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Cervical length; Microbial diversity; Pessary Longitud cervical; Diversidad microbiana; Pesario Longitud cervical; Diversitat microbiana; Pessari Introduction Our objective was to compare the vaginal microbiome in low-risk and high-risk pregnant women and to explore a potential association between vaginal microbiome and preterm birth. Material and methods A pilot, consecutive, longitudinal, multicenter study was conducted in pregnant women at 18–22 weeks of gestation. Participants were assigned to one of three groups: control (normal cervix), pessary (cervical length ≤25 mm) and cerclage (cervical length ≤25 mm or history of preterm birth). Analysis and comparison of vaginal microbiota as a primary outcome was performed at inclusion and at 30 weeks of gestation, along with a follow-up of pregnancy and perinatal outcomes. We assessed the vaginal microbiome of pregnant women presenting a short cervix with that of pregnant women having a normal cervix, and compared the vaginal microbiome of women with a short cervix before and after placement of a cervical pessary or a cervical cerclage. Results The microbiome of our control cohort was dominated by Lactobacillus crispatus and inners. Five community state types were identified and microbiome diversity did not change significantly over 10 weeks in controls. On the other hand, a short cervix was associated with a lower microbial load and higher microbial richness, and was not correlated with Lactobacillus relative abundance. After intervention, the cerclage group (n = 19) had a significant increase in microbial richness and a shift towards community state types driven by various bacterial species, including Lactobacillus mulieris, unidentified Bifidobacterium or Enterococcus. These changes were not significantly observed in the pessary (n = 26) and control (n = 35) groups. The cerclage group had more threatened preterm labor episodes and poorer outcomes than the control and pessary groups. Conclusions These findings indicate that a short cervix is associated with an altered vaginal microbiome community structure. The use of a cerclage for preterm birth prevention, as compared with a pessary, was associated with a microbial community harboring a relatively low abundance of Lactobacillus, with more threatened preterm labor episodes, and with poorer clinical outcomes. This study was supported by the Instituto de Salud Carlos III/FEDER FIS PI15/02043; Beca Dexeus Mujer 2015. Francisca Yáñez was supported by a grant from ANID, BECAS Chile, N° 72190278. Zixuan Xie received a fellowship from the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie Action, Innovative Training Network: FunHoMic; grant number 812969.

L’angle uterocervical és l’angle que formen el canal cervical i la paret uterina anterior. En els darers anys s’ha suggerit que aquesta mesura pot ser útil per a predir el risc de part prematur espontani, però l’evidència que en tenim encara és limitada. Els estudis que es detallen en aquesta tesi doctoral intenten posar llum als enigmes d’aquest nou marcador ecogràfic i proporcionen evidència científica sobre la seva utilitat i les seves limitacions. El ángulo uterocervical es el ángulo que forman el canal cervical y la pared uterina anterior. En los últimos años se ha sugerido que esta medida puede ser útil para predecir el riesgo de parto prematuro espontáneo, pero la evidencia que tenemos todavía es limitada. Los estudios que se detallan en esta tesis doctoral intentan arrojar luz a los enigmas de este nuevo marcador ecográfico y proporcionan evidencia científica sobre su utilidad y sus limitaciones. The uterocervical angle is the angle formed by the cervical canal and the anterior uterine wall. It has been suggested in recent years that this measurement may be useful in predicting the risk of spontaneous preterm birth, but the evidence we have is still limited. The studies detailed in this doctoral thesis attempt to shed light on the enigmas of this new ultrasound marker and provide scientific evidence on its usefulness and limitations. Universitat Autònoma de Barcelona. Programa de Doctorat en Pediatria, Obstetrícia i Ginecologia

Maternal body mass index; Newborn weight; Obesity Índice de masa corporal materno; Peso del neonato; Obesidad Índex de massa corporal matern; Pes del nounat; Obesitat Background: Obesity and thinness are serious diseases, but cases with abnormal maternal weight have not been excluded from the calculations in the construction of customized fetal growth curves (CCs). Method: To determine if the new CCs, built excluding mothers with an abnormal weight, are better than standard CCs at identifying SGA. A total of 16,122 neonates were identified as SGA, LGA, or AGA, using the two models. Logistic regression and analysis of covariance were used to calculate the OR and CI for adverse outcomes by group. Gestational age was considered as a covariable. Results: The SGA rates by the new CCs and by the standard CCs were 11.8% and 9.7%, respectively. The SGA rate only by the new CCs was 18% and the SGA rate only by the standard CCs was 0.01%. Compared to AGA by both models, SGA by the new CCs had increased rates of cesarean section, (OR 1.53 (95% CI 1.19, 1.96)), prematurity (OR 2.84 (95% CI 2.09, 3.85)), NICU admission (OR 5.41 (95% CI 3.47, 8.43), and adverse outcomes (OR 1.76 (95% CI 1.06, 2.60). The strength of these associations decreased with gestational age. Conclusion: The use of the new CCs allowed for a more accurate identification of SGA at risk of adverse perinatal outcomes as compared to the standard CCs.