Abstract
ObjectiveTo characterize the vaginal microbiota of women following preterm premature rupture of membranes (PPROM), and determine if microbiome composition predicts latency duration and perinatal outcomes.DesignA prospective cohort studySettingCanadaPopulationWomen with PPROM between 24+0 and 33+6 weeks gestational age (GA).MethodsMicrobiome profiles, based on pyrosequencing of the cpn60 universal target, were generated from vaginal samples at time of presentation with PPROM, weekly thereafter, and at delivery.Main Outcome MeasuresVaginal microbiome composition, latency duration, gestational age at delivery, perinatal outcomes.ResultsMicrobiome profiles were generated from 70 samples from 36 women. Mean GA at PPROM was 28.8 wk (mean latency 2.7 wk). Microbiome profiles were highly diverse but sequences representing Megasphaera type 1 and Prevotella spp. were detected in all vaginal samples. Only 13/70 samples were dominated by Lactobacillus spp. Microbiome profiles at the time of membrane rupture did not cluster by gestational age at PPROM, latency duration, presence of chorioamnionitis or by infant outcomes. Mycoplasma and/or Ureaplasma were detected by PCR in 81% (29/36) of women, and these women had significantly lower GA at delivery and correspondingly lower birth weight infants than Mycoplasma and/or Ureaplasma negative women.ConclusionWomen with PPROM had mixed, abnormal vaginal microbiota but the microbiome profile at PPROM did not correlate with latency duration. Prevotella spp. and Megasphaera type I were ubiquitous. The presence of Mollicutes in the vaginal microbiome was associated with lower GA at delivery. The microbiome was remarkably unstable during the latency period.
Highlights
Preterm delivery is the most important contributor to neonatal morbidity and mortality worldwide [1]
Results of the study show that women with premature rupture of membranes (PPROM) had mixed, highly variable vaginal microbiota but the specific type of microbiome profile at PPROM did not correlate with latency duration
Clinical variables were analyzed for relationship to latency and we found that proportional and absolute latency were negatively correlated with body mass index (BMI)
Summary
Preterm delivery is the most important contributor to neonatal morbidity and mortality worldwide [1]. The latency period between membrane rupture and delivery is a critical period for determining maternal and neonatal health outcomes, as longer latencies have been associated with reduced odds of neonatal morbidity [4], there is an associated increased risk of maternal and/or fetal infection [5, 6]. This dilemma in clinical management becomes more profound closer to term and results in much debate about optimal management [7]. It is vital to understand whether the composition of the vaginal microbiome would predict safe latency or if particular dysbiosis would predict adverse outcomes for the infant and/or mother
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