¹College of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran.
Email : Roxana_Behruzi@yahoo.com. Phone No . 98-151-49321. 98-151-40874. Fax: 98-151-44101.
²Faculty of Pharmacy. Mazandaran University of Medical Science, Sari, Iran.
Email: moussavi_Z@yahoo.fr Phone No . 98-151-59802.

Summary

Background and Purpose

Chlamydia trachomatis is one of the most common and spoiling sexually transmitted diseases in different countries. Chlamydia trachomatis plays an important role in disease such as salpingitis and urethritis/ cervicitis/ premature rupture of membrane / neonatal infection while passing through the vaginal / infertility and ectopic pregnancy.

This study was designed to investigate the prevalence of Chlamydia infection among the pregnant women who were referred to one of the perinatal clinics of Tehran University of Medical Sciences.

Materials and methods

This research included 400 pregnant women who had been selected by a two – stage program from the women referring to perinatal care clinics of Tehran University of Mediacal Sciences.

The mean for gathering data was a questionnaire contained demographical and socioeconomic questions. Samples of cervical discharge and serum examined by direct immunofluorescence and microimmunofluorescence techniques.

Results

The prevalence of Chlamydia infection among women referring to these perinatal care clinics was about 2.75 percent. Among 400 samples of cervical discharge examined by microimmunofluorescence technique/ IgG and secretory IgA titers ≥1:8were found in 8 women (2%) indicating active infection with Chlamydia trachomatis. The results showed that variables like the age of marriage/ history of vaginal discharge/ dysuria/ and education are related to the prevalence of Chlamydia infection in women .

Conclusion

According to the results/ Chlamydia infections are common among the pregnant women/ therefore it was suggested that all of the women high risk for Chlamydia infection should be screened during pregnancy.

Key Words

Pregnant women , Chlamydia trachomatis.

Introduction

???, gram To 1.5) Chlamydia trachomatis (C T) , is a Coccoid baccili (0.9 negative, non - motile and intracellular , Livining in man and animal Cells, because it requires host cell adenosine triphosphate (ATP) for life cycle (1). Approximately 3-4 millions get infection to chlamydia in the USA every year (2). The prevalence of (CT) infection in clinic of obstetric and gynecology varies between 2-26 (3) . Cervix chlamydial infection in 70% of women is either asymptomatic, and /or with slight vaginal discharge , beeding, and low abdominal pain. In some women , urethral chlamydial infection Leads to urethritis with symptoms of dysuria and pyuria (2). Special attension is paid to CT infection in midwifery, because this organism Causes Cervicitis, preterm delivery , amniotic sac rupturing and neonatal infection while passing through the birth canal (4) .

Although the effect of treatment of chlamydia infection is not clear on the future of pregnancy, but the advantage of identification and treatment in the prevention of neonatal infection is known to every body. Direct transmission of chlamydia to neonate during vaginal delivery occurs in 50-60% of the cases, which leads to Complications such as conjunctivitis and pneumonia in neonates (3). Repeatition of screening tests in the first prenatal examination and in the first trimester of pregnancy, also successful treatment with erythromycin can reduce the complication significantly (5).

Medical recommendation of CDC and American college of gyne cology emphasize on performance of screening tests in pregnants and specially in high risk cases (6), Indicates the importance of identification and treatment of infection.

This study aims at evaluation of the prevalence of chlamydial infection in pregnant women referring to hospitals affiliated to the Tehran University .

Materials and methods

This Research is a descriptive study done on 400 pregnant women referring to hospitals affiliated to the Tehran University for prenatal Care in the year 1996.

Selection of the number of the cases was determined on the basis of 13% prevalence rate of chlamydial infection in the Iranian society. Sampling was don randomly with simple method. The pregnants women being in their third trimester of pregnancy, and had no antibiotic months before the date of examination . Data were collected from questionnairs .

Information recorded in the reception sheet and the laboratory investigations. The questionairs comprised of 31 questions .

Part of the questions were about individual characteristics and the other part about the socioeconomical status of the the patients. All of the samples were collected by the researchor, as follow:

At first with the help of spacolum, cervix was visualized, the extra discharges were removed by sterile gauze One piece of sterile sponge which absorbed 0.1 ml of local discharge was palced in the cervical canal of uterus with the help of sterile panse, later on the sponge was taken out and kept in sterile glass container to be transported, and was kept at -20°^c in freezer. . local discharge was collected with the help of sterile cotton swab, smear was prepared for the direct immunofluonescence test, labelled and kept in special box, and fixed with acetone in laboratory, and kept at -20°C in freezer.

The identification methods were as following

1. Direct immunofluorescenc for the identification of CT from cervical discharge with the help of mono clonal antibody, using Biomerieux kits

2. Micro immunofluorescence method for the specific antibody against chlamydia in the serum and genital tract discharge of the patients. The analysis of the data was done by descriptive and analytical method using fishers’ . X² and odd ratio.

Results

Cansidering the table number (1) . In 8 cases there was the presence of IgG and secretary Ig A ≥1:8 against CT. From Cervical discharge with immuno fluorescene method which indicates active or recently infection with CT. The antibody titers were as following :

In 2 cases (0.5%) titer was 1:8 , three cases (0.75%) 1:16, 2 cases (0.5%) 1:65 and in one case 1:128. The direct immunofluorescence test was positive in 11 cases (2.75% ) under studying, which were conformed for the second time, (table No.1). In the cervical discharge of 8 patients .

