Novel PROM nomogram for pregnant women with vulvovaginal candidiasis

A novel premature rupture of membrane (PROM) nomogram that incorporates age, regular perinatal visits, history of vulvovaginal candidiasis (VVC) before pregnancy, symptoms of VVC, cured of VVC during pregnancy, and bacterial vaginitis could easily facilitate PROM risk prediction in gravidas.

That is the conclusion of a new study in the journal Frontiers in Medicine.

The study comprised 417 women who were hospital in-patients at First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2013 to December 2020. Inclusion criteria were women diagnosed with VVC in gestation, no matter whether cured or not; singleton pregnancies; and delivery of pregnancy at 28 to 42 weeks via vaginal delivery or cesarean.

Patients were divided into 2 groups, PROM (n=141) and no PROM (n=276), for a PROM incidence of 33.81%.

The prediction model displayed discrimination 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 intervention was decided at a PROM possibility threshold of 13%,” wrote the authors.

The relatively accurate nomogram indicates that the 4 likely key protective factors for PROM in pregnant women with VVC are avoiding pregnancy over the age of 35, regular perinatal visits, early detection of VVC, and treatment.

To the investigators’ surprise, routine perinatal visits had the greatest impact on PROM in pregnant women with VVC. Because of an uneven distribution of medical resources in China, along with development disparities between urban and rural areas, some pregnant women who live in remote mountain areas or have minimal education are unaware of the importance of antenatal care. Therefore, the government should broaden the spread of prenatal care to these women, according to the authors.

In addition, the information in the nomogram costs nearly nothing because it is based on existing medical history as opposed to proposed routine blood tests or a routine urine test for predicting PROM.

Other potential PROM risk factors are a low education level, an elevated body mass index (BMI) before pregnancy, malpresentation, and polyhydramnios, plus the combination of intracytoplasmic sperm injection for assisted reproductive technology and elevated BMI.

Because clinicians are more sensitive to observing PROM symptoms, regular perinatal visits could result in symptom identification and prevent the development of adverse events. For example, pregnant women with abnormal vaginal discharge are at higher risk of developing PROM because the discharge is indicative of infection: infection causes inflammation of the membrane, leading to subsequent rupture.

For women who have no complaints, at least 1 vaginal discharge examination is advised during pregnancy, preferably in the first trimester. Once VVC is found, it should be treated without delay. According to the latest guidelines on 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 VVC.

The authors noted that future research for predicting PROM could entail Candida species, maternal and neonatal outcomes, and mechanisms. Optical coherence tomography might also be a potential tool.

Reference

1. Yang L, Wang H, Li Y, et al. Development of a novel nomogram for predicting premature rupture of membrane in pregnant women with vulvovaginal Candidiasis. Front Med (Lausanne). Published online November 15, 2021. doi:10.3389/fmed.2021.717978