OBJECTIVE: To analyze the cervical microbiota in women with preterm prelabor rupture of membranes (PPROM) by pyrosequencing and to document associations between cervical microbiota, cervical inflammatory response, microbial invasion of the amniotic cavity (MIAC), histological chorioamnionitis, and intraamniotic infection (IAI). STUDY DESIGN: Sixty-one women with singleton pregnancies complicated by PPROM were included in the study. Specimens of cervical and amniotic fluid were collected on admission. The cervical microbiota was assessed by 16S rRNA gene sequencing by pyrosequencing. Interleukin (IL)-6 concentration in the cervical fluid and amniotic fluid was measured by ELISA and lateral flow immunoassay, respectively. RESULTS: Four bacterial community state types [CST I (Lactobacillus crispatus dominated), CST III (Lactobacillus iners dominated), CST IV-A (non-Lactobacillus bacteria dominated), and CST IV-B (Gardnerella vaginalis and Sneathia sanguinegens dominated)] were observed in the cervical microbiota of women with PPROM. Cervical fluid IL-6 concentrations differed between CSTs (CST I = 145 pg/mL, CST III = 166 pg/mL, CST IV-A = 420 pg/mL, and CST IV-B = 322 pg/mL; p = 0.004). There were also differences in the rates of MIAC, of both MIAC and histological chorioamnionitis, and of IAI among CSTs. No difference in the rate of histological chorioamnionitis was found among CSTs. CONCLUSIONS: The cervical microbiota in PPROM women in this study was characterized by four CSTs. The presence of non-Lactobacillus CSTs was associated with a strong cervical inflammatory response and higher rates of MIAC, both MIAC and histological chorioamnionitis, and IAI representing a PPROM subtype with pronounced inflammation. CST I represents the dominant type of PPROM with a low rate of MIAC, IAI, and the combination of MIAC and histological chorioamnionitis.

4th Department of Medicine Hematology University Hospital Hradec Kralove and Charles University Prague Faculty of Medicine in Hradec Kralove Hradec Kralove Czech Republic

Biomedical Research Center University Hospital Hradec Kralove Hradec Kralove Czech Republic; Department of Obstetrics and Gynecology Charles University Prague Faculty of Medicine Hradec Kralove Hradec Kralove Czech Republic

Department of Clinical Immunology and Allergology University Hospital Hradec Kralove Charles University Prague Hradec Kralove Czech Republic

Department of Obstetrics and Gynecology Charles University Prague Faculty of Medicine Hradec Kralove Hradec Kralove Czech Republic

Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine and Perinatal Research The University of Texas Medical Branch at Galveston Galveston Texas United States of America

Department of Obstetrics and Gynecology University of Southern Denmark Odense University Hospital Odense Denmark

Institute of Clinical Biochemistry and Diagnostics University Hospital Hradec Kralove Hradec Kralove Czech Republic

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