Distribution characteristics of vaginal flora and pregnancy outcomes in cervical incompetence patients

doi:10.3969/j.issn.1674-8115.2023.11.009

Abstract

Abstract:

Objective ·To investigate the distribution characteristics of vaginal flora in patients with cervical incompetence (CIC), and the effect of cervical cerclage on pregnancy outcome in patients with CIC with abnormal vaginal flora. Methods ·A total of 1 261 pregnant women participated in the study. According to the diagnosis, they were divided into cervical incompetence group (CIC group) and normal pregnancy group (NP group). The CIC group patients randomly received cervical cerclage (CIC-C group) or expectation therapy (CIC-E group). Vaginal secretion samples of the patients in the groups were collected and analyzed in the laboratory. Meanwhile, through the results of vaginal flora, the CIC-C group and CIC-E group were further divided into normal vaginal flora groups (CIC-C-N group and CIC-E-N group) and abnormal vaginal flora groups (CIC-C-A group and CIC-E-A group). All groups were processed accordingly and analyzed on pregnancy outcomes. T-test and Chi-squared test were used for comparison between the groups, and One-way ANOVA was used for comparison among the three groups. Statistical significance was accepted at a value of P<0.05. Results ·Among 1 261 vaginal secretion specimens, the positive rate of pathogenic bacteria was 22.0% (277/1 261). The pathogen detection rates in the CIC group and NP group were 32.9% (229/696) and 8.5% (48/565). Twenty-three types of vaginal flora were detected in the CIC group, and 9 were detected in the NP group. The proportions of women who had term birth were 75.94% in the CIC-C group, 70.03% in the CIC-E group, and 87.79% in the NP group (P=0.000). Compared with the CIC-C-A group, the CIC-E-A group had a lower term delivery rate (61.84% vs 77.78%, P=0.011) and a higher incidence of pregnancy complications (22.37% vs 9.15%, P=0.006). Conclusion ·There are differences in the distribution and diversity of vaginal flora between CIC patients and normal pregnant women. Cervical cerclage can improve pregnancy outcomes in CIC patients with abnormal vaginal flora.

Key words: vaginal flora, cervical incompetence (CIC), cervical cerclage, perinatal outcomes, preterm birth rate

CLC Number:

R714.4

LI Xue, XIAO Yi, ZHANG Hong. Distribution characteristics of vaginal flora and pregnancy outcomes in cervical incompetence patients[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(11): 1417-1422.

Figures/Tables 4

TrendMD

References 24

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Flora	Vaginal flora/n (%)		χ²	P value
Flora	CIC group (n=696)	NP group(n=565)	χ²	P value
Enterococcus faecalis	11 (1.58)	3 (0.53)	3.131	0.077
Candida albicans	55 (7.90)	14 (2.48)	17.965	0.000
Candida tropicalis	6 (0.86)	8 (1.41)	4.905	0.027
Candida glabrata	33 (4.74)	10 (1.77)	8.402	0.004
Escherichia coli	21 (3.01)	2 (0.35)	12.455	0.000
Streptococcus agalactiae	11 (1.58)	5 (0.88)	1.203	0.273
Gardnerella vaginalis	48 (6.90)	7 (1.24)	24.353	0.000
Klebsiella pneumoniae	5 (0.71)	1 (0.18)	1.930	0.165
Staphylococcus aureus	5 (0.71)	0 (0)	4.082	0.044
Staphylococcus epidermidis	3 (0.43)	1 (0.18)	0.636	0.425
Streptococcus bovis	2 (0.29)	0 (0)	1.626	0.203
Acinetobacter baumannii	1 (0.14)	0 (0)	0.812	0.368
Proteus mirabilis	3 (0.43)	0 (0)	2.442	0.118
Haemophilus parainfluenzae	1 (0.14)	0 (0)	0.812	0.368
Enterobacter aerogenes	2 (0.29)	0 (0)	1.626	0.203
Hemophilus ducreyi	1 (0.14)	0 (0)	0.812	0.368
Streptococcus milleri	1 (0.14)	0 (0)	0.812	0.368
Neisseria subflava	1 (0.14)	0 (0)	0.812	0.368
Staphylococcus haemolyticus	2 (0.29)	0 (0)	1.626	0.203
Morganella morganii	2 (0.29)	0 (0)	1.626	0.203
Burkholderia cepacia	1 (0.14)	0 (0)	0.812	0.368
Pseudomonas aeruginosa	1 (0.14)	0 (0)	0.812	0.368
Enterobacter cloacae	1 (0.14)	0 (0)	0.812	0.368

