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Prospective observational study of vaginal microbiota pre- and post-rescue cervical cerclage

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Title: Prospective observational study of vaginal microbiota pre- and post-rescue cervical cerclage
Authors: Brown, R
Chan, D
Terzidou, V
Lee, Y
Smith, A
Marchesi, J
MacIntyre, D
Bennett, P
Item Type: Journal Article
Abstract: Objective To investigate the relationship between vaginal microbiota composition and outcome of rescue cervical cerclage. Design Prospective observational study. Setting Queen Charlotte’s and Chelsea Hospital, London Population Twenty singleton pregnancies undergoing a rescue cervical cerclage. Methods Vaginal microbiota composition was analysed in women presenting with a dilated cervix and exposed fetal membranes before and 10 days following rescue cervical cerclage and correlated with clinical outcomes. Main outcome measures Composition of vaginal bacteria characterised by culture independent next generation sequencing. Successful cerclage, defined as those resulting in the birth of a neonate discharged from hospital without morbidity. Unsuccessful cerclage, defined as procedures culminating in miscarriage, intrauterine death, neonatal death or significant neonatal morbidity. Results Reduced Lactobacillus spp. relative abundance was observed in 40% of cases prior to rescue cerclage compared to 10% of gestational age matched controls (8/20, 40% vs 3/30, 10%, P=0.017). Gardnerella vaginalis was over-represented in women presenting with symptoms (3/7, 43% vs 0/13, 0%, P=0.03, LDA (log 10) and casesculminating in miscarriage (3/6, 50% vs 0/14, 0%, P=0.017). In the majority of cases (10/14, 71%) bacterial composition was unchanged following cerclage insertionand peri-operative interventions. Conclusions Reduced relative abundance of Lactobacillus spp. is associated with premature cervical dilatation, whereas high levels of Gardnerella vaginalis are associated with unsuccessful rescue cerclage cases. The insertion of a rescue cerclage does not affect the underlying bacterial composition in the majority of cases.
Issue Date: 1-Jun-2019
Date of Acceptance: 7-Dec-2018
URI: http://hdl.handle.net/10044/1/66690
DOI: https://dx.doi.org/10.1111/1471-0528.15600
ISSN: 1470-0328
Publisher: Wiley
Start Page: 916
End Page: 925
Journal / Book Title: BJOG: An International Journal of Obstetrics and Gynaecology
Volume: 126
Issue: 7
Copyright Statement: © 2019 Imperial College London BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Sponsor/Funder: Medical Research Council (MRC)
Medical Research Council (MRC)
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: MR/L009226/1
MR/L009226/1
RDD03 79560
Keywords: Science & Technology
Life Sciences & Biomedicine
Obstetrics & Gynecology
Infection
preterm birth
rescue cerclage
vaginal microbiome
GARDNERELLA-VAGINALIS
PREGNANCY
WOMEN
INSUFFICIENCY
BIRTH
Infection
preterm birth
rescue cerclage
vaginal microbiome
Abortion, Spontaneous
Cerclage, Cervical
Female
Fetal Death
Gardnerella vaginalis
Humans
Labor Stage, First
Lactobacillus
Microbiota
Pregnancy
Pregnancy Outcome
Premature Birth
Prospective Studies
Uterine Cervical Incompetence
Vagina
Vagina
Humans
Gardnerella vaginalis
Lactobacillus
Abortion, Spontaneous
Fetal Death
Premature Birth
Pregnancy Outcome
Cerclage, Cervical
Prospective Studies
Pregnancy
Labor Stage, First
Uterine Cervical Incompetence
Female
Microbiota
11 Medical and Health Sciences
Obstetrics & Reproductive Medicine
Publication Status: Published
Online Publication Date: 2019-03-10
Appears in Collections:Division of Surgery
Faculty of Medicine



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