Introduction

The association of lactobacilli with other vaginal microflora has been documented in the development of Aerobic Vaginitis and Bacterial Vaginosis. As the numbers of lactobacilli dwindle, proliferation of other aerobic microflora, predominantly enteric commensals occurs. In our practice we find E coli as most common organism present in lochia of puerperal sepsis cases. In present study an attempt was made to study the relation between the Lactobacilli and other pathogenic organisms commonly present in the vagina during early labor and after delivery.

Aims and objectives

To study normal and abnormal vaginal microflora in low risk pregnant women during early labor at term pregnancy and 48 hours after delivery and its association to clinical findings.

Material and methods

50 low risk pregnant women in early labor at term pregnancy without any obstetric complications were studied for vaginal microflora. A vaginal swab was taken from all fornices and submitted for gram stain and culture. After 48 hrs of delivery repeat swabs were taken and submitted for gram stain and culture.

Abnormal vaginal microflora was defined as the absence or diminished amount of lactobacilli (BV, AV and intermediate vaginal microflora) or a positive culture for Candida sp.

In Gram stain, vaginal microflora was studied according to grading.

Grade 1– Predominance of lactobacilli and diminished ancillary flora

Grade 2 –Intermediary with a diminished number of lactobacilli coexisting with other bacteria

Grade 3– Markedly diminished or absence of lactobacilli and predominance of bacterial morphotypes

Results

Proportion of normal vaginal microflora (Grade 1) was 34% and abnormal vaginal microflora (Grade 2 & 3) was 66 % in the swabs taken during early labor at term pregnancy. The most frequent types among abnormal flora were Aerobic Vaginitis (34%), intermediate flora including BV (32%), Candidiasis (26%) and cytolytic vaginosis (6%). In spite of detection of abnormal vaginal microflora in 66% patients during early labor, none had developed complications like preterm labor, PROM, PPROM or chorioamnionitis. Grade 2 and Grade 3 microflora (abnormal flora) were more common in multigravida patients, 61.1%, 88.8%, and 100% in 2^nd, 3^rd and 4^th gravida patients respectively. In spite of strict aseptic precautions, abnormal vaginal microflora was present in 96% patients 48 hours after delivery. Thus increased parity had relation with abnormal flora in our study.

Itching was present in 81.8% patients with abnormal vaginal microflora with P value <0.05.

Altered vaginal pH was present in 69.7% patients with abnormal microflora with P value <0.05.

In bacterial morphotypes, E coli was the predominant bacterial morphotype isolated in culture in majority of patients (72 % ) after delivery and other organisms include staph epidermidis, pseudomonas, strepto pyogenes, enterobacter aeruginosa. After delivery, only 4% patients had normal or Grade 1 flora.

No patient had fever, subinvolution of uterus, foul smelling discharge P/V, episiotomy wound infection or gap in the puerperium.

Conclusion

Data from this study indicate a high proportion of alterations in vaginal microflora of low–risk pregnant women in early labor at term pregnancy without development of complications like preterm labor, PROM, PPROM or chorioamnionitis.

There is significant association between complaint of itching, altered vaginal PH and abnormal vaginal microflora.

E coli were the most common organisms isolated after delivery but none had developed puerperal sepsis. The ability of pathogenic organism to replicate is potentially governed by inhibitory or synergistic interrelationship with other microbes.

According to our study, the abnormal vaginal flora was more common with high parity. Does parity have any influence on vaginal microflora?