Introduction
Preterm birth, defined as birth before 37 weeks’ gestation, complicates
approximately 10% of all live births and is the leading cause of
neonatal mortality and long-term neonatal neurologic sequelae. Pregnant
individuals with a previous history of preterm birth or second-trimester
loss are especially at a higher risk of preterm birth; the incidence of
a subsequent preterm birth is approximately 20-30%. Another well-known
risk factor for preterm birth is genital tract infections or
colonization such as Chlamydia trachomatis, bacterial vaginosis,
Trichomonas vaginalis, and Ureaplasma species. Given these associations,
we started a quality improvement study that performs Ureaplasma cervical
culture in addition to routine sexually transmitted infection screening
for pregnant individuals with high-risk factors for preterm birth.
Ureaplasma species are normal genital flora, carried by 50-80% of
pregnant and non-pregnant individuals. Some studies showed that
Ureaplasma species are associated with spontaneous preterm birth whereas
others did not confirm this association. A proposed mechanism is the
presence of toxins and cytokines from Ureaplasma, which lead to high
levels of prostaglandins, and later either induce preterm labor or
preterm prelabour rupture of membranes (PPROM). Despite this
association, previous studies did not show that antibiotics including
Erythromycin and Clindamycin to treat Ureaplasma for asymptomatic
individuals actually decrease spontaneous preterm birth. This lack of
effectiveness could be due to difficulty eradicating Ureaplasma species.
A randomized control trial of 60 pregnant individuals who presented with
preterm labor or PPROM showed that 93.3% of individuals still had a
positive culture for Ureaplasma after 1 gram of Azithromycin. These
studies did not treat sexual partners, nor treat pregnant individuals
again if the culture was positive after the initial treatment.
It is not known if treating both pregnant individuals and their sexual
partners would result in lower positivity rates after treatment, as well
as improvement of gestational age at delivery. Since 2014, our
institution has been performing cervical cultures of pregnant
individuals who are at high-risk for preterm birth and treating both
pregnant individuals and their sexual partners. We sought to examine
gestational age at delivery according to Ureaplasma cervical culture
results and whether pregnant individuals received appropriate
antibiotics. We also sought to examine the Ureaplasma positive rates
after treatment of pregnant individuals and their partners. Given the
data in the literature, we hypothesized that treatment of Ureaplasma was
not associated with improved gestational age at delivery, and the
treatment failure rate would be high.