A recent study published in the journal Frontiers in Microbiology found that the vaginal flora of women with premature births may be more diverse, and suggested that certain flora are more likely to induce premature birth.
Aren't we very pleased to see this research?
If a vaginal secretion examination during a pre-pregnancy checkup reveals the type of pathogen present and preventative measures can be taken, could this significantly reduce the rate of premature birth during pregnancy? Or could it identify high-risk groups for premature birth?
The study, through a large-scale survey, found that lactobacilli are widely present in pregnant women who deliver at full term, while eructophilia and clostridium are more likely to cause premature birth.
The vaginal environment in women stores a wide variety of bacteria.
As we all know, a variety of microorganisms reside in the vaginal environment of women. These microorganisms depend on each other, restrain each other, and coexist harmoniously without causing disease.
The resident flora of the vagina includes: lactobacilli, Gardnerella vaginalis, Escherichia coli, Corynebacterium, Group B streptococci, etc.
Lactobacillus is the most important bacterial group, accounting for over 90%. It can maintain the acidic environment of the vagina and kill other pathogenic bacteria, thus maintaining the ecological balance of the vagina.
Once the gut microbiota becomes imbalanced or exogenous pathogens invade, this ecological balance will be disrupted, leading to inflammation of the reproductive tract.
Causes of premature birth in pregnant women
There are many causes of premature birth, including genetic factors, infection and inflammation, decidual hemorrhage, environmental factors, behavioral factors and social stress.
Numerous studies have shown that up to 40% of idiopathic preterm births are caused by infections, including vaginal infections and intrauterine infections.
Pathogens can enter the amniotic cavity through ascending infection of the vaginal flora, blood dissemination via the placenta, or iatrogenic invasive procedures, leading to fetal infection.
So, what is premature birth? Medically, premature birth is defined as delivery at 28 weeks but before 37 weeks of gestation.
Typically, the signs of premature birth are not specific, making it difficult to distinguish between true and false premature births, which can easily lead to overdiagnosis and overtreatment.
Therefore, pregnant women with high-risk factors should pay attention and undergo early risk assessment for premature birth.
Methods for assessing preterm birth
1. Transvaginal ultrasound measurement of cervical length
A cervical length <25mm before 24 weeks of gestation, or the formation of an internal cervical funnel accompanied by cervical shortening, suggests an increased risk of preterm labor. The positive and negative predictive value is particularly significant for cervical lengths <15mm and >30mm.
2. Cervical secretion test
The predictive value of cervical length measured by ultrasound between 20-30 mm for preterm birth is uncertain. Further biochemical analysis of cervical secretions can be performed to improve the accuracy of the prediction.
The test indicators include: fetal fibronectin (fFN), phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1), and placental alpha microglobulin-1 (PAMG-1), among which fFN has a greater negative predictive value.
What are the signs of premature birth?
The initial signs of premature birth are irregular uterine contractions, often accompanied by a little vaginal bleeding or bloody discharge, which may later develop into regular uterine contractions.
Premature birth can be divided into two stages: threatened premature labor and premature labor.
Threatened preterm labor refers to regular or irregular uterine contractions accompanied by progressive shortening of the cervix.
Premature labor requires meeting the following conditions:
1. Regular uterine contractions (≥4 times in 20 minutes, or ≥8 times in 60 minutes) accompanied by progressive changes in the cervix;
2. Cervical dilation of more than 1 cm;
3. Cervical receptivity ≥80%.
Diagnosing preterm labor is not difficult, but it needs to be differentiated from physiological uterine contractions that occur in late pregnancy. Physiological uterine contractions are generally irregular, painless, and do not involve shortening of the cervix or dilation of the cervix; they are also known as false preterm labor.
Which pregnant women are more prone to premature birth?
For example, being under 18 or over 40 years old when pregnant, having a reproductive tract infection that was not treated in time, having a history of cervical insufficiency, having a short interval between pregnancies (generally referring to becoming pregnant again within six months postpartum), or having a history of adverse pregnancy outcomes.
How can we prevent premature birth?
First of all, regular prenatal checkups are very important. During each prenatal checkup, we need to tell the doctor about any discomfort we feel so that further examination can be conducted and preventive measures or treatment can be taken.
Secondly, actively treat complications. Pregnant women with hypertension or diabetes need to receive active treatment, otherwise their condition may worsen, leading to iatrogenic premature birth.
Finally, during pregnancy, if a pregnant woman is suspected of having cervical insufficiency, she will need to undergo cervical cerclage.
In addition, in our daily lives, we also need to avoid overwork and external stimuli, and maintain a good lifestyle, such as increasing rest time, maintaining a peaceful state of mind, eliminating tension, and consuming reasonable and sufficient nutrition.
Although there are many causes of premature birth, they are still preventable and controllable. It is hoped that pregnant mothers will pay attention to each prenatal check-up to avoid premature birth and have a smooth pregnancy.
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