Vaginal Probiotics as Adjunctive Therapy in Preterm Prelabor Rupture of Membranes: A Qualitative Systematic Review

Abstract

Introduction: Preterm prelabor rupture of membranes contributes substantially to maternal and neonatal morbidity. Because vaginal dysbiosis may promote ascending infection and membrane weakening, probiotics have been proposed as adjunctive therapy. This review evaluated maternal and neonatal outcomes associated with oral or vaginal probiotics in women with, or at risk of, preterm prelabor rupture of membranes.   

Methods: PubMed, Scopus, ScienceDirect, and the Cochrane Library were searched through January 2025. Randomized controlled trials of probiotic interventions were eligible. Two reviewers independently screened studies, extracted data, and performed domain-level appraisal using the Joanna Briggs Institute checklist. Owing to clinical and methodological heterogeneity, findings were synthesized qualitatively without meta-analysis.   

Results: Four randomized trials involving 306 participants were included. Several trials reported longer latency, higher gestational age at delivery, greater neonatal birth weight, or fewer neonatal intensive care admissions with adjunctive vaginal probiotics. However, one trial showed no significant latency benefit, and results varied by population, formulation, regimen, concomitant antibiotics, and outcome definition. Certainty was low to very low because of small samples, inconsistency, indirectness, and imprecision.   

Conclusion: Vaginal probiotics may have potential as adjunctive therapy, but current evidence is preliminary and insufficient to support routine use. Larger multicenter trials using standardized strains, doses, comparators, and outcomes are required.