Effects of vaginal microecology and immunity on the pregnancy outcome of cervical cerclage

Abstract

Objective To investigate the effects of vaginal microecology and immune status on the pregnancy outcome of cervical cerclage. Methods The clinical data of 125 patients with cervical incompetence who underwent transvaginal cervical cerclage in our hospital from January 2018 to January 2021 were collected, based on which the associations of vaginal microecology and related immune cytokines (IL-1β, IL-6, IL-8 and TNF-α) with the cervical cerclage outcome were explored. Results All of the 125 patients had singleton pregnancies, who were aged 20–43 years, with a mean of (32.34 ± 5.17) years. The surgery was successful in 104 patients (full-term delivery or survival of premature infants), while unsuccessful in 21 patients (late miscarriage or death of premature infants), revealing a success rate of 83.20%. There were 70 full-term deliveries, 34 premature deliveries (28 survived while 6 died), and 15 late miscarriages. Univariate analysis revealed statistically significant differences in the timing of surgery, gestational age of cerclage, preoperative cervical canal length, genital tract infections and preoperative invasive procedures between the successful and unsuccessful groups (P < 0.05). Insignificant differences were found in the pre-pregnancy body mass index (BMI) (P > 0.05). According to the multivariate analysis results, cerclage timing and genital tract infections were independent risk factors for postoperative pregnancy failure (P < 0.05). The pathogen detection rates in the two groups of pregnant women were analyzed, finding significantly higher incidence of bacterial vaginosis (BV) in the unsuccessful group than in the successful group (P < 0.05). Inter-group comparison revealed that the positive rates for vaginal microenvironmental factors (LE, NAG, SNA, H2O2 and pH) were all significantly higher in the unsuccessful group than in the successful group (P < 0.05). Besides, the immune cytokine levels in the cervicovaginal secretions were also all significantly higher in the unsuccessful group than in the successful group (P < 0.05). Conclusion The pregnancy outcome of patients undergoing cervical cerclage is associated with the imbalance of vaginal microecology and the levels of IL-1β, IL-6, IL-8 and TNF-α in cervicovaginal secretions.

Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: a retrospective study from a single centre

“…Congenital factors include cervical collagen and elastin deficiencies, Mullerian tube malformation, or intrauterine exposure to diethylstilbestrol, while acquired factors include multiple repeated mechanical dilation of the cervix, cervical conization and loop electrosurgical excision procedures (LEEPs), and obstetric lacerations during induced or emergency labour [ 13 ]. Although the etiology of cervical insufficiency is unclear, the last common pathway in the series of events leading to miscarriage or preterm labor is cervical os dilation and uterine extension; therefore, cervical cerclage is a major treatment method to prolong gestation [ 4 ].…”

“…Many risk factors have been shown to be related to preterm birth [ 3 ]. Among them, cervical incompetence (CIC) is a leading cause of PTB, and the PTB rate among pregnant women with cervical insufficiency is 3.3 times higher than that among pregnant women without cervical insufficiency [ 4 ]. CIC, a common clinical challenge in obstetrics, refers to the progressive, painless shortening, flattening, and dilation of the cervix in the absence of uterine contractions before 37 weeks of gestation, leading to irreversible miscarriage or preterm delivery [ 5 ].…”

Abnormal Cervical Remodeling Early Depiction by Ultrasound Elastography: Potential Opportunities for Preterm Birth Prevention and Delay

“…Vaginal microecology and immunity have great importance for cerclage outcomes [135], the epithelium protective effects on cervical stroma premature progression to ripening is not sufficient when abnormal vaginal microbiota, being recommended vaginal probiotics/eubiotics, according to Lactobacillus acidophilus known protective effects [136], topic therapy against bacterial vaginosis.…”