Microbiological safety of the Dr. Arabin cervical pessary in pregnant women with short cervix

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND: The insertion of a cervical pessary is a method for treating short cervix and preventing preterm birth. The study of the vaginal microbiota composition and the need for its routine correction after the pessary insertion remain to be investigated. To date, there are no works devoted to the assessment of changes in vaginal microbiocenosis after the cervical pessary insertion.

AIM: The aim of this study was to assess the microbiological safety of the Dr. Arabin cervical pessary in pregnant women with short cervix.

MATERIALS AND METHODS: This prospective study included 22 pregnant women with singleton or multiple pregnancies with short cervix (<25‰ L.J. Salomon scale) and threatened miscarriage in the second and third trimesters who received the Dr. Arabin cervical pessary. The obtained clinical materials included the secretion of the posterolateral vaginal fornix. We used the Femoflor 16 test (NPO DNA-Technology Ltd., Moscow, Russia) as a method of molecular biological analysis. In addition, the patients independently controlled the pH of the vaginal contents using the pH-balance express test. Vaginal microbiocenosis was assessed in a dynamic manner: before the cervical pessary insertion, then every two to four weeks after it, and on the day the pessary was removed. In all 22 pregnant women, clinical material was obtained twice: before the cervical pessary was inserted and when it was removed; in 15 women (68.18%) three times, and in nine pregnant women (40.91%) four times.

RESULTS: The analysis of vaginal microbiocenosis showed no significant changes in vaginal microbiocenosis in the examined pregnant women before and after the insertion of the cervical pessary (p > 0.05). The concentration of lactobacilli remained high (in the range of 107 lg DNA copies/ml) during the entire observation period. The numbers of facultative and obligate anaerobic bacteria, as well as yeast-like fungi of the Candida genus, Ureaplasma spp., and Mycoplasma hominis were within the physiological levels. No pathogenic microorganisms such as Mycoplasma genitalium were detected in any patient. After the cervical pessary insertion against the background of normocenosis, 72.73% of pregnant women noted an increase in the amount of light and odorless discharge from their genital tract. However, we found no changes in the vaginal microbiota composition.

CONCLUSIONS: The insertion of the Dr. Arabin cervical pessary under conditions of vaginal normocenosis is a microbiologically safe way to correct short cervix and prevent preterm birth, and does not disrupt the vaginal microflora in pregnant women before delivery.

Full Text

Restricted Access

About the authors

Gabriel S. Sargsyan

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Saint Petersburg

Author for correspondence.
Email: gabsarg89@yahoo.com
Russian Federation, 3 Mendeleyevskaya liniya, Saint Petersburg, 199034, Russian Federation

Olesya N. Bespalova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: shiggerra@mail.ru
ORCID iD: 0000-0002-6542-5953
SPIN-code: 4732-8089
ResearcherId: D-3880-2018

MD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Alevtina M. Savicheva

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; St. Petersburg State Pediatric Medical University

Email: savitcheva@mail.ru
ORCID iD: 0000-0003-3870-5930
SPIN-code: 8007-2630
Scopus Author ID: 6602838765
ResearcherId: P-6788-2015

MD, Dr. Sci. (Med.), Professor, Honored Scientist of the Russian Federation

Russian Federation, Saint Petersburg; Saint Petersburg

Tatyana A. Khusnutdinova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; St. Petersburg State Pediatric Medical University

Email: husnutdinovat@yandex.ru
ORCID iD: 0000-0002-2742-2655
SPIN-code: 9533-9754
Scopus Author ID: 57015542400
Russian Federation, Saint Petersburg; Saint Petersburg

Olga V. Budilovskaya

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; St. Petersburg State Pediatric Medical University

Email: o.budilovskaya@gmail.com
ORCID iD: 0000-0001-7673-6274
SPIN-code: 7603-6982
Scopus Author ID: 12545757500
ResearcherId: K-1854-2018
Russian Federation, Saint Petersburg; Saint Petersburg

Anna A. Krysanova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; St. Petersburg State Pediatric Medical University Saint Petersburg

Email: krusanova.anna@mail.ru
ORCID iD: 0000-0003-4798-1881
SPIN-code: 2438-0230
Russian Federation, Saint Petersburg; Saint Petersburg

Kira V. Shalepo

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; St. Petersburg State Pediatric Medical University Saint Petersburg

Email: 2474151@mail.ru
ORCID iD: 0000-0002-3002-3874
ResearcherId: K-1364-2018

Cand. Sci. (Biol.)

