Lower genital tract infections among pregnant women: a review

To determine the prevalence of lower genital tract infections, discuss briefly common maternal foetal complications associated with them and assess the usefulness of diagnostic algorithms in their management among pregnant women in the developing countries.

Articles published in English language since 1987 were looked through MEDLINE and OVID using key words supplemented by manual search in libraries except when full text of a subject was accessible via internet.

Original and review articles addressing genital tract infections, associated complications and diagnostic evaluation in pregnant women were included. Emphasis was given to articles reported from developing countries.

A total of thirty five articles were retrieved and reviewed for information on the performance of diagnostic algorithms, prevalence rates and adverse maternal-foetal effects of lower genital tract infections in pregnancy.

Lower genital tract infections are very common among apparently healthy looking pregnant women with an overall prevalence of 40-54%. Specific pathogens that were isolated from the vagina and/or cervix of asymptomatic pregnant women include: C. albicans (14-42%), T. vaginalis (11-20%), C. trachomatis (7-31%), N. gonorrhoea (0.5-14%) and group B streptococcus (4-25%). Untreated, genital tract infections in pregnant women may result in: foetal loss, preterm labour, preterm birth, premature rupture of the membranes, low birthweight, eye and lung damage in the newborn. Although the feasibility is good, the performance of clinical algorithms in the evaluation and management of lower genital tract infections is worse in pregnant women and better results are achieved for vaginal infections than cervical infections.

Routine screening for clinically important pathogens should be considered during antenatal service. There is a need to develop simple, cheap and reliable laboratory tests and better clinical algorithms for the diagnosis of reproductive tract infections among pregnant women.