginecología y Citopatología de LALCEC, en los meses de marzo a mayo de 1986, se detectan 110 resultados colpocitológicos inflamatorios (36,6%), sus edades oscilan entre los 15 y 54 años con un promedio de 32. Se da la frecuencia de la flora de los extendidos cérvico-vaginales: Cocos (23,6%), Gardnerella (13,6%), Hongos (4,6%), Trichomonas (3,6%) y Flora Mixta (2,6%). Se analiza la flora de los extendidos cérvico-vaginales en relación a los antecedentes obstétricos: Parto, Aborto más Parto, Cesárea, Nuligestas, etc. Se realiza una comparación con los resultados de otros autores obtenidos de la bibliografía