This systematic review aims to identify, critically appraise and summarize the results of studies examining the relationship between the vaginal microbiota and preterm birth (PTB). We searched the electronic databases Medline, EMBASE and the Cochrane Controlled Register of Trials for studies in any language reporting on vaginal microbiota and PTB published from 1990 to November 29th, 2017. We included any study that performed lower genital tract microbiota assessment in asymptomatic pregnant women and reported on spontaneous preterm birth, with either intact or ruptured membranes. The search strategy yielded 2171 unique citations, of which nine studies were eligible for inclusion in this review. In six studies an association was found between the composition of the vaginal microbiota and PTB, but findings differed between subgroups, ethnicities and degree of risk of PTB. In three studies no association was found. Two of these studies found a significant difference in richness and Shannon diversity between term and PTB. We have demonstrated that there is a paucity of molecular based, culture-independent studies that analyse the relationship between the vaginal microbiota and PTB as an outcome. The heterogeneity precluded a meta-analysis. Studies provide contradictory evidence and the quality of the clinical information in the studies is poor. To improve quality of future studies we have provided a database of essential and desirable items of quality that are method and topic specific.

Introduction: The use of antibiotics prenatally, during pregnancy, or neonatally may have adverse effects on the neonatal gut microbiome, and adversely affect the development of the infant immune system, leading to the development of childhood atopy, asthma, allergy and obesity. Areas covered: We reviewed new evidence about vaginal eubiosis and dysbiosis from molecular-based, cultivation-independent techniques, and how this affects the neonatal gut microbiome and early development of the immune system in infants. We have considered the association between maternal use of antibiotics and the potentially beneficial role of vitamin D in the development of atopy, asthma, allergy and obesity. We have presented what efforts might be made to reduce the use of antibiotics in pregnancy. Finally, we have also addressed therapeutic interventions such as vaginal “seeding”, probiotics, breastfeeding and neonatal dietary supplementation. Expert opinion: The weakness of the currently available research is that insufficient assessment has been paid to confounding variables. There also remains uncertainty as to whether it is relevant that the mother suffered from the same condition such as asthma, as the purported infant outcome variable, for which she may have received antibiotics. In most studies, there is also a lack of control for the number of antibiotic courses administered, the timing of use, the use of broad spectrum or narrow range antibiotics, the indication for antibiotic use, the dose dependent nature of the effect, the class of antibiotics used, or a varying degree of risk.

Ventilation strategies for septic pregnant women may have to be adapted from the general population with sepsis. The maternal arterial partial pressure of arterial oxygen (PaO₂) should be maintained at >70mmHg and partial pressure of carbon dioxide (PaCO₂) at <60–70mmHg to ensure fetal oxygenation and placental perfusion {1}. The evidence suggests that prone ventilation may become increasingly used in pregnant women with sepsis {2-4}. In addition, in this 2016 publication, the Surviving Sepsis Campaign strongly recommends low tidal volume ventilation in acute respiratory distress syndrome (ARDS) of 6mL/kg and an upper limit plateau pressure of 30cm H2O, based on evidence from several clinical trials that have demonstrated benefit from lung protective ventilation strategies. This Recommendation is of an article referenced in an F1000 Faculty Review also written by Amaan Ali and Ronnie F Lamont.

Introduction: Preterm birth is the major cause of neonatal mortality and morbidity worldwide and a huge cost burden on healthcare. Between 22 and 26 completed weeks of gestation, for every day that delivery is delayed, survival increases by 3%. Areas covered: Following a systematic review of the literature, we have provided an overview of the use of tocolytics for the prevention of preterm birth and have examined the fetal and maternal adverse effects of the various tocolytic agents currently in use. Expert opinion: No tocolytic currently in use was developed specifically to treat preterm labour so most have multi-organ side effects. β₂-agonists are relatively safe for the fetus but have rare and potentially serious maternal adverse effects. In contrast, prostaglandin synthetase inhibitors have potentially serious side effects for the fetus and neonate but have mild maternal gastrointestinal side effects. In Europe, the choice of first line therapy is either atosiban or nifedipine. The evidence base for atosiban is much more robust than for nifedipine. While their efficacy is similar, atosiban has placebo level side effects and is safer than nifedipine but is much more expensive.

Background: Listeria monocytogenes is a commonly found organism in processed and prepared food and the disease of listeriosis is associated with a high morbidity and mortality. Compared with the general population, the risk of being diagnosed with listeriosis increases during pregnancy. Listeriosis can lead to miscarriage, spontaneous preterm labour and preterm birth, stillbirth and congenital neonatal infections.Objectives: We conducted a universal review of listeriosis in pregnancy and in the newborn.Search strategy: The EMBASE, PubMed, Cinahl and Web of Science databases were searched for systematic reviews indexed before 1 December 2020.Selection criteria: Any systematic reviews evaluating the prevalence, treatment, diagnosis and effects of listeriosis during pregnancy and up to 4 weeks postnatally were included.Data collection and analysis: Eligibility assessment, data extraction and quality assessment by the Methodological Quality Assessment of Systematic Reviews (AMSTAR‐2) were performed in duplicate.Main results: We identified 397 citations of which nine systematic reviews comprising 330 studies and 487 patients’ reviews were included. Most systematic reviews (seven of nine) were of moderate to high quality. Prevention in pregnant women was based on adherence to strict dietary recommendations, such as reheating leftovers until steamed and avoiding unpasteurised dairy products. Listeriosis infections were likely to occur in the third trimester (66%) rather than in the first trimester (3%) of pregnancy. Symptoms are mostly fever and other flu‐like symptoms, such as fatigue. Diagnosis was primarily made by culture of the pathogen. Intravenous amoxicillin or ampicillin were first‐line treatment.Conclusions: Listeriosis, a rare but serious infectious disease in pregnancy, can cause devastating consequences for the fetus and newborn. Appropriate preventative treatment should be initiated during early pregnancy to avoid complications.Tweetable Listeria is commonly found in processed and prepared food. Prevention is the best way to avoid listeriosis during pregnancy.