前瞻性观察研究宫颈环扎术前和术后阴道微生物群。
Prospective observational study of vaginal microbiota pre- and post-rescue cervical cerclage.
机构信息
Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare National Health Service Trust, London, UK.
Imperial College Parturition Research Group, Division of the Institute of Reproductive and Developmental Biology, Imperial College London, London, UK.
出版信息
BJOG. 2019 Jun;126(7):916-925. doi: 10.1111/1471-0528.15600. Epub 2019 Mar 10.
OBJECTIVE
To investigate the relation 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 was correlated with clinical outcomes.
MAIN OUTCOME MEASURES
Composition of vaginal bacteria was characterised by culture-independent next generation sequencing. Successful cerclage was defined as that resulting in the birth of a neonate discharged from hospital without morbidity. Unsuccessful cerclage was 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 with 10% of gestation age-matched controls (8/20, 40% versus 3/30, 10%, P = 0.017). Gardnerella vaginalis was over-represented in women presenting with symptoms (3/7, 43% versus 0/13, 0%, P = 0.03, linear discriminant analysis, LDA (log 10) and cases culminating in miscarriage (3/6, 50% versus 0/14, 0%, P = 0.017). In the majority of cases (10/14, 71%) bacterial composition was unchanged following cerclage insertion and perioperative interventions.
CONCLUSIONS
Reduced relative abundance of Lactobacillus spp. is associated with premature cervical dilation, whereas high levels of G. 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.
TWEETABLE ABSTRACT
Preterm cervical dilatation associates with reduced Lactobacillus spp. Presence of Gardnerella vaginalis predicts rescue cerclage failure.
目的
研究阴道微生物群组成与挽救性宫颈环扎术结局的关系。
设计
前瞻性观察性研究。
地点
伦敦夏洛特皇后和切尔西医院。
人群
20 例接受挽救性宫颈环扎术的单胎妊娠。
方法
在挽救性宫颈环扎术前和术后 10 天，分析有扩张宫颈和暴露胎膜的女性的阴道微生物群组成，并将其与临床结局相关联。
主要观察指标
阴道细菌组成通过非培养的下一代测序来描述。成功的环扎术定义为导致新生儿出院且无并发症的分娩。不成功的环扎术定义为导致流产、宫内死亡、新生儿死亡或严重新生儿并发症的手术。
结果
与妊娠年龄匹配的对照组（8/20，40% 比 3/30，10%，P=0.017）相比，在挽救性环扎术前，40%的病例中乳酸杆菌相对丰度减少。在有症状的患者（3/7，43%比 0/13，0%，P=0.03，线性判别分析[LDA]（log 10））和以流产告终的病例（3/6，50%比 0/14，0%，P=0.017）中，阴道加德纳菌过度表达。在大多数情况下（10/14，71%），环扎术插入和围手术期干预后细菌组成没有变化。
结论
乳酸杆菌相对丰度降低与宫颈过早扩张有关，而阴道加德纳菌水平升高与挽救性宫颈环扎术失败有关。在大多数情况下（71%），挽救性宫颈环扎术的插入不会影响潜在的细菌组成。
推文摘要
早产性宫颈扩张与乳酸杆菌属丰度降低相关，阴道加德纳菌的存在预示着挽救性宫颈环扎术失败。
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