There was postive direct immunofluorescence specific antibody titer of ≥1:8 against chlamydia .

Table No.1: Distribution of antibody titers against CT. infection form cervical discharges by direct immunofluorescence method

Sample		Antibody titers										no		Posetive direct
		1/8		1/16		1.39		1/64		1.128		Titer		Immuno-fluorescence
Discharge		No	%	No	%	No	%	No	%	No	%	No	%	No	%
of Cervix		2	0.5	3	0.75	0	0	2	0.5	1	0.25	392	98	11	2.75
Total	400	8(2%)										392	98	11	2.75

In the study of 11 serum samples with micro immunofluorescence method in 9 samples different titers of antibodies against CT was observed , and in 5 cases there was indication of active or recent infection IgG ≥1:32. (Table No . 2 ).

Table No 2: Distribution of antibody titer in Serum and cervical discharge and posetive Result of Direct immunofluorescence test.

Positive result of Direct immunofluor-escence	Antibody titer in cervical discharge	Antibody titer in serum	Age	Patient (N= 11)
+ + + + + + + + + + +	-- 1/128 -- 1/8 1/8 1/16 1/64 -- 1/64 1/16 1/16	1/16 1/128 1/16 1/16 1/16 1/32 1/64 1/32 -- 1/32 --	21 18 21 20 19 31 18 36 26 18 24	1 2 3 4 5 6 7 8 9 10 11

Results shows the most percentage of disease (4.2%) in patients with more than 20 years or less of marriage life the chance of getting infection with CT in the patients with more than 20 years of marriage life was 12.38 times more. (Table No.3).

These findings show that the most prevalence of disase (4.5%) are observed in the patients with abnormal discharge and the chance of getting infection in these groups was 4.71 times more than those with normal discharge . The most Prevalence of disease in the patients with dysuria was (12.5%) against those without dysuria (1.9%) and the chance of infection in the patient with dyauria was 7.64 times more than those without dysuria.

Table No.3 : The absolute and relative frequency distribution of the cases under studying on the basis of some individual factors and the disease status

Patient’s condition		Patient		Healty		Total		Ratio	Confidency (%)		Analysis
Some individual factors		NO	%	NO	%	NO	%	Chanle	high	Low	Fisher
Age of Marriage	20 years or less	11	4.2	253	45.8	264	100	12.28	5.56	0.01	Significant
	more than 20 years	0	0	136	100	136	100	0.08	50	0.17
History of Vaginal Discharge	No	2	1	149	40	201	100	0.21	1.05	0.02	Significant
	Yes	9	9	4.5	95.5	199	100	4.71	45.23	0.98
Dysuria	No	7	1.9	361	98.1	368	100	0.14	0.68	0.03	Significant
	Yes	4	12.5	28	28	32	100	7.37	30.79	1.48

The results of analysis showed that there is significant relationship between disease and the variables such as the age of marriage life , history of vaginal discharge and dysuria (P<0.05). Table NO:3

Discussion

The result of this study shows that the rate of prevalence of chlamydial infection in pregnant women referring to the hospital affiliated to Tehran University is 2.75%. Mc Gregor and French (1991) reported the prevalence of chlamydial infection in the pregrant woman about 2 to 20 % (4).

Finding of this Reseach is similar to that of Robertson et al (1991) which was (2.9%) in pregnant women in north Ireland (7) .Bendell et al (1991) reported 3% in Germany (8). The result of this research is different from the other researches done in different countries, which show the high prevalence of chlamydial infection in pregnants. Beaujean et al (1990) reported 9% of prevalence in young women in Zaeer (9) . Nugent and Hillier (1999) in USA reported 14% of prevalence in pregnants (10).

The differnce of the rate of prevalence between our study and the other workers, may be due to the difference in cultures religious and social behaviours. High prevalence of disease (4.2%) in the persons with 20 years and less than 20 years of marriage life , is probably due to sexual activity or more pregnancies or having oral contraceptives, all of which are risk factors of chlamydial infecion (11) . In a report by Robertson et al (1991) The mean age of the first sexual contact in pregnants infected with chlamydia was 19 years of old (7) . The analysis of this research findings shows that the chance ratio in the group with apparently abnormal discharge is 4.71 times more than the group without abnormal vaginal discharge. In researches by Humpherys and others (1992) done in the pregnant referring to the family planning clinics the chance ratio in those with abnormal discharge was 2.8 times more (12) .

According to Carrington (1992) physicians must consider the patients with vaginal discharge and inflammation variations in their cervix sampls for cytologic study as a high risk for chlamydia infection .

The clinical manifestation of chlamydial infections in the pregnant women is generally with burning , Vaginal discharge and low abdominal pain (11).

From the result it is concluded that , in case of presence of symptoms, the prevalence rate of chlamydial infection is more and the chance ratio is higher 12.5% against 1.9% . Samji and other workers (1991) reported 11.8% of the chlamydial infecton in the pregnant women with symptoms of urinary tract infection (14) . Considering the results the researches and the awareness of the presence of chlamydial infections in the pregnants women, The midwifes and obstetrists, can identify this infection in the pregnant women referring to them and can help in treatment and controling the complications arised due to this infection .

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