Preterm premature rupture of membranes (pPROM) stands as a primary contributor to preterm deliveries worldwide, closely linked to consequential infectious peripartum complications, including chorioamnionitis and early-onset neonatal sepsis. As a prophylactic measure, individuals following pPROM routinely undergo antibiotic treatment. The aim of this study was to evaluate changes in the vaginal microbial colonization after antibiotic treatment following pPROM. Therefore, we retrospectively assessed the impact of antibiotic treatment on the maternal vaginal microbial colonization in 438 post-pPROM patients delivering before 29 gestational weeks. Vaginal samples were collected for microbiological analysis before and after antibiotic administration and analysed for seventeen pre-defined microbial groups. We observed eradication in eleven microbial groups, including beta-hemolytic streptococci group B and Gardnerella vaginalis. No significant reduction was found for the remaining groups, including Escherichia (E.) coli. Moreover, we found a notable increase in resistant bacteria after antibiotic treatment. In conclusion, broad-spectrum antimicrobial treatment exhibited substantial efficacy in eradicating the majority of pathogens in our cohort. However, certain pathogens, notably E. coli, showed resilience. Given E. coli’s prominent role in infectious peripartum complications, our findings underline the challenges in antibiotic management post-pPROM and the need to establish international guidelines, particularly regarding emerging concerns about antibiotic resistances.

Background: Nausea and vomiting in pregnancy (NVP), or emesis gravidarum, is a frequent complication of early gestation with unclear causes, suspected to involve genetic, hormonal, and gastrointestinal factors. Our study investigated the association of human chorionic gonadotropin (hCG), histamine, diamine oxidase (DAO), thyroxine and pyridoxine and the severity of NVP symptoms and assessed the efficacy of a vitamin C-containing chewing gum as a potential NVP treatment. Methods: In this prospective, double-blinded, randomized, controlled trial, 111 participants were assigned to receive vitamin C-containing chewing gum, placebo gum, or no treatment at two follow-ups during early pregnancy. Maternal serum levels of hCG, histamine, DAO, thyroxine, and pyridoxine were measured and correlated with NVP severity using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24) score. Results: Elevated maternal hCG levels were significantly associated with an increased PUQE-24 score (p < 0.001), while histamine levels showed no significant correlation (p = 0.68). Maternal DAO levels negatively correlated with NVP symptoms (p < 0.001) and elevated thyroxine (p < 0.001) and pyridoxine levels (p < 0.001) were associated with increased PUQE-24 scores. The vitamin C-containing chewing gum did not demonstrate efficacy in alleviating NVP symptoms compared to placebo gum or no treatment during the first (p = 0.62) and second follow-up visits (p = 0.87). Conclusions: Our study underscores the complexity of factors contributing to NVP, highlighting the significant roles of hCG and DAO, while histamine levels appear unrelated. Maternal thyroxine and pyridoxine levels also significantly correlate with NVP symptoms. Vitamin C-containing chewing gum was not effective as a treatment for NVP. Further large-scale studies are needed to better understand these interactions and develop targeted treatments in the future.

Objective: Short cervix (SC) and vulvovaginal infections, such as bacterial vaginosis (BV) and vulvovaginal candidosis (VVC), are known risk factors for preterm birth (PTB). The objective of this study was to investigate whether the combined presence of SC and vulvovaginal infections further elevates the risk of PTB. Methods: We retrospectively analyzed data from women treated at our institution for SC between June 2021 and March 2024, defined as having a cervical length ≤25 mm prior to 34 ⁺⁰ gestational weeks. At the time of SC diagnosis, infection screening was performed using Gram‐stained smears, and cases of infection were adequately treated. The risk of PTB was analyzed using a Cox regression model. Results: Among 220 eligible women with SC, 157 (71.4%) had no infection, 26 (11.8%) had BV, 33 (15%) had VVC, and four (1.8%) had both BV and VVC. All participants received standard‐of‐care antibiotic or antifungal treatment. The median gestational age at SC diagnosis was 26 ⁺² gestational weeks at an average cervical length of 20 mm. Preterm delivery occurred in 94 women (42.7%). Cox regression analysis revealed no significant effect of BV ( P = 0.48) and/or VVC ( P = 0.30) on gestational age at delivery in women with SC. Conclusion: Adequately treated vulvovaginal infections do not appear to exacerbate the risk of PTB in women with SC, highlighting the importance of routine infection screening and timely treatment to ensure effective mitigation of the potential impact of coexisting infections. Prospective studies are required to confirm our findings and explore the underlying mechanisms.

Background: Cervical insufficiency is one of the main risk factors for preterm birth. It has been suggested that a more diverse vaginal microbial colonization might lead to cervical insufficiency and subsequently further increase the risk for preterm birth. To date, the microbial colonization in women with cervical insufficiency has not been sufficiently categorized. Therefore, this study is aimed at describing the vaginal microbial colonization in this high‐risk collective and exploring a possible association with preterm birth. Methods and Study Design: All women treated for cervical insufficiency from June 2021 until March 2024 at the Division for Obstetrics and Feto‐Maternal Medicine of the Medical University of Vienna were evaluated for inclusion. Vaginal bacterial/fungal culture results during pregnancy were used for the characterization of the vaginal microbial colonization and categorized in 17 predefined microbial groups. Results: We included 118 women with cervical insufficiency with available vaginal culture results, of whom 58.5% experienced preterm birth. Lactobacillus spp., coagulase‐negative staphylococci, Enterococcus spp. and Ureaplasma spp. were the most frequently detected microorganisms. Further, we conducted a secondary exploratory analysis of the association of each individual microbial group with preterm birth, which found an absence of lactobacilli ( p = 0.047) and the presence of a more diverse microbial composition with Gram‐negative anaerobes, Ureaplasma spp. and Enterococcus spp. to be more frequent in PTB. Conclusion: Cervical insufficiency is associated with a diverse vaginal microbial colonization. Especially colonization with coagulase‐negative staphylococci, Ureaplasma spp., and Enterococcus spp. seems to play an important role in cervical insufficiency. Lactobacillus spp. absence was associated with subsequent preterm birth.