THE ROLE OF THE VAGINAL MICROBIOTA IN THE PATHOGENESIS OF PRETERM PREMATURE BIRTH IN WOMEN WITH IC: A SYSTEMATIC REVIEW.

Abstract

Background: Cervical insufficiency and vaginal microbiota imbalance impact preterm birth outcomes.

Objectives: To examine the role of vaginal microbiota in prelabor rupture of membranes in women with cervical insufficiency, focusing on microbial profile, risk factors, biomarkers, management, and neonatal outcomes.

Methods: This systematic review (2020-2025) analyzed 13 original studies written in English on vaginal microbiota's role in PROM in women with cervical insufficiency, retrieved via ProQuest, Web of Science, Scopus, Cochrane Library, PubMed, and Google Scholar, with bias evaluation using RoB 1 and ROBINS-I tools.

Results: Key findings show that Lactobacillus depletion and increased pathogenic bacteria like Gardnerella, E. coli, and Mycoplasma are common in dysbiosis microbiota. Diagnostic criteria for cervical insufficiency include short cervix and cervical dilation, with cerclage and progesterone being common treatments. PROM typically occurs around 24 weeks gestation, often spontaneously, with risk factors including bacterial vaginosis, short cervix, and cervical insufficiency. Preterm birth rates vary (8.9% to 84%), with neonatal outcomes including respiratory distress and mortality. Some studies show up to 93% fetal survival, with MMP-8 and elevated inflammatory cytokines linked to microbial imbalance.

Conclusions: Microbial dysbiosis in cervical insufficiency linked to preterm birth outcomes.