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.