Publications
669 results found
Tzafetas M, Mitra A, Paraskevaidi M, et al., 2020, The intelligent-Knife (i-Knife) and its intraoperative diagnostic advantage for the treatment of cervical disease, Proceedings of the National Academy of Sciences of USA, Vol: 117, Pages: 7338-7346, ISSN: 0027-8424
Clearance of surgical margins in cervical cancer prevents the need for adjuvant chemoradiation and allows fertility preservation. In this study, we determined the capacity of the rapid evaporative ionization mass spectrometry (REIMS), also known as intelligent knife (iKnife), to discriminate between healthy, preinvasive, and invasive cervical tissue. Cervical tissue samples were collected from women with healthy, human papilloma virus (HPV) ± cervical intraepithelial neoplasia (CIN), or cervical cancer. A handheld diathermy device generated surgical aerosol, which was transferred into a mass spectrometer for subsequent chemical analysis. Combination of principal component and linear discriminant analysis and least absolute shrinkage and selection operator was employed to study the spectral differences between groups. Significance of discriminatory m/z features was tested using univariate statistics and tandem MS performed to elucidate the structure of the significant peaks allowing separation of the two classes. We analyzed 87 samples (normal = 16, HPV ± CIN = 50, cancer = 21 patients). The iKnife discriminated with 100% accuracy normal (100%) vs. HPV ± CIN (100%) vs. cancer (100%) when compared to histology as the gold standard. When comparing normal vs. cancer samples, the accuracy was 100% with a sensitivity of 100% (95% CI 83.9 to 100) and specificity 100% (79.4 to 100). Univariate analysis revealed significant MS peaks in the cancer-to-normal separation belonging to various classes of complex lipids. The iKnife discriminates healthy from premalignant and invasive cervical lesions with high accuracy and can improve oncological outcomes and fertility preservation of women treated surgically for cervical cancer. Larger in vivo research cohorts are required to validate these findings.
Kyriacou C, Kim SH, Bobdiwala S, et al., 2020, MicroRNA Expression in Pregnancy of Unknown Location (PUL)., 67th Annual Scientific Meeting of the Society-for-Reproductive-Investigation (SRI), Publisher: SPRINGER HEIDELBERG, Pages: 99A-99A, ISSN: 1933-7191
Budwig L, Brown R, Lee YS, et al., 2020, The Use of Peripheral Blood Neutrophil Counts in the Prediction of Funisitis Following Preterm Prelabour Rupture of Membranes., 67th Annual Scientific Meeting of the Society-for-Reproductive-Investigation (SRI), Publisher: SPRINGER HEIDELBERG, Pages: 212A-212A, ISSN: 1933-7191
Grewal K, Lee YS, Smith A, et al., 2020, Euploid Miscarriage is Associated with <i>Lactobacillus</i> spp. Deplete Vaginal Microbial Composition and Local Inflammation., 67th Annual Scientific Meeting of the Society-for-Reproductive-Investigation (SRI), Publisher: SPRINGER HEIDELBERG, Pages: 65A-65A, ISSN: 1933-7191
Riaposova L, Kim SH, Hanyaloglu A, et al., 2020, Can Atosiban Inhibit Prostaglandin F2α-driven Inflammation in Myometrium Through C/EBP-β and CREB Signalling?, 67th Annual Scientific Meeting of the Society-for-Reproductive-Investigation (SRI), Publisher: SPRINGER HEIDELBERG, Pages: 210A-211A, ISSN: 1933-7191
Shennan A, Chandiramani M, Bennett P, et al., 2020, MAVRIC: a multicenter randomized controlled trial of transabdominal vs transvaginal cervical cerclage, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, Vol: 222, ISSN: 0002-9378
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- Citations: 39
Hua R, Edey LF, O'Dea KP, et al., 2020, CCR2 mediates the adverse effects of LPS in the pregnant mouse, Biology of Reproduction, Vol: 102, Pages: 445-455, ISSN: 0006-3363
