Correlation of High Vaginal Swab Culture with Early Onset Neonatal Sepsis in Prelabour Rupture of Membrane

Background: Prelabor rupture of membranes (PROM) refers to rupture of fetal membranes after fetal viability but before the onset of labor. PROM is associated with several maternal and neonatal complications, including chorioamnionitis, puerperal sepsis, and early onset neonatal sepsis (EONS). Ascending microbial infection from the cervico-vaginal canal is an important contributing factor. High vaginal swab (HVS) culture may help identify microorganisms associated with PROM and neonatal infection. This study aimed to evaluate the association between HVS culture positivity and the occurrence of EONS in mothers with PROM. Methods: A cross-sectional study was conducted at Kalinga Institute of Medical Sciences, Bhubaneswar, from October 2020 to September 2022. A total of 334 pregnant women with PROM after 25 weeks of gestation were included. High vaginal swabs were collected before vaginal examination and antibiotic administration and were sent for culture and sensitivity testing. Neonates were followed for evidence of EONS based on clinical features, sepsis screening parameters, and blood culture results. Data were analyzed to determine the association between HVS status, PROM duration, gestational age, and neonatal sepsis. Results: Among 334 mothers, 216 (64.5%) had positive HVS culture. EONS occurred in 12.6% of neonates. Neonates born to mothers with positive HVS had higher risk of sepsis compared to those with negative HVS (15.3% vs 7.6%; OR=2.18). PROM duration >18 hours significantly increased the risk of EONS, particularly in neonates born after 34 weeks of gestation. Conclusion: Positive HVS culture and prolonged PROM are associated with increased risk of EONS. Early identification and close neonatal monitoring are essential to reduce neonatal morbidity.