A randomised comparative study to determine the effects of screening for lower genital tract infections on fetomaternal outcomes

Objectives: The study aimed to determine the prevalence of lower genital tract infections (LGTI) in asymptomatic pregnant women and then compare the maternal and neonatal outcomes in screened and unscreened group.Methods: A randomized comparative study was conducted in the Department of Obstetrics and Gynaecology of Safdarjung hospital over a period of 18 months.It included 300 singleton low risk asymptomatic pregnant women with period of gestation <20 weeks.All the recruited participants were randomly divided into two groups: Group A: screened group, and Group B: unscreened group.The screened participants (if found positive for infections) were managed as per the hospital protocol.Feto-maternal outcomes were assessed and compared.Results: LGTI was present in 30.67% patients which included B. Vaginosis (65.22%),Candida (21.74%), T. Vaginalis (6.52%), N. Gonorrhoea (4.35%) and Chlamydia (2.17%).Compared to the unscreened group, in terms of maternal outcomes, women in the screened group had significantly more vaginal deliveries (84% vs 74.67%, p=0.046), significantly more spontaneous labour (80.67% vs 62.67%, p=0.0005); significantly less preterm labour (2.67% vs 13.33%, p=0.001); significantly less PPROM (3.33% vs 10%, p= 0.021); significantly less chorioamnionitis (0% vs 5.33%, p=0.007); significantly less wound gaping (0% vs 5.33%, p=0.007) and significantly less preterm births (2.67% vs 20%, p<.0001); and in terms of neonatal outcomes, neonates born to screened group women had significantly more birth weight (2.71 ± 0.26 vs 2.59 ± 0.31, p=0.0005), significantly more APGAR at 5 minutes (96% vs 90%, p=0.042); and significantly less NICU admission (6% vs 13.33%, p=0.032).Conclusion: There is a high prevalence of LGTI in asymptomatic pregnant women.Screening of infections and the simultaneous management results in significant improvement in the maternal and neonatal outcomes.