The rapid long read DNA sequencing method identified bacterial species causing silent intra-amniotic infection

A 38-year-old at 30+5 weeks presented to the Delivery Unit due to the onset of vaginal bleeding and abdominal cramps. At 30+3 weeks of gestation, she experienced vaginal bleeding with regular uterine contractions. Tocolytic drug and dexamethasone were given. One day after admission, the patient ruptured the membranes. Transabdominal ultrasound demonstrated a single viable fetus in breech presentation with an estimated fetal weight of 1,507 g and anhydramnios. Transvaginal ultrasound showed a cervical length of 24 mm with placenta previa posterior low-lying. The patient's initial laboratory examination on admission showed anemia and elevated white blood cell count as well as C-reactive protein (WBC 26,110 cells/microlitres and CRP 69.91 mg/L). At 31+1 weeks, the patient developed regular uterine contractions. Pelvic examination showed cervical dilatation of 2 cm and 50% effacement. A Caesarean section was performed due to preterm labour with placenta previa and a fetus in breech presentation. Intraoperative findings demonstrated anhydramnios, foul-smelling yellowish pus in the uterine cavity (∼ 7 cc) and in both nostrils and mouth of a female fetus. Pus was obtained for the evaluation of microorganisms for clinical and research purposes. The post-surgery course was uneventful for the mother. The neonate was diagnosed with suspected sepsis. Placental histopathology demonstrated acute chorioamnionitis stage and grade 3 with acute funisitis. Pus Gram stain showed gram negative rods and gram positive cocci. A culture of pus from nostril and intrauterine cavity was negative for bacteria. Placental tissue culture demonstrated Enterococcus faecium and Trichosporon asahii. While a culture from chorioamniotic membranes revealed Stenotrophomonas maltophilia, Nanopore sequencing from pus showed Prevotella bivia and Peptoniphilus spp.