In our earlier work, we found that intrauterine (i.u.) and intraperitoneal (i.p.) injection of LPS (10-μg serotype 0111:B4) induced preterm labor (PTL) with high pup mortality, marked systemic inflammatory response and hypotension. Here, we used both i.u. and i.p. LPS models in pregnant wild-type (wt) and CCR2 knockout (CCR2-/-) mice on E16 to investigate the role played by the CCL2/CCR2 system in the response to LPS. Basally, lower numbers of monocytes and macrophages and higher numbers of neutrophils were found in the myometrium, placenta, and blood of CCR2-/- vs. wt mice. After i.u. LPS, parturition occurred at 14 h in both groups of mice. At 7 h post-injection, 70% of wt pups were dead vs. 10% of CCR2-/- pups, but at delivery 100% of wt and 90% of CCR2-/- pups were dead. Myometrial and placental monocytes and macrophages were generally lower in CCR2-/- mice, but this was less consistent in the circulation, lung, and liver. At 7 h post-LPS, myometrial ERK activation was greater and JNK and p65 lower and the mRNA levels of chemokines were higher and of inflammatory cytokines lower in CCR2-/- vs. wt mice. Pup brain and placental inflammation were similar. Using the IP LPS model, we found that all measures of arterial pressure increased in CCR2-/- but declined in wt mice. These data suggest that the CCL2/CCR2 system plays a critical role in the cardiovascular response to LPS and contributes to pup death but does not influence the onset of inflammation-induced PTL.
Kalliala I, Athanasiou A, Veroniki AA, et al., 2020, Incidence and mortality from cervical cancer and other malignancies after treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis of the literature., Annals of Oncology, Vol: 31, Pages: 213-227, ISSN: 0923-7534
Background: While local treatments for cervical intraepithelial neoplasia (CIN) are highly effective, it has been reported that treated women remain at increased risk of cervical and other cancers. Our aim is to explore the risk of developing or dying from cervical cancer and other HPV- and non-HPV-related malignancies after CIN treatment and infer about its magnitude compared to general population.Materials and methods:Design: Systematic review and meta-analysis.Eligibility criteria: Studies with registry-based follow-up reporting cancer incidence or mortality after CIN treatment. Data synthesis: Summary effects were estimated using random-effects models.Outcomes: Incidence rate of cervical cancer among women treated for CIN (per 100,000 woman-years). Relative risk (RR) of cervical cancer, other HPV-related anogenital tract cancer (vagina, vulva, anus), any cancer, and mortality, for women treated with CIN versus the general population.Results: Twenty-seven studies were eligible. The incidence rate for cervical cancer after CIN treatment was 39 per 100,000 woman-years (95% CI 22 to 69). RR of cervical cancer was elevated compared to the general population (3·30, 2·57 to 4·24; P<0·001). RR was higher for women over 50 years old and remained elevated for at least 20 years after treatment. RR of vaginal (10·84, 5·58 to 21·10; P<0·001), vulvar (3·34, 2·39 to 4·67; P<0·001), and anal cancer (5·11, 2·73 to 9·55; P<0·001) was also higher. Mortality from cervical/vaginal cancer was elevated, but our estimate was more uncertain (RR 5·04, 0·69 to 36·94; P=0·073).Conclusions: Women treated for CIN have considerably higher risk to be later diagnosed with cervical and other HPV-related cancers compared to general population. The higher risk of cervical cancer lasts for at least 20 years after treatment and is higher for women
Al-Memar M, Bobdiwala S, Fourie H, et al., 2020, The association between vaginal bacterial composition and miscarriage: a nested case-control study, BJOG: an International Journal of Obstetrics and Gynaecology, Vol: 127, Pages: 264-274, ISSN: 1470-0328
OBJECTIVE: To characterise vaginal bacterial composition in early pregnancy and investigate its relationship with first and second trimester miscarriages. DESIGN: Nested case-control study. SETTING: Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London. POPULATION: 161 pregnancies; 64 resulting in first trimester miscarriage, 14 in second trimester miscarriage and 83 term pregnancies. METHODS: Prospective profiling and comparison of vaginal bacteria composition using 16S rRNA gene-based metataxonomics from 5 weeks gestation in pregnancies ending in miscarriage or uncomplicated term deliveries matched for age, gestation and body-mass index. MAIN OUTCOME MEASURES: Relative vaginal bacteria abundance, diversity and richness. Pregnancy outcomes defined as first or second trimester miscarriage, or uncomplicated term delivery. RESULTS: First trimester miscarriage associated with reduced prevalence of Lactobacillus spp.-dominated vaginal microbiota classified using hierarchical clustering analysis (65.6% vs. 87·7%; P=0·005), higher alpha diversity (mean Inverse Simpson Index 2.5 (95% confidence interval 1.8-3.0) vs. 1.5 (1.3-1.7), P=0·003) and higher richness 25.1 (18.5-31.7) vs. 16.7 (13.4-20), P=0·017), compared to viable pregnancies. This was independent of vaginal bleeding and observable before first trimester miscarriage diagnosis (P=0·015). Incomplete/complete miscarriage associated with higher proportions of Lactobacillus spp.-deplete communities compared to missed miscarriage. Early pregnancy vaginal bacterial stability was similar between miscarriage and term pregnancies. CONCLUSIONS: These findings associate the bacterial component of vaginal microbiota with first trimester miscarriage and indicate suboptimal community composition is established in early pregnancy. While further studies are required to elucidate the mechanism, vaginal bacterial composition may represent a modifiable risk factor fo
Jones BP, Saso S, L'Heveder A, et al., 2020, The vaginal microbiome in uterine transplantation, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 127, Pages: 230-238, ISSN: 1470-0328
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- Citations: 14
Norman JE, Norrie J, MacLennan G, et al., 2020, Randomized controlled trial: Arabin pessary to prevent preterm birth in twin pregnancies with short cervix, 40th Annual Pregnancy Meeting of the Society-for-Maternal-Fetal-Medicine (SMFM), Publisher: MOSBY-ELSEVIER, Pages: S756-S756, ISSN: 0002-9378
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Bennett P, 2020, The Pathogenesis of Preterm Birth: A Guide to Potential Therapeutic Targets, FETAL THERAPY: SCIENTIFIC BASIS AND CRITICAL APPRAISAL OF CLINICAL BENEFITS, 2ND EDITION, Editors: Kilby, Johnson, Oepkes, Publisher: CAMBRIDGE UNIV PRESS, Pages: 302-310
Pavagada S, Channon RB, Chang JYH, et al., 2019, Oligonucleotide-templated lateral flow assays for amplification-free sensing of circulating microRNAs (vol 55, pg 12451, 2019), CHEMICAL COMMUNICATIONS, Vol: 55, Pages: 13470-13470, ISSN: 1359-7345
Mitra A, Macintyre D, Lee Y, et al., 2019, CERVICAL INTRAEPITHELIAL NEOPLASIA IS ASSOCIATED WITH AN ALTERED VAGINAL MICROBIOME AND INNATE IMMUNE DISRUPTION, Publisher: BMJ PUBLISHING GROUP, Pages: A71-A71, ISSN: 1048-891X
Semertzidou A, MacIntyre D, Marchesi J, et al., 2019, CHARACTERISATION OF THE MICROBIOME ALONG THE FEMALE GENITAL TRACT AND RECTUM IN ENDOMETRIAL CANCER, Publisher: BMJ PUBLISHING GROUP, Pages: A363-A364, ISSN: 1048-891X
Mitra A, Macintyre D, Ntritsos G, et al., 2019, THE ROLE OF THE VAGINAL MICROBIOTA IN THE REGRESSION OF UNTREATED CIN2 LESIONS, Publisher: BMJ PUBLISHING GROUP, Pages: A37-A37, ISSN: 1048-891X
Pavagada S, Channon RB, Chang JYH, et al., 2019, Oligonucleotide-templated lateral flow assays for amplification-free sensing of circulating microRNAs, Chemical Communications, Vol: 55, Pages: 12451-12454, ISSN: 1359-7345
Herein we demonstrate the first example of oligonucleotide-templated reaction (OTR) performed on paper, using lateral flow to capture and concentrate specific nucleic acid biomarkers on a test line. Quantitative analysis, using a low-cost benchtop fluorescence reader showed very high specificity down to the single nucleotide level and proved sensitive enough for amplification-free, on-chip, detection of endogenous concentrations of miR-150-5p, a recently identified predictive blood biomarker for preterm birth.
