Prevalence of bacteria in intraamniotic infections among women in spontaneous preterm labour with intact membranes at kenyatta national hospital: an exploratory cross-sectional study.

Abstract

Background and objectives: preterm births are a major public health concern with global estimates at 10.6% of all births. It is estimated at 13.5% at the kenyatta national hospital, nairobi kenya. Asia and sub-saharan africa accounts for about 80% of all preterm births. It remains an obstetric dilemma. Intraamniotic bacterial invasion causes spontaneous preterm labour, most commonly from ascending infections. It's associated with increased maternal and neonatal morbidities, decreased preterm-labour onset to delivery time and poor response to tocolysis. There is paucity of information on identification and antimicrobial susceptibility patterns of the involved bacteria. The aim of this study was to determine the prevalence of subclinical intraamniotic bacterial infection in women in spontaneous preterm labour with intact membranes presenting at a tertiary teaching hospital located in subsahara africa, the identity of the bacterial isolates and their antimicrobial sensitivity. Design: this was an exploratory cross-sectional study involving 22 gravid women consecutively recruited from the antenatal and labour wards of kenyatta national hospital, nairobi, kenya. Methodology: 22 women with singleton pregnancies in spontaneous preterm labour with intact membranes were consecutively sampled and recruited in the study. Informed consent was obtained. Pretested questionnaires used to collect demographic and obstetric data. Continuous ultrasound guided amniocentesis was performed aseptically and samples cultured forr presence of bacteria and their antibacterial sensitivity. Descriptive analysis was applied and prevalence of subclinical intra-amniotic bacterial infection calculated. Bacterial isolates and their antimicrobial susceptibility were described in proportions. Results: 22 gravid mothers in spontaneous preterm labour with intact membranes were recruited with a mean age of 26.7 years (sd 6.3). 36% and 41% had primary and secondary level of education respectively. 36% were primi-gravida. 68% presented at gestational ages

Of 32-36weeks. There was bacterial growth in amniotic fluid samples from 2 of the 22 participants. Enterococci feacalis and staphylococcus epidermidis were the identified bacteria with varied anti-microbial susceptibility. Conclusion: the prevalence of subclinical bacterial intra-amniotic infection amongst women in spontaneous preterm labour with intact membranes was 9%. Spontaneous preterm labour with intact membranes is potentially associated with subclinical intraamniotic bacterial invasion and needs to be further evaluated to ascertain causative association and to guide its management.