Infectious causes of stillbirths among women at Rahima Moosa Mother and Child Hospital

Abstract

Background: Stillbirths are associated with socio-economic consequences including physical and mental impairment to the bereaved family as well as financial implications to the family and the health-care system. There is a close association of stillbirths in developing countries and infections, however, often without specific microorganisms identified. Objectives: To determine the prevalence and causes of intrauterine infections by describing the microbiology, culture and sensitivity (MCS) as well as histopathological findings identified in placental samples of stillbirths Methods: A retrospective, descriptive study was conducted at RMMCH, Johannesburg, (from 1 January 2020 to 31 December 2020) to review infections in placentas of stillborn fetuses of at least 22 weeks’ gestational age or with a birth weight of ≥500g. Medical records were used to abstract maternal clinical information. Microbiological and histopathological data of placentas were retrieved and assessed to identify their associations with chorioamnionitis as well as for assessment of microorganisms’ drug sensitivity and resistance patterns. Statistical software (STATA) version 17 was utilized for data analysis. Descriptive data was reported using means, medians, and standard deviations. Results: A total of 103 patient records were reviewed. Placental reports of 79/103 (76.7%) stillbirths were examined, with (33/79) 41.7% showing the presence of chorioamnionitis. The findings showed that 17 out of 33 cases (51.5%) had acute chorioamnionitis with a fetal inflammatory response. A total of 50/79 (63.3%) placental membranes were sent for analysis with 35 microorganisms cultured from 25 specimens. The incidence of the various organisms included: 9/35 (25.7%), Staphylococcus (S) epidermidis, 7/35 (20.0%) Escherichia (E) coli, 7/35 (14.3%) Enterococcus faecalis, 4/35 (11.4%) Staphylococcus haemolyticus, 3/35 (8.6%) Staphylococcus aureus and 3/35 (8.6%) Group B Streptococcus cases. Most of the Gram- negative organisms, namely E coli and Klebsiella oxytoca were 100% sensitive to amoxicillin -clavulanic acid, second, third and fourth generation cephalosporins (ceftriaxone, cefoxitin, cefuroxime and cefepime) and carbapenems (ertapenem, meropenem and imipenem). One case (2.9%) had Candida albicans cultured which was sensitive to fluconazole. No viruses or parasites were found in this study. v Conclusion: Chorioamnionitis was associated with 41.7% of stillbirths. S. Epidermidis, E. coli and Enterococcus faecalis were among the commonest microorganisms identified in this study with most of them being sensitive to amoxicillin-clavulanic acid, cephalosporins, ciprofloxacin and ertapenem. Routine investigation including placental histopathology and MCS of all stillbirths and poor fetal outcomes should be emphasized with prompt review of results and appropriate clinical follow-up.