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Improved criteria to identify risk for spontaneous preterm birth due to a short cervix
  • +10
  • Antonio Moron,
  • Steven Witkin (USA),
  • Iara Linhares,
  • Evelyn Minis,
  • Alan Hatanaka,
  • Stephanno Sarmento,
  • Marcelo Franca,
  • Francisco Carvalho,
  • Tatiana Hamamoto,
  • Rosiane Mattar,
  • Ester Sabino,
  • Marilza Rudge,
  • Larry Forney
Antonio Moron
Federal University of Sao Paulo
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Steven Witkin (USA)
Weill Cornell Medical College
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Iara Linhares
University of Sao Paulo
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Evelyn Minis
Weill Cornell Medical College
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Alan Hatanaka
Federal University of Sao Paulo
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Stephanno Sarmento
Hospital e Maternidade Santa Joana
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Marcelo Franca
Federal University of Sao Paulo
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Francisco Carvalho
Federal University of Ceara
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Tatiana Hamamoto
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Rosiane Mattar
Sao Paulo Federal University
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Ester Sabino
Tropical Medicine Institute, University of Sao Paulo
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Marilza Rudge
Sao Paulo State University Medical School
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Larry Forney
University of Idaho
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Abstract

Objective Does the combined analysis of compounds in vaginal secretions plus vaginal microbiota composition improve the ability to predict risk for spontaneous preterm birth (SPTB) in women with a short cervix. Design Prospective observational study Setting Three hospitals in Brazil Samples Vaginal secretions from 568 women at 21-24 weeks gestation with cervical length measurement. Method Vaginal microbiome composition was determined by analysis of the V1-V3 region of the bacterial 16S ribosomal RNA gene. D- lactic acid and tissue inhibitor of matrix metalloproteinase (TIMP)-1 in vaginal secretions were measured by ELISA. Main outcome measures SPTB in relation to cervical length and dominant vaginal bacteria. Results When Lactobacillus crispatus was the dominant bacterium the concentration of TIMP-1 was lower, and D-lactic acid was higher, than when either L. iners or Gardnerella vaginalis predominated (p < 0.001). By ROC analysis, a D-lactic acid level < 0.7 mM, and a TIMP-1 level > 1.5 ng/ml best predicted the absence of L. crispatus dominance. Vaginal levels of TIMP-1 were highest (p = 0.024) and D-lactic acid levels were lowest (p=0.032) in women with the shortest cervical length. The absence of L. crispatus dominance increased the sensitivity for predicting a SPTB from 22.4% to 81.8% or 78.3% in women with a cervical length <25mm or <30mm, respectively. Conclusions Low vaginal D-lactic acid and high TIMP-1 indicates the loss of L. crispatus dominance and increased risk for SPTB in women with a short cervix.