Comparison Of Oral Microbiota In Various Modes During Births – Viz., Normal, Induced, Episiotomy, Forceps, Cesarean And Premature Neonates
S D. P., S V.V., S N.D.
S D. P., S V.V., S N.D.. Comparison Of Oral Microbiota In Various Modes During Births – Viz., Normal, Induced, Episiotomy, Forceps, Cesarean And Premature Neonates. The Internet Journal of Dental Science. 2010 Volume 10 Number 1.
Myriads of bacteria abound in the world, and these and other single cell creatures represent the major diversity of life on our planet. Bacteria also constitute the communal or normal microflora and populate the mucosal surfaces of the oral cavity, gastrointestinal tract, urogenital tract and skin surface1.
The microflora of the vagina normally varies during different phases of a woman's life, but they can also be strikingly different in individual women during the fertile age. Two major patterns of vaginal microflora exist among reproductive age group women. The normal or physiologic pattern in the birth canal is dominated by facultative lactobacilli. The other major pattern is synonymous with the clinical entity known as bacterial vaginitis (BV), which is characterized by mixed anaerobic and facultative bacteria. The lactobacilli most frequently present in normal vaginal secretions are
The possibility of the maternal microflora being transferred to the infant during childbirth has been observed in different birth modes. The present study was, therefore, undertaken with the following aims and objectives:
To compare the vaginal microflora of mothers just before delivery and the oral microflora of the newborns immediately after birth.
To compare the microbiota obtained from the mouth of the neonates at birth, born via normal delivery, episiotomy delivery, induced delivery, forceps delivery, cesarean delivery and premature delivery .
To compare the microbiota obtained from the mother’s birth canal during normal delivery, episiotomy delivery, induced delivery, forceps delivery, caesarean delivery and premature delivery.
Materials And Methods
This study was conducted in the Obstetrics and Gynecology department of Women and Child Hospital, K.R. Market, Davangere, in collaboration with the Department of Microbiology, J.J.M.M.C. Davangere, after obtaining ethical clearance. This was an observational study in which the newborn’s oral cavity, was observed for microorganism transfer from pregnant women’s birth canals during various delivery modes. The present study involved 150 healthy, pregnant women, with no history of antibiotic usage. Deliveries resulting in twins, triplets, quadruplets etc. were excluded from the study. Infants born by Normal, Induced, Episiotomy, Forceps, Cesarean, and Premature deliveries alone were studied. Deliveries resulting in infant death were excluded from the study.
The procedures, the possible discomforts, risks and benefits were explained fully to the human subjects involved and informed consent for the study was obtained from the families of the pregnant women, prior to the investigation.
Parturient canal sample was obtained from each of the 150 pregnant subjects. A sterile cotton swab was used to obtain the vaginal material from the vagina, by rotating and swabbing, just prior to the delivery. Oral cavity samples were obtained immediately following the infant’s birth. Sterile swabs were rotated and swabbed from the cheeks, buccal sulci and edentulous ridges; the tongue and hard palate were uniformly sampled with a single swab obtained using a wooden stick. Both the birth canal and oral cavity samples, before transferring to the transportation medium, were used to make a smear on a sterile glass slide, which was then air dried, fixed with alcohol and finally transferred to the sterile leak-proof test tube containing 5% glucose broth. This was stored on ice and transported to the microbiological laboratory for analysis. Z test and Chi-square test were applied for statistical analysis.
