The complexity of an optimal vaginal biome.

I commend the effort required to undertake a modestly large trial to alter the vaginal microbiome.[1] Its aim was to reduce preterm birth, the single most important and unsolved issue in obstetrics. Very early preterm birth, before 34 weeks of gestation, is strongly linked to an ascending chorioamnionitis infection with resulting inflammation from vaginal bacteria, particularly with bacterial vaginosis (BV). Hence, it may be more efficient to attempt BV prevention after treatment among those shown to have a propensity to develop BV than to use a I Lactobacillus i probiotic in those with and without BV. [Extracted from the article]