Cervical Bacterial Colonization In Women With Preterm Labor Or Premature Rupture Of Membranes [colonização Bacteriana Do Canal Cervical Em Gestantes Com Trabalho De Parto Prematuro Ou Ruptura Prematura De Membranas]

PURPOSE: to study cervical colonization in women with preterm labor or premature rupture of membranes. METHODS: two hundred and twelve pregnant women with preterm labor or premature rupture of membranes were studied. Two cervical samples from each woman were collected and bacterioscopy and culture were performed. Association of cervical microorganisms and urinary tract infection, chorioamnionitis, fetal stress, antibiotic use, prematurity, neonatal infection, and neonatal death were evaluated. RESULTS: the prevalence of endocervical colonization was 14.2% (CI95%=9.5-18.9%), with similar results in preterm labor or premature rupture of membranes. Group B streptococcus was the most prevalent organism (9.4%). Other organisms isolated were Candida sp, Streptococcus sp, Streptococcus pneumoniae, Escherichia coli and Enterococcus sp. The most common findings of bacterioscopy were a reduced number of lactobacilli and a great number of leukocytes. Endocervical colonization was associated with a higher occurrence of urinary tract infection (23.8 versus 5.4%; p<0.01), early-onset neonatal infection (25.0 versus 7.3%; p<0.01) and neonatal mortality (two cases in colonized women; p<0.02) when compared with a negative culture of endocervical mucus. CONCLUSIONS: this study showed high prevalence of endocervical colonization despite the use of a nonselective culture media. The main microorganism isolated was group B streptococcus, but other organisms were present in one third of the studied population. More studies are needed to evaluate the influence of endocervical colonization on obstetrical outcome and on neonatal infection and mortality.308393399Usui, R., Ohkuchi, A., Matsubara, S., Izumi, A., Watanabe, T., Suzuki, M., Vaginal lactobacilli and preterm birth (2002) J Perinat Med, 30 (6), pp. 458-466Svare, J.A., Schmidt, H., Hansen, B.B., Lose, G., Bacterial vaginosis in a cohort of Danish pregnant women: Prevalence and relationship with preterm delivery, low birthweight and perinatal infections (2006) BJOG, 113 (12), pp. 1419-1425Verstraelen H, Verhelst R, Roelens K, Claeys G, Weyers S, De Backer E, et al. Modified classification of Gram-stained vaginal smears to predict spontaneous preterm birth: a prospective cohort study. Am J Obstet Gynecol. 2007;196(6):528.e1-6Sakai, M., Ishiyama, A., Tabata, M., Sasaki, Y., Yoneda, S., Shiozaki, A., Relationship between cervical mucus interleukin-8 concentrations and vaginal bacteria in pregnancy (2004) Am J Reprod Immunol, 52 (2), pp. 106-112Sawada, M., Otsuki, K., Mitsukawa, K., Yakuwa, K., Nagatsuka, M., Okai, T., Cervical inflammatory cytokines and other markers in the cervical mucus of pregnant women with lower genital tract infection (2006) Int J Gynaecol Obstet, 92 (2), pp. 117-121Romero, R., Gotsch, F., Pineles, B., Kusanovic, J.P., Inflammation in pregnancy: Its roles in reproductive physiology, obstetrical complications, and fetal injury (2007) Nutr Rev, 65 (12 PART 2), pp. S194-S202Glasow, S., Stepan, H., Sack, U., Faber, R., Cervical immunoglobulin A and altered vaginal flora in pregnant women with threatened preterm delivery (2004) J Perinat Med, 32 (1), pp. 37-41Svare, J., Andersen, L.F., Langhoff-Roos, J., Madsen, H., Jensen, E.T., Bruun, B., Uro-genital microbial colonization and threatening preterm delivery (1994) Acta Obstet Gynecol Scand, 73 (6), pp. 460-464Curzik, D., Drazancić, A., Hrgović, Z., Nonspecific aerobic vaginitis and pregnancy (2001) Fetal Diagn Ther, 16 (3), pp. 187-192Romero, R., Chaiworapongsa, T., Espinoza, J., Micronutrients and intrauterine infection, preterm birth and the fetal inflammatory response syndrome (2003) J Nutr, 133 (5 SUPPL. 