The glass slides with the smear were stained with Gram's stain and microscopically observed for organism morphology. The specimens inoculated in the 5% glucose broth were then placed in the incubator for 18-24 hours and then inoculated into the blood agar and McConkey media, using a sterile inoculating loop. The media were incubated for 18-24 hours. After 24 hours, the culture media were observed for growth. If no growth was evident, it was further incubated. Colonies
In (Group-1) Normal Delivery and (Group-2) Induced Delivery:
In (Group-3) Episiotomy Delivery:
In Cesarean Delivery (Group-5):
In Premature Delivery (Group-6):
The overall transfer of microorganisms from the birth canal to the oral cavity in all the birth modes were identified as
When normal delivery was interred compared with Induced Delivery, Episiotomy Delivery, Forceps Delivery, Cesarean Delivery and Premature Delivery, it was not significant. When induced delivery was interred compared with the episiotomy delivery and forceps delivery, it was considered statistically significant (P<0.05) and with cesarean delivery and premature delivery it was not significant. When the episiotomy delivery was interred compared with forceps delivery and premature delivery it was not significant, whereas for the forceps delivery it was statistically significant (P<0.01). When the forceps delivery was interred compared with the cesarean delivery and premature delivery it was statistically significant (P<0.001) and (P< 0.05), respectively. When the cesarean delivery was interred compared with premature delivery it was not significant (Table- 8).
The series of movements that occurs on the baby’s head, in the process of adaptation during its passage through the pelvis, is termed normal delivery. This delivery is by the vaginal route3. Episiotomy is an incision of the perineum. It is performed because the perineum bulges increasingly and the vulvo-vaginal opening becomes progressively more dilated by the fetal head4. Induction of labor is an obstetric procedure designed to pre-empt the natural process of labor by initiating its onset artificially before it occurs spontaneously. Forceps delivery is the delivery using mechanical aids. It is indicated to expedite vaginal delivery, which may be slowed due to poor progress or because of some maternal or fetal emergency. Cesarean section is the delivery by the abdominal route. A preterm infant is defined as one born at less than 259 days of pregnancy5.
The normal microflora of the vagina include
In this study, the oral cavity at birth, in all the delivery types showed, besides the above listed microorganisms,
In Group — I (Normal Delivery): In the present study, the infants’ mouths were observed to be sterile in 20% of the newborns. The aseptic precautions undertaken in this study, and the vaginal flora could be considered as the possible factors for the higher number of sterile oral cavities at birth, in this type of delivery. Witkowski (1935)8 reported that the oral cavity was sterile in only 2% infants, a few hours after birth. Gundel and Schwarz (L932)7 stated that the mouth was sterile in 37.5% within six hours of birth. Panesar J. (1997)12 noted that the oral cavity was sterile in only 12% of the newborns at birth. Hegde S. (1998)9 observed that the oral cavity was sterile in 6% of the new born infants, at birth.
In this study, the microorganisms found are
In Group – II (Induced Delivery): The oral cavity was sterile in 32% of the newborns.
In Group – III (Episiotomy Delivery): The oral cavity was sterile in 8% of the infants.
Group – IV (Forceps Delivery): The oral cavity was sterile in 4% of the newborns.
In Group – V (Cesarean Delivery): In this study, the oral cavity was sterile in 44% of the newborn infants, whereas Panesar (1997)11 reported 28%. This difference could be because of the maintenance of a sterile operation theater. Sterilization methods employed in the operation theater, surgical instruments and equipment could also be considered.
In Group — VI (Premature Delivery): The oral cavity was sterile in 24% of the neonates.
The following conclusions were drawn from this study:
The oral cavity of the neonates delivered by Forceps was found to be the most sterile of all the types of deliveries. Neonates delivered by Cesarean section were found to have the least sterile oral cavities.
A greater number of mother-child pairs showed the presence of Lactobacilli, Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella, E. coli, Candida species, enterococci, bacteroides species and pseudomonas. However, α-¬hemolytic streptococci, diphtheroids, Neisseria species, Staphylococcus citrius and Acinetobacter were only occasionally isolated from mother-child pairs.
In all the cases, regardless of the delivery type, the mothers’ vagina was contaminated. However, the oral cavity of the newborn was contaminated with the microorganisms from any of three sources - by contamination from the birth canal or hospital infection or contaminated instruments.
In all the birth modes, the oral cavity was contaminated by one or the other microorganism.
Total or 100% sterile oral cavity was not observed in any of the neonates, in any type of delivery. The degree of contamination in the oral cavity of the neonates varied from 4-44% in Forceps type and Cesarean type of delivery, respectively.