Contribution of vaginal culture to predict early onset neonatal infection in preterm prelabor rupture of membranes

• Published in: European Journal of Obstetrics & Gynecology and Reproductive Biology 2021-06, Vol.261, p.78-84
• Main Authors: Ben M’Barek, Imane, Landraud, Luce, Desfrere, Luc, Sallah, Kankoé, Couffignal, Camille, Schneider, Marion, Mandelbrot, Laurent
• Format: Article
• Language: English
• Subjects: Bacterial vaginosis; Early onset neonatal infection; Intra uterine infection; Life Sciences; Preterm delivery; Preterm prelabor rupture of membrane; Quantitative Methods; Vaginal dysbiosis; Vaginal swab
• ISSN: 0301-2115; 1872-7654; 2590-1613
• DOI: 10.1016/j.ejogrb.2021.04.016

•In PPROM before 34 WG, potential pathogens were cultured from vaginal swabs in 16.9 % at rupture and 24.5 % at delivery.•Vaginal swab culture positivity was not associated with the risk of early onset neonatal infection (EONI).•Lack of lactobacilli was a major risk factor for EONI.•Clinical intra uterine infection was highly predictive of EONI. Preterm prelabor rupture of membranes (PPROM) is a major cause of morbidity and mortality for both the mother and the newborn. The vaginal germ profile in PPROM is poorly known, particularly regarding the risk of early-onset neonatal infection (EONI). To determine microbiological risk factors for EONI in case of PPROM before 34 weeks of gestation (WG). A retrospective single-center cohort of patients with PPROM before 34 W G from 2008 to 2016. Vaginal swabs were obtained at admission and at delivery as per usual care and were analyzed by Gram stain and culture for vaginal dysbiosisi.e lactobacilli depletion and/or presence of potential pathogens. Among 268 cases of PPROM, 39 neonates had EONI 14.55 %; (95 %CI 0.11 - 0.19) Overall, vaginal samples culture was positive in 16.67 % (95 %CI 11.95 %–22.32 %) at the time of rupture and 24.76 % (95 %CI 19.02 %–31.23 %) at delivery, with no significant differences between EONI and no-EONI groups (p = 0.797 and 0.486, respectively), including for Group B Streptococci (GBS) and Escherichia coli. EONI was significantly associated with dysbiosis at the time of rupture (23.94 % versus 10.35 % in the absence of dysbiosis, p = 0.009) and at delivery (19.70 % versus 3.90 % if no dysbiosis, p