Russian Federation, Saint Petersburg; Saint Petersburg

References

  1. Goya M, Pratcorona L, Merced C, et al. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet. 2012;379(9828):1800–1806. doi: 10.1016/S0140-6736(12)60030-0
  2. Jin Z, Chen L, Qiao D, et al. Cervical pessary for preventing preterm birth: a meta-analysis. J Matern Fetal Neonatal Med. 2019;32(7):1148–1154. doi: 10.1080/14767058.2017.1401998
  3. Saccone G, Maruotti GM, Giudicepietro A, et al.; Italian Preterm Birth Prevention (IPP) Working Group. Effect of cervical pessary on spontaneous preterm birth in women with singleton pregnancies and short cervical length: a randomized clinical trial. JAMA. 2017;318(23):2317–2324. doi: 10.1001/jama.2017.18956
  4. Goya M, de la Calle M, Pratcorona L, et al. Cervical pessary to prevent preterm birth in women with twin gestation and sonographic short cervix: a multicenter randomized controlled trial (PECEP-Twins). Am J Obstet Gynecol. 2016;214(2):145–152. doi: 10.1016/j.ajog.2015.11.012
  5. Liem S, Schuit E, Bais J, et al. Pessaries in multiple pregnancy as a prevention of preterm birth (ProTWIN): a randomized controlled trial. Am J Obstet Gynecol. 2013;208(1 Suppl):S2. doi: 10.1016/j.ajog.2012.10.175
  6. Liem S, Schuit E, Hegeman M, et al. Cervical pessaries for prevention of preterm birth in women with a multiple pregnancy (ProTWIN): a multicentre, open-label randomised controlled trial. Lancet. 2013;382(9901):1341–1349. doi: 10.1016/S0140-6736(13)61408-7
  7. Liem SM, van Baaren GJ, Delemarre FM, et al. Economic analysis of use of pessary to prevent preterm birth in women with multiple pregnancy (ProTWIN trial). Ultrasound Obstet Gynecol. 2014;44(3):338–345. doi: 10.1002/uog.13432
  8. Sargsyan GS, Bespalova ON. Assessment of the risk of spontaneous preterm birth in pregnant women with the Dr. Arabin cervical pessary. Journal of Obstetrics and Women’s Diseases. 2022;71(2):49–60. (In Russ.) doi: 10.17816/JOWD104472
  9. Sargsyan GS, Pachuliya OV, Bespalova ON. The effectiveness of the Dr. Arabin cervical pessary in the prevention of extreme preterm birth and very preterm birth in twins. Journal of Obstetrics and Women’s Diseases. 2022;71(3):31–42. doi: 10.17816/JOWD107434
  10. Agrawal V, Hirsch E. Intrauterine infection and preterm labor. Semin Fetal Neonatal Med. 2012;17(1):12–19. doi: 10.1016/j.siny.2011.09.001
  11. Bang H, Bae GE, Park HY, et al. Chronic placental inflammation in twin pregnancies. J Pathol Transl Med. 2015;49(6):489–496. doi: 10.4132/jptm.2015.09.09
  12. Gilman-Sachs A, Dambaeva S, Salazar Garcia MD, et al. Inflammation induced preterm labor and birth. J Reprod Immunol. 2018;129:53–58. doi: 10.1016/j.jri.2018.06.029
  13. Kemp MW. Preterm birth, intrauterine infection, and fetal inflammation. Front Immunol. 2014;5:574. doi: 10.3389/fimmu.2014.00574
  14. Hassan S, Romero R, Hendler I, et al. A sonographic short cervix as the only clinical manifestation of intra-amniotic infection. J Perinat Med. 2006;34(1):13–19. doi: 10.1515/JPM.2006.002
  15. Vaisbuch E, Hassan SS, Mazaki-Tovi S, et al. Patients with an asymptomatic short cervix. Am J Obstet Gynecol. 2010;202(5):433.e1–433.e4338. doi: 10.1016/j.ajog.2010.02.007
  16. Lee SE, Romero R, Park CW, et al. The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency. Am J Obstet Gynecol. 2008;198(6):633.e1–633.e6338. doi: 10.1016/j.ajog.2007.11.047
  17. US Preventive Services Task Force, Owens DK, Davidson KW, et al. Screening for bacterial vaginosis in pregnant persons to prevent preterm delivery: us preventive services task force recommendation statement. JAMA. 2020;323(13):1286–1292. doi: 10.1001/jama.2020.2684
  18. Gerson KD, McCarthy C, Elovitz MA, et al. Cervicovaginal microbial communities deficient in Lactobacillus species are associated with second trimester short cervix. Am J Obstet Gynecol. 2020;222(5):491.e1–491.e8. doi: 10.1016/j.ajog.2019.11.1283
  19. Khodzhaeva ZS, Guseinova GE, Muravyeva VV, et al. Characteristics of the vaginal microbiota in pregnant women with preterm premature rupture of the membranes. Obstetrics and Ginecology. 2019;(12):64–73. doi: 10.18565/aig.2019.12.66-74
  20. Drew RJ, LeBlanc L, Kent E, Eogan M. Relationship between absence of lactobacilli in the vagina of pregnant women and preterm birth: A retrospective pilot study. Obstet Gynecol Rep. 2018;2(2):1–4. doi: 10.15761/OGR.1000128
  21. Sinyakova AA, Shipitsyna EV, Budilovskaya OV, et al. Anamnestic and microbiological predictors of miscarriage. Journal of Obstetrics and Women’s Diseases. 2019;68(2):59–70. doi: 10.17816/JOWD68259-70
  22. Gudnadottir U, Debelius JW, Du J, et al. The vaginal microbiome and the risk of preterm birth: a systematic review and network meta-analysis. Sci Rep. 2022;12(1):7926. doi: 10.1038/s41598-022-12007-9

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Total bacterial mass of the vaginal contents of the examined pregnant women (four time points)

Download (73KB)
Indexing metadata
3. Fig. 2. The concentration of Lactobacillus spp. in the examined pregnant women (four time points)

Download (82KB)
Indexing metadata
4. Fig. 3. Facultative anaerobic microorganisms in the examined pregnant women (four time points)

Download (247KB)
Indexing metadata
5. Fig. 4. The concentration of obligate anaerobes and Ureaplasma spp. in the examined pregnant women (four time points)

Download (324KB)
Indexing metadata
6. Fig. 5. Detection of Eubacterium spp. and yeast-like fungi of the genus Candida among patients with term birth and spontaneous preterm birth (time point 4; * p < 0.05). SPB — spontaneous preterm birth

Download (151KB)
Indexing metadata

Copyright (c) 2022 Eсо-Vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 66759 от 08.08.2016 г. 
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия Эл № 77 - 6389 от 15.07.2002 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies