How microbial bacteria could help detect signs of premature births

It came to light with a recent study that changes to the communities of microbes living in the reproductive tract of pregnant women could help to spot those at risk of giving birth prematurely.

The study found that the subtle changes to the bacteria present in the vagina were strongly associated with the woman's waters breaking early which led preterm birth of the baby, i.e. before 37 weeks. According to the researchers, it could have an impact on the health of mother and baby, including increasing the risk of sepsis for newborns.

In the published study, the team of researchers also highlighted that while the standard antibiotic treatment given to women whose waters break early, a precursor of labour, can help to reduce infection, for a small subset of women it may actually be detrimental.

They explained that for a small proportion of women the treatment, administered as a protective measure in hospital, can disrupt the balance of the mother's microbes by eradicating the 'good' bacteria and allowing more harmful bacteria to take their place in the vagina - with potentially devastating consequences for the baby.

The team suggested alternative treatments should be used for these women to mitigate their risk. They pointed out that in case of preterm birth, rupture of amniotic sac leaves baby more susceptible to infections as compared to normal birthing circumstances.

The team looked at the impact of premature rupturing of the membrane and antibiotic treatment on the vaginal microbia.

They took swabs from the vaginas of pregnant women at different points during their pregnancy and analysed them to reveal the types of bacteria present, their proportions, and any changes. Samples were collected from a prospective group of 250 pregnant women with and without risk factors for giving birth prematurely - such as having a history of preterm birth or miscarriage - of which 27 did, in fact, have a premature birth.

They also collected samples from a second, smaller group of 87 women who presented to the hospital with premature membrane rupture.
 
Previous research had shown that over the course of pregnancy the bacteria that colonize the vagina became less diverse and were dominated chiefly by Lactobacillus species - the same type of bacteria found elsewhere in the body including the gut and mouth.

Thorough analysis revealed that premature membrane rupture was associated with a shift in the microbia, with a drop in Lactobacillus and an increase in other types of bacteria, including potentially harmful bugs such as Staphylococcus and Streptococcus.

The team also analyzed samples from the small group of women with premature rupture before and after the preventative antibiotic treatment - oral erythromycin, four times a day for 10 days. Swabs were taken before treatment and then at 48 hours, one week and two weeks.

The study also revealed associations between specific vaginal bacteria and newborns who developed sepsis following delivery. While the mothers of healthy babies were dominated by Lactobacillus, samples from the mothers of newborns with sepsis revealed a greater diversity of bacteria, including the presence of Streptococcus and E. coli.

The group added that further studies are needed to assess current clinical guidelines for women with premature rupture and that developing alternative ways to treat women, such as using more selective antibiotics, could potentially improve outcomes for women and their babies.

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Mussel-inspired glue may make foetal surgery safer

Scientists have developed a strong glue based on a mussel adhesive which could make performing surgery on fetuses safer in the future. 

Whether to perform surgery on a foetus is a heart- wrenching decision. It involves penetrating the highly delicate amniotic sac, increasing health risks to the foetus. 

Now, researchers have created a glue, inspired by the tenacious grip of mussels on slippery rocks, that could one day help save the lives of the youngest patients. 

"One of the biggest risks in performing surgery on fetuses is not the surgical procedure itself, but the insertion of a foetal scope through the amniotic sac, which is very fragile," said, a researcher.

"After the surgery, the small hole where the scope penetrates the membrane can start to tear. If it tears completely, premature labour is likely," said the researcher.

Since these operations are often done in the second trimester well before the foetus is fully developed, early delivery increases the risk of foetal morbidity. 

An adhesive that can prevent the amniotic sac from tearing could help the foetus remain in the womb longer, which would potentially lead to a healthier future for the baby, researchers said. 

A well-known example of a severe birth defect that would make a foetus a candidate for surgery is spina bifida, a condition in which the neural tube - the part that becomes the baby's brain and spinal cord - does not develop or close properly. 

To fix such problems a few decades ago, surgeons had to cut open a woman's abdomen and womb.
Now, doctors can use skinny endoscopic tools to perform operations through a small hole. Still, to reach the foetus, the instruments must penetrate the amniotic sac, which cannot heal or easily be sewn shut because it is so fragile. 

Sealing it with an adhesive is a challenge because the membrane is wet. Delivering a surgical glue post-operation is a major hurdle. 

Mussels produce sticky substances that allow them to cling to rocks and ship hulls in wet environments, even under pounding waves. 

Developing mimics of these substances for surgical use involves turning them into hydrogels. However, this conversion so far has required chemical cross-linkers that could be toxic to fetuses. 

The scientist wanted to eliminate the cross-linkers. He infused an adhesive ingredient from the mussel foot called dihydroxyphenylalanine, or DOPA, into a special polymer that can dissolve in a bio-compatible solvent. 

The solution can then be drawn into a syringe. To test their material, the researchers used pieces of a membrane that surrounds a cow's heart as a model of the amniotic sac. 

They applied the solution with the syringe to overlapping pieces of the wet, filmy tissues. On contact with moisture on the tissues, the mixture immediately became rubbery. After about an hour, the glue set and held the pieces together. 

However, even with the right polymer and solvent, the researchers still needed to figure out how the solution might work in a real surgery. 

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