Cervicovaginal microbial colonization in preterm labour and preterm premature rupture of membranes and its association with maternal and neonatal outcomes: a prospective observational study from a tertiary care centre in South India
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background. Preterm labour (PTL) and preterm premature rupture of membranes (PPROM) are leading contributors to perinatal morbidity and mortality and are frequently associated with lower genital tract infection. The role of cervicovaginal microbial colonization in adverse maternal and neonatal outcomes remains incompletely defined in South Asian settings. We aimed to determine the prevalence of abnormal vaginal flora among women presenting with PTL or PPROM and to evaluate its association with maternal and neonatal outcomes. Methods. We conducted a prospective observational study at a tertiary care teaching hospital in Karnataka, India, from May 2023 to December 2024. High vaginal swabs were collected from consecutive antenatal women presenting with PTL or PPROM and processed by standard microbiological culture and antibiotic susceptibility testing. Women were classified as having normal or abnormal vaginal flora. Maternal outcomes (mode of delivery, postpartum complications) and neonatal outcomes (birth weight, APGAR scores, neonatal intensive care unit [NICU] admission, neonatal sepsis) were compared. Associations were assessed using the chi-square or Fisher exact test and the Mann–Whitney U test; multivariable logistic regression was used to estimate the independent association of abnormal flora with NICU admission. Results. Of 81 women recruited, 79 with an evaluable culture were analysed. Abnormal vaginal flora was identified in 30 women (38.0%). The commonest isolates were Klebsiella pneumoniae (33.3%), Candida non-albicans (23.3%) and Candida albicans (13.3%). Abnormal flora was significantly associated with NICU admission (53.3% vs 14.3%; odds ratio [OR] 6.86, 95% confidence interval [CI] 2.34–20.08; p < 0.001), neonatal sepsis among NICU-admitted neonates (p = 0.019), lower median birth weight (2.49 vs 2.68 kg; p = 0.019) and lower APGAR scores at 1 and 5 minutes (p = 0.001 and p = 0.013). After adjustment for birth weight, abnormal flora remained independently associated with NICU admission (adjusted OR 6.06, 95% CI 1.62–22.69; p = 0.007). Women with abnormal flora were younger and had a higher total leucocyte count. Caesarean delivery (70.0% vs 49.0%; p = 0.110) and postpartum complications (20.0% vs 12.2%; p = 0.542) were more frequent with abnormal flora but did not differ significantly, nor did presenting diagnosis, gravidity or residence. Conclusions. Abnormal cervicovaginal flora was present in more than one-third of women with PTL or PPROM and was independently associated with adverse neonatal outcomes, particularly NICU admission and neonatal sepsis. Routine high vaginal swab screening with early, culture-directed treatment may help mitigate neonatal risk in this population.
Source: Research Square
Institution: JSS Academy of Higher Education and Research
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7212307833