Abstract

Background: Preterm labor (PTL) is the onset of uterine contractions with cervical changes before 37 weeks of gestation and remains a major cause of neonatal morbidity and mortality worldwide. Genital tract infections are strongly implicated in its pathogenesis, yet data from Iraq remain scarce.
Aim of the Study: To identify the bacteriological spectrum of genital tract infections among women presenting with active preterm labor, to guide preventive and therapeutic strategies.
Methods: A cross-sectional study was conducted at Al-Mawani Teaching Hospital for Maternity and Children in Basra, Iraq, over nine months (October 2024–July 2025). A total of 111 pregnant women (28–36 weeks) with clinically diagnosed active PTL were enrolled. Data on demographics, obstetric history, and clinical presentation were collected using a structured questionnaire. Endocervical swabs were obtained aseptically, cultured on standard media, and analyzed using Gram staining and biochemical tests.
Results: Culture positivity was 78.4%, with Staphylococcus spp. (48.6%) as the predominant isolate, followed by Streptococcus spp. (13.5%), E. coli (8.1%), and Candida spp. (5.4%). Mixed Candida + Staphylococcus infections (2.7%) were strongly associated with neonatal mortality (p <0.001). Significant predictors of positive cultures included younger maternal age (<20 years, 100%; p  <0.001), low parity (p <0.001), vaginal discharge (p = 0.024), vaginal itching (p = 0.045), and prolonged symptom duration (p = 0.008). Neonatal outcomes included 55.9% NICU admissions and 10.8% mortality.
Conclusions: Genital tract infections, particularly mixed infections, represent a preventable and clinically significant determinant of PTL and adverse neonatal outcomes. Routine microbiological screening of high-risk women is recommended to improve maternal and neonatal health.