Athanasiou A, Veroniki AA, Efthimiou O, et al., 2019, Comparative fertility and pregnancy outcomes after local treatment for cervical intra-epithelial neoplasia and stage 1a1 cervical cancer: protocol for a systematic review and network meta-analysis from the CIRCLE Group, BMJ Open, Vol: 9, ISSN: 2044-6055
Introduction: There are several local treatment methods for cervical intra-epithelial neoplasia that remove or ablate a cone-shaped part of the uterine cervix. There is evidence to suggest that these increase the risk of preterm birth and that this is higher for techniques that remove larger parts of the cervix, although the data is conflicting. We present a protocol for a systematic review and network meta-analysis that will update the evidence and compare all treatments in terms of fertility and pregnancy complications. Methods and Analysis: We will search electronic databases (CENTRAL, MEDLINE, EMBASE) from inception till October 2019, in order to identify randomised controlled trials (RCTs) and cohort studies comparing the fertility and pregnancy outcomes amongst different excisional and ablative treatment techniques and/or to untreated controls. The primary outcome will be preterm birth (PTB; <37weeks). Secondary outcomes will include severe or extreme PTB, prelabour rupture of membranes, low birth weight (<2500gr), neonatal intensive care unit admission, perinatal mortality, total pregnancy rates, 1st and 2nd trimester miscarriage. We will search for published and unpublished studies in electronic databases, trial registries and we will hand-search references of published papers. We will assess the risk of bias in RCTs and cohort studies using tools developed by the Cochrane Collaboration. Two investigators will independently assess the eligibility, abstract the data and assess the risk of bias of the identified studies. For each outcome, we will perform a meta-analysis for each treatment comparison and a network meta-analysis once the transitivity assumption holds, using the odds ratio for dichotomous data. We will use CINEMA to assess the quality of the evidence for the primary outcome.Ethics and dissemination: Ethical approval is not required. Results will be disseminated to academic beneficiaries, medical practitioners, patients and the public.PROSPE
Al-Memar M, Vaulet T, Fourie H, et al., 2019, The impact of early pregnancy events on long-term pregnancy outcomes: a prospective cohort study, Ultrasound in Obstetrics and Gynecology, Vol: 54, Pages: 530-537, ISSN: 0960-7692
OBJECTIVES: To prospectively assess the impact of pelvic pain, vaginal bleeding and nausea and vomiting in the first trimester of pregnancy on long-term pregnancy outcomes. METHODS: Prospective observational cohort study at Queen Charlotte's & Chelsea Hospital, London, UK, from March 2014-2016. Consecutive women with confirmed intrauterine pregnancies between 5-14 weeks gestation were recruited. Serial ultrasound scans were performed in the first trimester. Participants completed validated symptom scores for vaginal bleeding, pelvic pain, and nausea and vomiting. The key symptom of interest was any pelvic pain and/or vaginal bleeding. Pregnancies were followed up until the final outcome was known. Antenatal, delivery, and neonatal outcomes were obtained from hospital records. We calculated adjusted odds ratios (aOR) using logistic regression with correction for maternal age. RESULTS: We recruited 1003 women. After excluding first trimester miscarriages (N=99), terminations (N=20), lost to follow up (N=32) and withdrawals (N=5), 847 pregnancies were analysed. Adverse antenatal complications were observed in 166/645 (26%) women with pain and/or bleeding, and in 30/181 (17%) women without (aOR=1.79, 95% CI=1.17-2.76). Neonatal complications were observed in 66/635 (10%) women with and 11/176 (6%) women without pain and/or bleeding (aOR=1.73, 95% CI=0.89-3.36). Delivery complications were observed in 402/615 (65%) women with and 110/174 (63%) women without pain and/or bleeding (aOR=1.16, 95% CI=0.81-1.65). For 18 of 20 individual antenatal complications, incidence was higher among women with pain and/or bleeding, despite the overall incidences being low. Nausea and vomiting in pregnancy showed little association with adverse pregnancy outcomes. CONCLUSIONS: Our study suggests that there is an increased incidence of antenatal complications in women with pelvic pain and/or vaginal bleeding in the first trimester. This should be considered when advising women attending
Ridout AE, Ibeto L, Ross G, et al., 2019, Cervical length and quantitative fetal fibronectin in the prediction of spontaneous preterm birth in asymptomatic women with congenital uterine anomaly, American Journal of Obstetrics and Gynecology, Vol: 221, Pages: 341.e1-341.e9, ISSN: 0002-9378
BACKGROUND: Congenital uterine anomalies (CUA) are associated with late miscarriage and spontaneous preterm birth (sPTB). OBJECTIVES: Our aim was to 1) determine the rate of sPTB in each type of CUA and 2) assess the performance of quantitative fetal fibronectin (qfFN) and transvaginal cervical length (CL) measurement by ultrasound in asymptomatic women with CUA for the prediction of sPTB at <34 and <37 weeks of gestation. STUDY DESIGN: This was a retrospective cohort of women with CUA asymptomatic for sPTB, from four UK tertiary referral centres (2001-2016). CUAs were categorised into fusion (unicornuate, didelphic and bicornuate uteri) or resorption defects (septate, with or without resection and arcuate uteri), based on pre-pregnancy diagnosis. All women underwent serial transvaginal ultrasound CL assessment in the second trimester (16 to 24 weeks' gestation); a subgroup underwent qfFN testing from 18 weeks' gestation. We investigated the relationship between CUA and predictive test performance for sPTB before 34 and 37 weeks' gestation. RESULTS: Three hundred and nineteen women were identified as having CUA within our high-risk population. 7% (23/319) delivered spontaneously <34 weeks, and 18% (56/319) <37 weeks' gestation. Rates of sPTB by type were: 26% (7/27) for unicornuate, 21% (7/34) for didelphic, 16% (31/189) for bicornuate, 13% (7/56) for septate and 31% (4/13) for arcuate. 80% (45/56) of women who had sPTB <37 weeks did not develop a short CL (<25 mm) during the surveillance period (16-24 weeks). The diagnostic accuracy of short CL had low sensitivity (20.3) for predicting sPTB <34 weeks. Cervical Length had ROC AUC of 0.56 (95% CI 0.48 to 0.64) and 0.59 (95% CI 0.55 to 0.64) for prediction of sPTB <34 and 37 weeks' respectively. The AUC for CL to predict sPTB <34 weeks was 0.48 for fusion defects (95% CI 0.39 to 0.57) but 0.78 (95% CI 0.66 to 0.91) for women with resorption defects. Overall quantitative fetal fibronectin had
O'Byrne S, Elliott N, Rice S, et al., 2019, Discovery of a CD10 negative B-progenitor in human fetal life identifies unique ontogeny-related developmental programs, Blood, Vol: 134, Pages: 1059-1071, ISSN: 0006-4971
Human lymphopoiesis is a dynamic life-long process that starts in utero 6 weeks post-conception. Fetal B-lymphopoiesis remains poorly defined and yet is key to understanding leukemia initiation in early life. Here, we provide a comprehensive analysis of the human fetal B-cell developmental hierarchy. We report the presence in fetal tissues of two distinct CD19+ B-progenitors, an adult-type CD10+ve ProB-progenitor and a new CD10-ve PreProB-progenitor, and describe their molecular and functional characteristics. PreProB- and ProB-progenitors appear early in the first trimester in embryonic liver, followed by a sustained second wave of B-progenitor development in fetal BM, where together they form >40% of the total HSC/progenitor pool. Almost one-third of fetal B-progenitors are CD10-ve PreProB-progenitors while, by contrast, PreProB-progenitors are almost undetectable (0.53{plus minus}0.24%) in adult BM. Single-cell transcriptomics and functional assays place fetal PreProB- upstream of ProB-progenitors, identifying them as the first B-lymphoid restricted progenitor in human fetal life. Fetal BM PreProB- and ProB-progenitors both give rise solely to B-lineage cells yet they are transcriptionally distinct. Like their fetal counterparts, adult BM PreProB-progenitors give rise only to B-lineage cells in vitro and express the expected B-lineage gene expression program. However, fetal PreProB-progenitors, display a distinct, ontogeny-related gene expression pattern which is not seen in adult PreProB-progenitors; and share transcriptomic signatures with CD10-ve B-progenitor infant acute lymphoblastic leukemia blast cells. These data identify PreProB-progenitors as the earliest B-lymphoid-restricted progenitor in human fetal life, and suggest that this fetal-restricted committed B-progenitor might provide a permissive cellular context for prenatal B-progenitor leukemia initiation.
