Anaerobic dysbiosis of the cervical canal as a risk factor for premature rupture of membranes

Abstract

BACKGROUND: To identify the most significant predictors of premature rupture of membranes in full-term pregnancy with the use of RT-PCR analysis of cervical canal smear.
 
 MATERIALS AND METHODS: On the basis of City Clinical Hospital No. 1 named after N.I. Pirogov (Samara), a cervical smear was examined by RT-PCR using a standard panel Femoflor-16. The study involved 47 pregnant women at 37-41 weeks of gestation: the control group consists of 19 pregnant women without premature rupture of the membranes (PROM), and 28 pregnant women with PROM, were included in the main group. The most significant risk factors of PROM were revealed with the use of the Classification Trees.
 RESULTS: The following risk factors of PROM were identified: the number of Lactobacillus spp. less than 99.3% (sensitivity 75%, specificity 68%); total anaerobic microflora above 0.55% (sensitivity 71%, specificity 68%), Gardnerella vaginalis / Prevotella bivia / Porphyromonas spp. more than 0.08% (sensitivity 64.3%, specificity 73.7%) and Megasphaera spp. / Veilonella spp. / Dialister spp. more than 0.06% (sensitivity 66.7%, specificity 52.6%). If at least one of the above criteria was identified, the patient was attributed to the high risk group for PROM; when all four indicators of the distribution of microorganisms are taken into account, the sensitivity of the method was 85.5%, specificity was 68.4%, the predictive value of positive and negative diagnostic results (models accuracy) were 78.7%.
 CONCLUSIONS: The most prognostically significant risk factors for the development of PROM in the study of the cervical microbiota are the number of Lactobacillus spp. less than 99.3%; Gardnerella vaginalis / Prevotella bivia / Porphyromonas spp. more than 0.08%; Megasphaera spp. / Veilonella spp. / Dialister spp. more than 0.06%.