Evaluation of vaginal microbiota in women admitted to the hospital for premature labour

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Bruno Arena
Maria Diletta Daccò


dysbiosis, premature labour, tocolytic treatment, vaginal flora, microbiota, Dysbiosis, vaginal microbiota, Premature labour, Tocolytic treatment


SUMMARY: Background and aim of the work: The aim of this study was to evaluate the vaginal microbiota of women admitted to the hospital for premature labour and to compare the flora of those who responded to the tocolytic treatment with the flora of those who did not respond to the treatment and delivered prematurely Materials: the hospital records of 245 women admitted to the division of Obstetrics and Gynaecology of 'Guglielmo da Saliceto' Hospital in Piacenza for premature labour, between 24 completed weeks and 36 weeks plus 6 days of pregnancy, were reviewed and the results of vaginal swabs collected on admission were evaluated. Results : a vaginal dysbiosis, with reduction or absence of lactobacilli and presence of pathogenic microbial species, was found in all women admitted to the hospital for premature labour. Among them, 200 women (81,63%) responded to the tocolytic treatment while 45 women (18,36%) did not respond  and delivered before 37 completed weeks. The four microbial species most prevalent  in the vaginal flora were :Ureaplasma urealyticum, Streptococcus agalactiae, Candida albicans and Gardnerella vaginalis. When the characteristics of the vaginal flora of the two groups were compared, a more severe dysbiosis, with absence of lactobacilli and evidence of more than one pathogenic  species, was found in 18% of women who responded to the tocolysis and in 71,4% of women who did not respond. The difference was statistically significant (p< 0,05, two-tailed test). Conclusions: vaginal dysbiosis was diagnosed in all women admitted to the hospital for premature labour . A more severe dysbiosis, with complete absence of lactobacilli and presence of two or more pathogenic microbial species, was  in the majority of women who showed no response to the tocolytic treatment compared to women with minor degrees of alteration of the vaginal flora.



