Cervical microbiota in women with preterm prelabor rupture of membranes.

Marian Kacerovsky,Ivana Musilova,Jana Nekvindova,Ramkumar Menon,Ronald Lamont,Filip Vrbacky,Ctirad Andrys,Radka Kutova,Lenka Pliskova,Colette Kanellopoulos-Langevin

doi:10.1371/journal.pone.0126884

Abstract

ObjectiveTo analyze the cervical microbiota in women with preterm prelabor rupture of membranes (PPROM) by pyrosequencing and to document associations between cervical microbiota, cervical inflammatory response, microbial invasion of the amniotic cavity (MIAC), histological chorioamnionitis, and intraamniotic infection (IAI).Study DesignSixty-one women with singleton pregnancies complicated by PPROM were included in the study. Specimens of cervical and amniotic fluid were collected on admission. The cervical microbiota was assessed by 16S rRNA gene sequencing by pyrosequencing. Interleukin (IL)-6 concentration in the cervical fluid and amniotic fluid was measured by ELISA and lateral flow immunoassay, respectively.ResultsFour bacterial community state types [CST I (Lactobacillus crispatus dominated), CST III (Lactobacillus iners dominated), CST IV-A (non-Lactobacillus bacteria dominated), and CST IV-B (Gardnerella vaginalis and Sneathia sanguinegens dominated)] were observed in the cervical microbiota of women with PPROM. Cervical fluid IL-6 concentrations differed between CSTs (CST I = 145 pg/mL, CST III = 166 pg/mL, CST IV-A = 420 pg/mL, and CST IV-B = 322 pg/mL; p = 0.004). There were also differences in the rates of MIAC, of both MIAC and histological chorioamnionitis, and of IAI among CSTs. No difference in the rate of histological chorioamnionitis was found among CSTs.ConclusionsThe cervical microbiota in PPROM women in this study was characterized by four CSTs. The presence of non-Lactobacillus CSTs was associated with a strong cervical inflammatory response and higher rates of MIAC, both MIAC and histological chorioamnionitis, and IAI representing a PPROM subtype with pronounced inflammation. CST I represents the dominant type of PPROM with a low rate of MIAC, IAI, and the combination of MIAC and histological chorioamnionitis.

Highlights

Preterm prelabor rupture of membranes (PPROM), is defined as rupture of the fetal membranes with leakage of amniotic fluid (AF) before the onset of regular uterine contractions before 37 completed weeks of gestation, and represents a serious perinatal problem [1,2]
No difference in the rate of histological chorioamnionitis was found among CSTs
The presence of non-Lactobacillus CSTs was associated with a strong cervical inflammatory response and higher rates of microbial invasion of the amniotic cavity (MIAC), both MIAC and histological chorioamnionitis, and intraamniotic infection (IAI) representing a PPROM subtype with pronounced inflammation

Summary

Introduction

Preterm prelabor rupture of membranes (PPROM), is defined as rupture of the fetal membranes with leakage of amniotic fluid (AF) before the onset of regular uterine contractions before 37 completed weeks of gestation, and represents a serious perinatal problem [1,2]. PPROM pregnancies are often characterized by thinning of the chorion and bacterial colonization of the fetal membranes compared to uncomplicated pregnancies or pregnancies with spontaneous preterm labor with intact membranes [11]. Abnormal lower genital tract flora or viral infection of the cervix may predispose to ascending infection, microbial adhesion, colonization and infiltration of the choriodecidual space and fetal membranes leading to MIAC [12]. The subsequent host inflammatory response to MIAC can be detrimental to the fetus through the fetal inflammatory response syndrome [13,14]

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Conclusion