2), pp. 1668S-1673Sa public health perspective. Centers for Disease Control and Prevention (1996) MMWR Recomm Rep, 45 (RR-7), pp. 1-24. , Prevention of perinatal group B streptococcal diseaseSchrag, S., Gorwitz, R., Fultz-Butts, K., Schuchat, A., Prevention of perinatal group B streptococcal disease. Revised guideline from CDC (2002) MMWR Recomm Rep, 51 (RR-11), pp. 1-22Kenyon, S., Boulvain, M., Neilson, J., Antibiotics for preterm rupture of membranes: A systematic review (2004) Obstet Gynecol, 104 (5 PART 1), pp. 1051-1057King, J., Flenady, V., Prophylactic antibiotics for inhibiting preterm labour with intact membranes Cochrane Database Syst Rev, 2002 (4). , CD000246Ovalle, A., Romero, R., Gómez, R., Martínez, M.A., Nien, J.K., Ferrand, P., Antibiotic administration to patients with preterm labor and intact membranes: Is there a beneficial effect in patients with endocervical inflammation? (2006) J Matern Fetal Neonatal Med, 19 (8), pp. 453-464Hagberg, H., Wennerholm, U., Sävman, K., Sequelae of chorioamnionitis (2002) Curr Opin Infect Dis, 15 (3), pp. 301-306Cunningham, F.G., Gant, N.F., Leveno, K.J., Gilstrap III, L.C., Hauth, J.C., Wenstrom, K.D., (2001) Williams obstetrics, pp. 689-727. , 21st ed. New York: McGraw-Hill;Regan, J.A., Klebanoff, M.A., Nugent, R.P., Eschenbach, D.A., Blackwelder, W.C., Lou, Y., Colonization with group B streptococci in pregnancy and adverse outcome. VIP Study Group (1996) Am J Obstet Gynecol, 174 (4), pp. 1354-1360Rezeberga, D., Lazdane, G., Kroica, J., Sokolova, L., Donders, G.G., Placental histological inflammation and reproductive tract infections in a low risk pregnant population in Latvia (2008) Acta Obstet Gynecol Scand, 87 (3), pp. 360-365Bélec, L., Defenses of the female genital tract against infection]. J Gynecol Obstet Biol Reprod (Paris (2002), p. 31. , 6 Suppl:4S45-4S59. FrenchDunne Jr, W.M., Holland-Staley, C.A., Comparison of NNA agar culture and selective broth culture for detection of group B streptococcal colonization in women (1998) J Clin Microbiol, 36 (8), pp. 2298-2300Hordnes, K., Tynning, T., Kvam, A.I., Jonsson, R., Haneberg, B., Colonization in the rectum and uterine cervix with group B streptococci may induce specific antibody responses in cervical secretions of pregnant women (1996) Infect Immun, 64 (5), pp. 1643-1652Nomura, M.L., Passini Júnior, R., Oliveira, U.M., Selective versus non-selective culture medium for group B streptococcus detection in pregnancies complicated by preterm labor or preterm-premature rupture of membranes (2006) Braz J Infect Dis, 10 (4), pp. 247-250Silva, M.G., Peraçoli, J.C., Sadatsune, T., Abreu, E.S., Peraçoli, M.T., Cervical Lactobacillus and leukocyte infiltration in preterm premature rupture of membranes (2003) Int J Gynaecol Obstet, 81 (2), pp. 175-182Ustün, C., Koçak, I., BariŞ, S., Uzel, A., Saltik, F., Subclinical chorioamnionitis as an etiologic factor in preterm deliveries (2001) Int J Gynaecol Obstet, 72 (2), pp. 109-115Zlatnik, F.J., Gellhaus, T.M., Benda, J.A., Koontz, F.P., Burmeister, L.F., Histologic chorioamnionitis, microbial infection, and prematurity (1990) Obstet Gynecol, 76 (3 PART 1), pp. 355-359Heller, D.S., Rimpel, L.H., Skurnick, J.H., Does histologic chorioamnionitis correspond to clinical chorioamnionitis? (2008) J Reprod Med, 53 (1), pp. 25-28Svare, J.A., Andersen, L.F., Langhoff-Roos, J., Jensen, E.T., Bruun, B., Lind, I., The relationship between prior cervical conization, cervical microbial colonization and preterm premature rupture of the membranes (1992) Eur J Obstet Gynecol Reprod Biol, 47 (1), pp. 41-4