Abstract
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.