Genital Microbial Isolates in Women with Premature Rupture of Foetal Membranes in North West Nigeria

Export Objective: Premature rupture of fetal membranes is considered an obstetrical emergency as it has been associated with an increased risk of maternal and perinatal morbidity and mortality. The aetiology and pathogenic mechanisms underlying premature rupture of membrane (PROM) are not clearly understood. The evidence for a bacteriogical cause appears to have been established. The aim of this study was to determine the association and the profile of genital microbiological isolates among women presenting with PROM. Methods: The study was a comparative cross sectional study conducted among patients presenting with PROM at a Teaching Hospital, North West Nigeria. The control group consisted of selected women attending antenatal clinics of the hospital with fetal membranes. Subsequently high vaginal and endocervical swabs were taken from all subjects. Results: The incidence of PROM was 7.7%. The mean ages for the cases and control were 27.6±5.2 and 27.3±5.3 years, respectively. The Hausa/Fulani ethnic group was the predominant 67.5% among cases and 70% among the controls, while majority (72.5%) of both cases and controls were Muslim. Most of the cases were multipara 20 (50%) and presented at term 33 (82.5%). Vaginal discharge was the most common symptom in both groups. Organisms from HVS were isolated in 23 (57.5%) of the cases and 13 (32.5%) of the control. The difference was statistically significant (χ2=5.051, df =1, p=0.025). The common organisms isolated from cases were Streptococcus agalactiae (25%), Trichomonas vaginalis (20.8%), Gardnerella vaginalis (20.8%) and Escherichia coli (12.5%). Most of the organisms were sensitive to erythromycin (81.90%), gentamycin (63.6%) and co-amoxiclav (45.50%). The risk of genital infection was 2.8 times more likely among women with PROM than the control group (OR=2.8, 95% CI= 1.1–7.0, p=0.026). High parity was the most common risk factor for genital infection. Conclusions: The incidence of PROM from this study was 7.7%, which is within reported incidence of PROM worldwide. The most common organism isolated from this study was Streptococcus agalactiae and the most sensitive antibiotics were erythromycin and gentamycin. The risk of infection was almost 3 times higher among women with PROM when compared to the women with intact fetal membranes. High parity was the most common risk factor for genital infection.