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1) Lajos GJ, Passini Junior R, Nomura ML, Amaral E, Pereira BG, Milanez H, Parpinelli MA, (2008) Cervical bacterial colonization in women with preterm labour or premature rupture of membranes. Rev Bras Ginecol Obstet 30(8):393-399.
2) Svare JA, Schmidt H, Hansen BB, Lose G (2007): Bacterial vaginosis in a cohort of danish pregnant women: prevalence and relationship with premature delivery, low birthweight and perinatal infections. BJOG 114(4):510-511.
3) Monif GRG, Baker DA (2004). Candida Albicans In 'Infectious diseases in obstetrics and gynecology, 5th ed. Tha Parthenon Publishing Group, New York, NY, pp405-421.
4) Hay P, Czeizel AE (2007). Asymptomatic trichomonas and candida colonization and pregnancy outcome. Best Pract Res Clin Obstegt Gynecol 21(3):403-409.
5) Hyman RW, Fukushima M, Diamond L, Kumm J, Giudice L, Davis R (2005). Microbes on the human vaginal epithelium. Proc Natl Acad Sci USA 102(22):79852-7957.
6) Aroutcheva A, Gariti D, Simon M, Shotts S, Faro J, Simoes JA, Gurgius A, Faro S (2001): Defence factors of vaginal lactobacilli. Am J Obstet Gynecol 185(2):375-379.
7) Zhang D, Huang Y, Ye D: Intestinal dysbiosis: an emerging cause of pregnancy complications?. Med Hypotheses, Med Hypotheses, 2015 Mar;84(3):223-6.
8) Barrett HL, Dekker NM, Conwell LS, Callaway LK,: Probiotics for preventing gestational diabetes. Cochrane Database of Systematic Reviews 2014, Issue 2
9) Baldwin EA, Walther-Antonio M, MacLean AM, Gohl DM, Beckman KB, Chen J, White B, Creedon DJ, Chia N: Persistent microbial dysbiosis in preterm premature rupture of the membranes from onset until delivery. Peer Journal, 2015 Nov 26;3:e1398.
10) Chase D, Goulder A, Zenhausern F, Monk B, Herbst-Kralovetz M: Tha vaginal and gastrointestinal microbiomes in gynecologic cancers: a review of applications in etiology, symptoms and treatment.Gynecologic Oncology 205 july: 138(1):190-200
11) Melkumyan AR, Priputnevich TV, Ankirskaya AS, Murav'eva VV, Lubasovskaya LA,: Effects of antibiotic treatment on the lactobacillus composition of vaginal microbiota. Bull Exp Biol Med 2015 Apr; 158(6): 766-8.
12) Rautava S, Kalliomaki M, Isolauri E: probiotics during pregnancy and breast feeding might confer immunomodulatory protection against atopic disease in the infant. J Allergy Clin Immunol 2002; 109:119-121
13) Huurre A, Laitinen K, Rautava S, Korkeamaki M, Isolauri E. Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization: a double blind placebo controlled study. Clin Exp Allergy, 2008; 38:1342-1348.
14) Sewankambo N, Gray RH, Waver MJ, Pazton L, McNaim D, Wabwire- Mangen F, Serwadda D, Li C, Kiwanuka N, Hillier SL, Rabe L, Gaydos CA, Quin TC, Konde Lule J (1997) HIV infection associated with abnormal vaginal flora morpholgy and bacterial vaginosis. Lancet 350:546-550.
15) Charonis G, Larsson PG (2006): use of PH/whiff test test or Quick Vue Advanced pH and Amines test for the diagnosis of bacterial vaginosis and prevention of postabortion PID. Acta Obstet Gynecol Scand 85(7):837-843.
16) Lo E, Moore DE, Patton DL, Agnew KJ, Eschenbach DA Relationship of vaginal bacteria and inflammation with conception and early pregnancy loss following in vitro-fertilization. Infect Dis Obstet Gynecol 11-17, 2003
17) Usui R, Ohkuchi A, Matsubara S, Izumi A, Watanabe T, SuzukiM, Minakami H (2002). Vaginal lactobacilli and preterm birth. J Perinatol Med 30(6):458-466.
18) Vitali B, Cruciani F, Baldassarre ME, Capursi T, Spisni E, Valerr MC, Candela M, Turroni S, Brigidi P: Dietary supplementation with probiotics during late pregnancy: outcome of vaginal microbiota and cytokine secretion. BMC Microbiology 2012, 12-36 (online publication).
19) Reid G, Kumar H, Khan AI, Rautava S, Tobin J, Salminen S: The case in favour of probiotics before, during and after pregnancy: insights from the first 1500 days. Benef Microbes 2016 Feb 3:1-10
20) Laschke M W, Menger M D. The gut microbiota: a puppet master in the pathogenesis of endometriosis? AmJ Obst Gyn Vol 215, Issue 1, July 2016. page 68.
21) T.J.Meyers, B. Arena, C.O. Granai: Pelvic endometriosis mimicking ovarian cancer: presentation with pleural effusion, ascites and elevated serum CA-125 levels. Am J Obstet Gynecol, 173: 966/7, 1995.
22) Ma J, Prince AL, Bader D, Hu M< Ganu R, Baquero K, Blundell P, Alan Harris R, Frias AE, Grove KL, Aagaard KM : High fat maternal diet during pregnancy persistently alters the offspring microbiome in a primate model. Nat Commun, 2014 May, 20;5:3889.
23) Alvarez -Calatayud G, Suarez E, Rodriguez JM, Perez-Mporeno J: Microbiota in women; clinical applications of probiotics. Nutrit Hosp 2015 July 18;32.
24) Kungursteva EA, Popkova SM, Leschenko OY. : Reciprocal formation of mucosal microflora of open cavities of different habitats in women as an important factor of their reproductive health. Vestn Ross Akad Med Nauk 2014; (9-10):27-32.
25) Yarbrough VL, Winkle S, Herbst-Kralovetz MM: Antimicrobial peptides in the female reproductive tract: a critical component of the mucosal immune barrier with physiological and clinical implications. Human Reprod Update 2015 May-Jun 21(3):353-77)
26) Nelson TM, Borgogna JL, Brotman RM, Ravel J, Walk ST, Yeoman CJ: Vaginal biogenic amines: biomarkers of bacterial vaginosis or precursors to vaginal dysbiosis?. Front Physiol 2015 Sept 29; 6:253.
27) Donders GGG, Basmans E, Dekkersmaecker, Verecken A, Bulck BV, Spitz B: Pathogens of abnormal vaginal bacterial flora. Am J Obste Gynecol 182:872-878, 2000.
28) Green KA, Zarek SM, Catherino WH: Gynecologic health and disease in relation to the microbiome of the female reproductive tract., Fertil Steril 2015 Dec 104(6)1351-7.
29) Kim YH, Kim CH, Cho MK, Na JH, Soing TB, Oh JS (2006) Hydrogen peroxide- producing lactobacilli in the vaginal flora of pregnant women with preterm labour with intact membranes. Int J Gynecol Obst 93(1):22-27.
30) Garland SM, Chuileannain F, Satzkw C, Robins-Browne R 92002) Mechanism, organisms and markers of infection in pregnancy. J Reproduct Immunology 57(1-2):169-183.
31) Sakai M, Ishyiama A, TABATA m, Sasaki Y, Yoneda S, Shiozaki A, Saito S(2004) Relationship between cervical mucus interleukin 8 concentrations and vaginal bacteria in pregnancy. Am J Reprod Immunol 52(2):106-112.
32) Menon R, Fortunato SJ (2007). Infection and the role of inflammation in preterm premature rupture of the membranes. Best Pract Research Clin Obst Gynecol 21(3):467-478.