Flora	Vaginal flora/n (%)		χ²	P value
Flora	CIC group (n=696)	NP group(n=565)	χ²	P value
Enterococcus faecalis	11 (1.58)	3 (0.53)	3.131	0.077
Candida albicans	55 (7.90)	14 (2.48)	17.965	0.000
Candida tropicalis	6 (0.86)	8 (1.41)	4.905	0.027
Candida glabrata	33 (4.74)	10 (1.77)	8.402	0.004
Escherichia coli	21 (3.01)	2 (0.35)	12.455	0.000
Streptococcus agalactiae	11 (1.58)	5 (0.88)	1.203	0.273
Gardnerella vaginalis	48 (6.90)	7 (1.24)	24.353	0.000
Klebsiella pneumoniae	5 (0.71)	1 (0.18)	1.930	0.165
Staphylococcus aureus	5 (0.71)	0 (0)	4.082	0.044
Staphylococcus epidermidis	3 (0.43)	1 (0.18)	0.636	0.425
Streptococcus bovis	2 (0.29)	0 (0)	1.626	0.203
Acinetobacter baumannii	1 (0.14)	0 (0)	0.812	0.368
Proteus mirabilis	3 (0.43)	0 (0)	2.442	0.118
Haemophilus parainfluenzae	1 (0.14)	0 (0)	0.812	0.368
Enterobacter aerogenes	2 (0.29)	0 (0)	1.626	0.203
Hemophilus ducreyi	1 (0.14)	0 (0)	0.812	0.368
Streptococcus milleri	1 (0.14)	0 (0)	0.812	0.368
Neisseria subflava	1 (0.14)	0 (0)	0.812	0.368
Staphylococcus haemolyticus	2 (0.29)	0 (0)	1.626	0.203
Morganella morganii	2 (0.29)	0 (0)	1.626	0.203
Burkholderia cepacia	1 (0.14)	0 (0)	0.812	0.368
Pseudomonas aeruginosa	1 (0.14)	0 (0)	0.812	0.368
Enterobacter cloacae	1 (0.14)	0 (0)	0.812	0.368

Top	Vaginal flora/n (%)
Top	CIC group (n=696)		NP group (n=565)
Total percent		168 (24.13)		44 (7.78)
1	Candida albicans	55 (7.90)	Candida albicans	14 (2.48)
2	Gardnerella vaginalis	48 (6.90)	Candida glabrata	10 (1.77)
3	Candida glabrata	33 (4.74)	Candida tropicalis	8 (1.41)
4	Escherichia coli	21 (3.01)	Gardnerella vaginalis	7 (1.24)
5	Streptococcus agalactiae	11 (1.58)	Streptococcus agalactiae	5 (0.88)

Top	Vaginal flora/n (%)
Top	CIC group (n=696)		NP group (n=565)
Total percent		168 (24.13)		44 (7.78)
1	Candida albicans	55 (7.90)	Candida albicans	14 (2.48)
2	Gardnerella vaginalis	48 (6.90)	Candida glabrata	10 (1.77)
3	Candida glabrata	33 (4.74)	Candida tropicalis	8 (1.41)
4	Escherichia coli	21 (3.01)	Gardnerella vaginalis	7 (1.24)
5	Streptococcus agalactiae	11 (1.58)	Streptococcus agalactiae	5 (0.88)

Item	Pregnancy outcome			P value
Item	CIC-C group (n=399)	CIC-E group (n=297)	NP group (n=565)	P value
Gestational weeks at delivery	36.1±5.2	35.3±4.5	37.3±3.5	0.362
Pregnancy loss/n(%)	34 (8.52)	30 (10.10)	31 (5.49)	0.034
Preterm birth/n(%)	62 (15.54)^①	59 (19.87)^①②	38 (6.72)	0.000
Term birth/n(%)	303 (75.94)^①	208 (70.03)^①③	496 (87.79)	0.000
Live birth/n(%)	371 (92.98)	273 (91.92)	534 (94.51)	0.315
Pregnancy complications/n(%)	26 (6.51)^④	27 (9.09)^①⑤	16 (2.83)	0.000
Puerperal infection/n(%)	5 (1.25)	5 (1.68)	3 (0.53)	0.245