Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes

Autor: Vargas, Mireia, Yañez, Francisca, Elias, Andrea, Bernabeu, Andrea, Goya, M, Xie, Zixuan, Farràs Llobet, Alba, Sánchez Martínez, M. Olga, Soler, Zaida, Blasquez, Carlos, Valle, Leonor, Olivella, Anna, Muñoz, Begoña, Brik, Maia, Carreras Moratonas, Elena, Manichanh, Chaysavanh, Universitat Autònoma de Barcelona
Přispěvatelé: Institut Català de la Salut, [Vargas M, Farrás A] Servei d’Obstetrícia i Medicina Reproductiva, Unitat de Medicina Fetal, Vall d'Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Yañez F, Elias A, Xie Z, Manichanh C] Maternal and Child Health and Development Network (SAMID), Instituto de Salud Carlos III, Madrid, Spain. [Bernabeu A] Servei d’Obstetrícia i Medicina Reproductiva, Unitat de Medicina Fetal, Vall d'Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Department of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain. [Goya M, Carreras E] Servei d’Obstetrícia i Medicina Reproductiva, Unitat de Medicina Fetal, Vall d'Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Laboratori de Microbioma, Vall d'Hebron Hospital Universitari, Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Sánchez O] Laboratori de Microbioma, Vall d'Hebron Hospital Universitari, Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. Women and Perinatal Health Research Group, Institut d'Investigació Biomèdica de Sant Pau (IIB-Sant Pau). Hospital Universitari de Sant Pau, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus
Rok vydání: 2022
Předmět:
Otros calificadores::Otros calificadores::/prevención & control [Otros calificadores]
enfermedades de los genitales femeninos y complicaciones del embarazo::complicaciones del embarazo::complicaciones del parto::parto prematuro [ENFERMEDADES]
Cervix Uteri
equipos y suministros::equipo quirúrgico::pesarios [TÉCNICAS Y EQUIPOS ANALÍTICOS
DIAGNÓSTICOS Y TERAPÉUTICOS]
Other subheadings::Other subheadings::/prevention & control [Other subheadings]
Obstetric Labor
Premature
vaginal bacterial load
fenómenos microbiológicos::microbiota [FENÓMENOS Y PROCESOS]
Pregnancy
Part prematur - Prevenció
Humans
community state type
Vagina - Microbiologia
Equipment and Supplies::Surgical Equipment::Pessaries [ANALYTICAL
DIAGNOSTIC AND THERAPEUTIC TECHNIQUES
AND EQUIPMENT]
Microbiota
pessary
Infant
Newborn
cerclage
Female Urogenital Diseases and Pregnancy Complications::Pregnancy Complications::Obstetric Labor Complications::Obstetric Labor
Premature [DISEASES]
Obstetrics and Gynecology
General Medicine
Pessaries
cervical length
microbial richness
Cervical Length Measurement
microbial diversity
Premature Birth
Female
16S rRNA gene
microbial community
Microbiological Phenomena::Microbiota [PHENOMENA AND PROCESSES]
Zdroj: Scientia
ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA
r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname
ISSN: 1600-0412
0001-6349
DOI: 10.1111/aogs.14460
Popis: Cervical length; Microbial diversity; Pessary Longitud cervical; Diversidad microbiana; Pesario Longitud cervical; Diversitat microbiana; Pessari Introduction Our objective was to compare the vaginal microbiome in low-risk and high-risk pregnant women and to explore a potential association between vaginal microbiome and preterm birth. Material and methods A pilot, consecutive, longitudinal, multicenter study was conducted in pregnant women at 18–22 weeks of gestation. Participants were assigned to one of three groups: control (normal cervix), pessary (cervical length ≤25 mm) and cerclage (cervical length ≤25 mm or history of preterm birth). Analysis and comparison of vaginal microbiota as a primary outcome was performed at inclusion and at 30 weeks of gestation, along with a follow-up of pregnancy and perinatal outcomes. We assessed the vaginal microbiome of pregnant women presenting a short cervix with that of pregnant women having a normal cervix, and compared the vaginal microbiome of women with a short cervix before and after placement of a cervical pessary or a cervical cerclage. Results The microbiome of our control cohort was dominated by Lactobacillus crispatus and inners. Five community state types were identified and microbiome diversity did not change significantly over 10 weeks in controls. On the other hand, a short cervix was associated with a lower microbial load and higher microbial richness, and was not correlated with Lactobacillus relative abundance. After intervention, the cerclage group (n = 19) had a significant increase in microbial richness and a shift towards community state types driven by various bacterial species, including Lactobacillus mulieris, unidentified Bifidobacterium or Enterococcus. These changes were not significantly observed in the pessary (n = 26) and control (n = 35) groups. The cerclage group had more threatened preterm labor episodes and poorer outcomes than the control and pessary groups. Conclusions These findings indicate that a short cervix is associated with an altered vaginal microbiome community structure. The use of a cerclage for preterm birth prevention, as compared with a pessary, was associated with a microbial community harboring a relatively low abundance of Lactobacillus, with more threatened preterm labor episodes, and with poorer clinical outcomes. This study was supported by the Instituto de Salud Carlos III/FEDER FIS PI15/02043; Beca Dexeus Mujer 2015. Francisca Yáñez was supported by a grant from ANID, BECAS Chile, N° 72190278. Zixuan Xie received a fellowship from the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie Action, Innovative Training Network: FunHoMic; grant number 812969.
Databáze: OpenAIRE
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