Culture-Based Cervicovaginal Findings and Candida Colonization in Third-Trimester Pregnancy: A Prospective...

Background and Objectives: Culture-based cervicovaginal assessment in late pregnancy may reveal bacterial and fungal findings beyond routine Group B Streptococcus (GBS) detection; however, third-trimester non-GBS findings remain insufficiently characterized. This study aimed to describe the distribution of culture-based cervicovaginal findings and to explore the associations between culture-confirmed Candida colonization and maternal, obstetric, and microscopic parameters. Materials and Methods: This prospective observational study included 300 third-trimester pregnant women at ≥28 gestational weeks who were receiving routine antenatal care at a tertiary center. Cervicovaginal samples were obtained using sterile swabs and analyzed with conventional culture-based methods. Findings were categorized according to the identified microorganisms, and GBS positivity was recorded. For Candida-focused analyses, only samples reported as fecal contamination were excluded; women with GBS-positive cervicovaginal cultures were retained in the evaluable cohort. Associations were evaluated using the Mann-Whitney U test and Fisher's exact test. Results: The mean maternal age was 26.48 ± 5.67 years. Normal vaginal flora was observed in 252 women (84.0%). Candida colonization was the most frequent non-GBS finding, identified in 35 women (11.7%), whereas GBS was detected in seven women (2.3%). Other non-GBS bacterial isolates and fecal contamination were reported in four women (1.3%) and two samples (0.7%), respectively. Clue cells, direct microscopic yeast positivity, and Trichomonas vaginalis were identified in 20 women (6.7%), 12 women (4.0%), and 6 women (2.0%), respectively. After excluding samples reported as fecal contamination, 298 evaluable cervicovaginal cultures were included in the Candida-focused analysis. Direct microscopic yeast detection was more frequent among women with culture-confirmed Candida colonization than among those without colonization (14.3% vs. 2.3%, p = 0.005), whereas Candida colonization was not associated with maternal age, gravidity, parity, gestational age, clue cell positivity, Trichomonas vaginalis positivity, or GBS-positive cervicovaginal culture. Conclusions: In third-trimester pregnancy, culture-based cervicovaginal assessment showed that Candida colonization was the most prominent non-GBS finding. The higher detection rate of culture-confirmed Candida colonization compared with direct microscopic yeast positivity suggests that microscopy alone may underestimate fungal colonization. These findings suggest that reporting non-GBS culture-based cervicovaginal findings may provide additional descriptive microbiological information beyond routine GBS detection in late pregnancy; however, they should not be interpreted as evidence of clinical outcome associations.