Kyrgiou M, Valasoulis G, Stasinou S-M, et al., 2019, Erratum to “Proportion of cervical excision for cervical intraepithelial neoplasia as a predictor of pregnancy outcomes”[Int J Gynecol Obstet 128(2015) 141–147], International Journal of Gynecology and Obstetrics, Vol: 146, Pages: 392-392, ISSN: 0020-6695
Stevenson K, Alamaddine R, Rukbi G, et al., 2019, High rates of maternal depression amongst Syrian refugees in Lebanon - a pilot study, Scientific Reports, Vol: 9, ISSN: 2045-2322
This pilot study compares symptoms of depression and risk factors amongst Syrian refugees and low-income Lebanese mothers accessing a primary care centre in Beirut between January and June 2018. Women who gave birth in the previous two years or who were currently pregnant were included in the study. Depressive symptoms were assessed using the Arabic Edinburgh Postnatal Depression Scale (EPDS). Correlations between EPDS score and sociodemographic and mental health variables were analysed using Pearson’s coefficient and ANOVA. 35 Syrian and 25 Lebanese women were recruited, 15 of whom were pregnant. EPDS scores were high in the whole group (mean 16.12 (SD 7.72), n=60). Scores were higher amongst Syrian refugees than Lebanese mothers (17.77, SD 7.66 vs, 13.80, SD 7.34, p<0.05). Illegal residence (p<0.001), domestic violence (p<0.05) and a history of mental illness (p<0.01) were associated with higher scores. This pilot study demonstrates high rates of symptoms of depression amongst mothers in this population. Symptoms were particularly prevalent amongst Syrian refugees; three-quarters were ‘probably depressed’ and would warrant psychiatric assessment. This highlights the importance of improved mental healthcare for refugee mothers, the importance of addressing the social determinants of maternal mental health and further research into the effects of depression on these women and their children.
Athanasiou A, Veroniki A, Efthimiou O, et al., 2019, Comparative efficacy and complication rates after local treatment for cervical intra-epithelial neoplasia and stage 1a1 cervical cancer: protocol for a systematic review and network meta-analysis from the CIRCLE Group, BMJ Open, Vol: 9, Pages: 1-7, ISSN: 2044-6055
Introduction: Local treatments for cervical intra-epithelial neoplasia (CIN) and microinvasive disease remove or ablate a cone-shaped part of the uterine cervix containing theabnormal cells. A trend towards less radical techniques has raised concerns that this mayadversely impact the rates of precancerous and cancerous recurrence. However, there hasbeen no strong evidence to support such claims. We hereby describe a protocol of asystematic review and network meta-analysis that will update the evidence and compare allrelevant treatments in terms of efficacy and complications.Methods and Analysis: Literature searches in electronic databases (CENTRAL, MEDLINE,EMBASE) or trial registries will identify published and unpublished randomised controlledtrials (RCTs) and cohort studies comparing the efficacy and complications amongst differentexcisional and ablative techniques. The excisional techniques include cold knife, laser orfischer cone, large loop or needle excision of the transformation zone and the ablative radicalpoint diathermy, cryotherapy, cold coagulation or laser ablation. The primary outcome willbe residual/recurrent disease defined as abnormal histology or cytology of any grade, whilesecondary outcomes will include treatment failure rates defined as high-grade histology orcytology, histologically-confirmed CIN1+ or histologically-confirmed CIN2+, HPVpositivity rates, involved margins rates, bleeding and cervical stenosis rates. We will assessthe risk of bias in RCTs and observational studies using tools developed by the CochraneCollaboration. Two authors will independently assess study eligibility, abstract the data, andassess the risk of bias. Random-effects meta-analyses and network meta-analyses will beconducted using the odds ratio for dichotomous outcomes and the mean difference forcontinuous outcomes. The quality of the evidence for the primary outcome will be assessedusing the CINEMA tool.
