EXPLORATION OF THE VAGINAL MICROBIOME COMPOSITION IN PARTURIENT WOMEN ADMITTED TO A TERTIARY CARE HOSPITAL: A COMPREHENSIVE INVESTIGATION

Abstract

Abstract

Background: Vaginal microbiome is the microorganism that colonizes the vagina and has a significant impact on women's health and disease conditions. Microbiome starts to develop from the uterus and is further influenced by various factors like timing of birth, environmental exposures, diet, inflammatory immune responses, clinical infection, and sexual and hygiene practices. Anaerobic bacteria replace the lactobacillus, the usual vaginal flora, in bacterial vaginosis. About 20% of expectant mothers have it, and most of them have no symptoms. It is associated with premature rupture of membranes, preterm delivery, chorioamnionitis, and intra-uterine death. It also leads to adverse neonatal outcomes like assisted ventilation or respiratory distress at birth, neonatal Intensive care unit admission, fetal and infant mortality, neonatal sepsis, chronic lung disease and delayed development.

Methods: A case series study was conducted among 300 women to study the vaginal microbiome in women admitted for delivery to a tertiary care hospital at Belagavi. Vaginal swabs were collected from the posterior vaginal fornix and then placed in a sterile tube which was stored immediately until the sample is tested at -70°C. The samples were smeared onto MRS agar plates and left in an anaerobic room for a whole day at 370C. A biochemical test (Gram staining and IMViC test) was performed for the samples followed by DNA extraction using QIAamp ® DNA Mini Kit. After the amplification, the samples were analyzed by Sanger Sequencing.

Results: Gram staining was performed for all the samples followed by IMVIC test. Out of all samples, 106 were Voges-Proskauer test positive and 69 were citrate test positive. In the study, 18 samples (6%) were gram negative and 282 samples (94%) were gram positive. After identifying the samples with similar characteristics, representatives were selected for DNA isolation and then sanger sequencing was performed. The result showed that the women who had full term delivery showed more abundance of L. crispatus (39.3%), L. jensenii (27.8%), L.iners (26.3%), Bacillus cereus (6.6%); and the women who had preterm delivery showed the presence of Lactobacillus iners (48.8%), L.Gasseri (7.3%), Atopobium vaginae (4.9%) and Enterococcus faecalis (39%).

Conclusion: Women who may benefit from interventions targeted at restoring a normal vaginal flora and who are at risk of premature delivery can be identified with the aid of early detection of aerobic vaginitis and bacterial vaginosis in pregnancy. A large population study will be needed to ascertain whether treating vaginal dysbiosis in asymptomatic pregnant women will have a meaningful impact on the onset of premature labour. The study suggests imparting awareness to health care professionals and all women of reproductive age group regarding the importance of maintaining healthy vaginal microbiome