Prevalence of Mycoplasma Hominis, Ureaplasma Urealyticum and Ureaplasma Parvum in Placentae of Mothers With Preterm Delivery and the Associated Neonatal Outcomes at Kenyatta National Hospital, 2020. A Descriptive Cross Sectional Study

Abstract

Background: The global preterm birth rate in 2014 was estimated at 10•6%, equivalent to 14•84 million live preterm births. 81•1% preterm births happened in Asia and sub-Saharan Africa. Intrauterine infection during pregnancy accounts for about 40% of preterm births. Mycoplasma hominis and Ureaplasmas are frequently isolated from the placenta, amniotic fluid and cord blood and contribute towards clinical and histological chorioamnionitis. The prevalence of M. hominis, U. urealyticum and U. Parvum in preterm delivery within our setting remains largely unknown despite the poor preterm neonatal outcomes. Broad Objective: To determine the prevalence of Mycoplasma hominis Ureaplasma urealyticum and Ureaplasma parvum in placentae following preterm labor and delivery and the neonatal outcomes associated with infection with these organisms. Methodology: The study utilized a descriptive cross sectional study design, involving 125 pregnant women admitted with preterm labor between 28 weeks 0 days and 36 weeks, 6 days gestation at Kenyatta National Hospital. Informed consent was obtained. Pretested questionnaires for socio-demographic data. Following delivery, placentae were immediately collected into sterile plastic containers and taken to the Kenyatta National Hospital mortuary in a cool box for refrigeration between 2o and 8o Celsius. Using CHAMPS protocol for (minimally invasive tissue sampling MITS) procedure Standard Operating Procedure (SOP) protocol v1.0 September 2016, placental cuts were made and frozen at -80o Celsius at KAVI laboratory. Polymerase chain reaction for M. hominis, U. urealyticum and U. Parvum was done at KAVI laboratory within the College of Health Sciences, University of Nairobi. Early neonatal outcomes were established for all the 125 newborns. Results: The mean gestation age at delivery was 34.1 weeks. The mean neonatal weight was 2336 gm. There were 81.6% vaginal deliveries. Placental isolation of organisms was 63.2% M. hominis, 25.6% U. urealyticum and 53.2% U. parvum. 29.2% of the neonates were admitted into the newborn unit was Newborn admission and a mortality rate of 24.3%. Conclusion and Recommendations: There was no significant difference in the burden of placental infection and early neonatal outcomes. Larger studies to confirm our findings, and investigate the infection with M. hominis, U. urealyticum and U. parvum among preterm neonates should be conducted. Screening for these organisms before conception and offering targeted treatment may provide knowledge about future practices with an attempt to reduce global burden of morbidity and mortality associated with preterm delivery. Key Words: Preterm Birth, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, Polymerase Chain Reaction