Story L, Simpson NAB, David AL, et al., 2019, Reducing the impact of preterm birth: Preterm birth commissioning in the United Kingdom, European Journal of Obstetrics & Gynecology and Reproductive Biology: X, Vol: 3, Pages: 100018-100018, ISSN: 2590-1613
Brown R, Chan D, Terzidou V, et al., 2019, Prospective observational study of vaginal microbiota pre- and post-rescue cervical cerclage, BJOG: An International Journal of Obstetrics and Gynaecology, Vol: 126, Pages: 916-925, ISSN: 1470-0328
ObjectiveTo investigate the relationship between vaginal microbiota composition and outcome of rescue cervical cerclage.DesignProspective observational study.SettingQueen Charlotte’s and Chelsea Hospital, LondonPopulationTwenty singleton pregnancies undergoing a rescue cervical cerclage.MethodsVaginal microbiota composition was analysed in women presenting with a dilated cervix and exposed fetal membranes before and 10 days following rescue cervical cerclage and correlated with clinical outcomes.Main outcome measuresComposition of vaginal bacteria characterised by culture independent next generation sequencing.Successful cerclage, defined as those resulting in the birth of a neonate discharged from hospital without morbidity.Unsuccessful cerclage, defined as procedures culminating in miscarriage, intrauterine death, neonatal death or significant neonatal morbidity.ResultsReduced Lactobacillus spp. relative abundance was observed in 40% of cases prior to rescue cerclage compared to 10% of gestational age matched controls (8/20, 40% vs 3/30, 10%, P=0.017). Gardnerella vaginalis was over-represented in women presenting with symptoms (3/7, 43% vs 0/13, 0%, P=0.03, LDA (log 10) and casesculminating in miscarriage (3/6, 50% vs 0/14, 0%, P=0.017). In the majority of cases (10/14, 71%) bacterial composition was unchanged following cerclage insertionand peri-operative interventions.ConclusionsReduced relative abundance of Lactobacillus spp. is associated with premature cervical dilatation, whereas high levels of Gardnerella vaginalis are associated with unsuccessful rescue cerclage cases. The insertion of a rescue cerclage does not affect the underlying bacterial composition in the majority of cases.
Chan D, Lee YS, Ahmed S, et al., 2019, The vaginal microbiome influences the maternal local immune response in women who deliver preterm and at term, Publisher: WILEY, Pages: 165-166, ISSN: 1470-0328
Rasheed ZBM, Martin CRS, Sullivan MHF, et al., 2019, The placenta exhibits selective immune response in an in vitro model of haematogenous multi-pathogen-induced preterm labour, Publisher: WILEY, Pages: 158-158, ISSN: 1470-0328
Al-Memar M, Vaulet T, Nikolic G, et al., 2019, Pain and bleeding in the first trimester and long-term pregnancy outcomes: a prospective cohort study, Publisher: WILEY, Pages: 18-18, ISSN: 1470-0328
Grewal K, Lee Y, Smith A, et al., 2019, Lactobacillus-deplete vaginal microbiota composition is associated with chromosomally normal miscarriage, Publisher: WILEY, Pages: 29-29, ISSN: 1470-0328
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