| Title | Cervical cerclage using braided suture material for the prevention of preterm birth induces significant disruption of vaginal microbial stability and increases inflammation leading to premature cervical remodeling and adverse pregnancy outcomes; a review of suture material used in cervical cerclage is warranted. |
| Study Type | Other |
| Abstract |
Preterm birth, the leading cause of death in children under five, is an inflammatory driven process frequently triggered by ascending vaginal infection. Some 2 million cervical cerclages are performed annually to prevent preterm birth. The procedure is thought to provide structural support and maint .. [more]ain the endocervical mucus plug as a barrier to ascending infection. Multifilament braided suture material is predominantly used for cerclage without an evidence base. In a study of 678 women receiving cervical cerclage in 5 UK university hospitals, we showed that braided cerclage was associated with increased rates of intrauterine death (16% v 5%, P < 0.0001) and preterm birth (28% v 17%, P < 0.001) compared to monofilament alternative. A prospective, longitudinal study of women at risk of preterm birth due to short cervical length (<25mm) randomised to braided (n=25) or monofilament cerclage (n=24) revealed that braided suture induces a persistent shift towards vaginal microbiome dysbiosis characterized by reduced Lactobacillus spp. and enriched numbers of pathobionts. Increased vaginal dysbiosis was associated with inflammatory cytokine and interstitial collagenase excretion into cervicovaginal fluid (CVF) and premature cervical remodeling. In comparison, monofilament suture has minimal impact upon the vaginal microbiome and maternal host-interactions. These data provide in vivo evidence that a dynamic shift of the human vaginal microbiome toward dysbiosis is a determinant of preterm birth. [less]
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| Description |
Preterm birth, the leading cause of death in children under five, is an inflammatory driven process frequently triggered by ascending vaginal infection. Some 2 million cervical cerclages are performed annually to prevent preterm birth. The procedure is thought to provide structural support and maint .. [more]ain the endocervical mucus plug as a barrier to ascending infection. Multifilament braided suture material is predominantly used for cerclage without an evidence base. In a study of 678 women receiving cervical cerclage in 5 UK university hospitals, we showed that braided cerclage was associated with increased rates of intrauterine death (16% v 5%, P < 0.0001) and preterm birth (28% v 17%, P < 0.001) compared to monofilament alternative. A prospective, longitudinal study of women at risk of preterm birth due to short cervical length (<25mm) randomised to braided (n=25) or monofilament cerclage (n=24) revealed that braided suture induces a persistent shift towards vaginal microbiome dysbiosis characterized by reduced Lactobacillus spp. and enriched numbers of pathobionts. Increased vaginal dysbiosis was associated with inflammatory cytokine and interstitial collagenase excretion into cervicovaginal fluid (CVF) and premature cervical remodeling. In comparison, monofilament suture has minimal impact upon the vaginal microbiome and maternal host-interactions. These data provide in vivo evidence that a dynamic shift of the human vaginal microbiome toward dysbiosis is a determinant of preterm birth. [less]
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| Center Name | Cardiff University |
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