A new premature diaphragm rupture nomogram (PROM) that incorporates age, regular perinatal visits, history of vulvovaginal candidiasis (VVC) before pregnancy, symptoms of VVC, healing of VVC during pregnancy pregnancy and bacterial vaginitis could easily facilitate the prediction of PROM risk in gravidas.
This is the conclusion of a new study in the journal Frontiers in medicine.
The study included 417 women hospitalized at the First Affiliated Hospital of the Guangzhou University of Chinese Medicine from January 2013 to December 2020. The inclusion criteria were women diagnosed with pregnant CVV, whether recovered or not; single pregnancies; and pregnancy delivery at 28 to 42 weeks vaginally or by cesarean section.
The patients were divided into 2 groups, PROM (n = 141) and no PROM (n = 276), for a PROM incidence of 33.81%.
The prediction model discriminated with a concordance index of 0.684; 95% confidence interval (CI): 0.631 to 0.737.
“Decision curve analysis showed that the PROM nomogram was clinically useful when the intervention was decided at a PROM threshold of 13%,” the authors wrote.
The relatively accurate nomogram indicates that the 4 key likely protective factors for PROM in pregnant women with CVV are avoidance of pregnancies over 35, regular perinatal visits, early detection of CVV, and treatment.
To the surprise of investigators, routine perinatal visits had the greatest impact on PROM in pregnant women with CVV. Due to an unequal distribution of medical resources in China, as well as development disparities between urban and rural areas, some pregnant women who live in remote mountainous areas or who have minimal education are not aware of the importance prenatal care. Therefore, the government should expand the provision of antenatal care to these women, according to the authors.
Additionally, the information in the nomogram costs next to nothing as it is based on existing medical history as opposed to the routine blood tests offered or a routine urine test to predict PROM.
Other potential risk factors for PROM are low level of education, high body mass index (BMI) before pregnancy, misrepresentation and hydramnios, as well as the combination of intracytoplasmic sperm injection for the assisted reproduction and a high BMI.
Since clinicians are more sensitive to observing symptoms of PROM, regular perinatal visits could lead to the identification of symptoms and prevent the development of adverse events. For example, pregnant women with abnormal vaginal discharge are at a higher risk of developing PROM because the discharge is indicative of an infection: the infection causes inflammation of the membrane, resulting in subsequent rupture.
For women who do not complain, at least 1 examination of vaginal discharge is advised during pregnancy, preferably in the first trimester. Once VVC is detected, it should be treated without delay. According to the latest guidelines for the management of vaginal discharge from the World Health Organization, a single dose (oral or vaginal) of azole is a simple and effective treatment for CVV.
The authors noted that future research to predict PROM could involve Candida species, maternal and neonatal outcomes, and mechanisms. Optical coherence tomography could also be a potential tool.
- Yang L, Wang H, Li Y et al. Development of a new nomogram to predict premature rupture of the membrane in pregnant women with vulvovaginal candidiasis. Middle front (Lausanne). Published online November 15, 2021. doi: 10.3389 / fmed.2021.717978