Роль мікробіоценозу піхви в генезі невиношування вагітності

О. А. Ночвіна

doi:10.18370/2309-4117.2019.45.22-28

Authors

О. А. Ночвіна M. I. Pirogov Vinnitsya National Medical University; Mother and Child Center, Vinnitsya, Ukraine https://orcid.org/0000-0002-0332-7610

DOI:

https://doi.org/10.18370/2309-4117.2019.45.22-28

Keywords:

miscarriage, threatened miscarriage, microflora, bacterial vaginosis

Abstract

Microbiocenosis plays an important role in maintaining homeostasis and is an essential component of the homeostatic system due to its participation in the immunological and endocrine regulation. As an organism’s microflora is a functional complex for supporting homeostasis due to metabolic activity and quantitative relationships, which not only directly affects the immunological status, but also indirectly impacts the reproductive system, the imbalance of the vaginal flora is considered as one of the important causes of a complicated pregnancy.

The aim of the study was to evaluate the vaginal microbiocenosis in women with complicated pregnancy and to study the effectiveness of the treatment scheme with using natural micronized progesterone Urozhestan® and the vaginal probiotic Lactoginal®LP for threatened miscarriage against the background of bacterial vaginosis.

67 pregnant women with complicated pregnancy up to 22 weeks of gestation prospectively were examined. Clinical signs of threatening miscarriage were aching pain in the lower abdomen with hemorrhagic secretions from the genital tract and without them, signs of myometrial hypertonus with ultrasound with retrochorial hematoma and without it, shortening of the cervix with the opening of the internal pharynx and cervical canal and without them.

The effectiveness of the vaginal microbiocenosis correction was determined by assessing the dynamics of clinical symptoms and the quantitative and qualitative composition of the vaginal biotope. It is proved that in in 70.1% patients with a threatened miscarriage changes in the vaginal biotope in the form of bacterial vaginosis are observed. Analysis of the clinical manifestations of the threatened miscarriage against the prescribed treatment has shown positive dynamics.

The presented study results prove the effectiveness of the Lactoginal®LP in combination with natural micronized progesterone Utrogestan® in women with threatened miscarriage against the background of bacterial vaginosis. The frequency of vaginal probiotics use and the possibility of choosing the administration route for progestogen simplifying and individualizing treatment regimens.

Author Biography

О. А. Ночвіна, M. I. Pirogov Vinnitsya National Medical University; Mother and Child Center, Vinnitsya

MD, assistant of Obstetrics and Gynecology Department No. 2;

obstetrician gynecologist at the Department of gynecology with minimally invasive operations

References

Anokhina, G.A., Skopichenko, S.V. “Modern aspects of microecological imbalance, prevention and treatment.” Journal of practical doctor 3–4 (2001): 28–33.
Berezhnoy, V.V., Yankovskyi, D.S., Kramarev, S.A., Shunko, E.E. “Disorders of human microbial ecology, their causes, consequences and methods of restoring the physiological norm.” Woman's Health 2.18 (2002): 170–8.
Ventskovskyi, B.M., Tovstanovskaya, V.A., Yankovskyi, D.S. “Microecological aspects of women's reproductive health and modern approaches to its maintenance.” Woman's Health 3.11 (2002): 86–92.
Gadieva, F.G. “The relationship of the immune and endocrine systems in women of reproductive age.” Obstetrics and Gynecology 1 (2001): 11–13.
Zhuk, S.I., Nochvina, E.A. “Modern approach to the correction of violations of the ovario-menstrual cycle against the background of systemic candidal dysbiosis.” Woman's Health 1.25 (2006): 92–5.
Zhuk, S.I., Nochvina, E.A. “Composition of intestinal microflora and vagina in women of early reproductive age on the background of dyshormonal disorders.” Collection of scientific works of the Association of Obstetricians-Gynecologists of Ukraine. Kyiv (2006): 273–6.
Podolskyi, V.V., Shkiriak-Nyzhnyk, Z.A. “Reproductive health of a woman and assessment of its condition in modern conditions.” Woman's Health 3.11 (2002): 111–7.
Tatarchuk, T.F., Mikhailenko, K.O. “Chronic recurrent candidiasis and woman reproductive system.” Obstetrics and gynecology 4 (2002): 61–5.
Yankovskyi, D.S. Human microbial ecology: modern possibilities of its maintenance and restoration. Kyiv. Expert LTD (2005): 361 p.
Yankovskyi, D.S., Dyment, G.S. “Modern aspects of the problem of microecology and dysbiosis.” Woman’s Health 4.24 (2005): 209–17.
Dover, S.E., Aroutcheva, A.A. “Natural antimicrobials and their role in vaginal health: a short review.” Int J Probiotics Prebiotics 3.4 (2008): 219–30.
Verstraelen, H., Verhelst, R. “Longitudinal analysis of the vaginal microflora in pregnancy suggests that L. crispatus promotes the stability of the normal vaginal microflora and that L. gasseri and/or L. iners are more conducive to the occurrence of abnormal vaginal microflora.” BMC Mocrobiol 9 (2009): 116.
McGregor, J.A., French, J.I. “Bacterial Vaginosis in Pregnancy.” Obstet Gynecol Survey 55.5 (2000): 1–19.
Svare, J.A., et al. “Bacterial vaginosis in a cohort of Danish pregnant women: prevalence and relationship with preterm delivery, low birth weight and perinatal infections.” BJOG 113.12 (2006): 1419–25.
Gille, C., Böer, B., Marschal, M., Urschitz, M.S. “Effect of probiotics on vaginal health in pregnancy. EFFPRO, a randomized controlled trial.” Am J Obstet Gynecol (2016).
Nivoliez, A., Camares, O., Paquet-Gachinat, M., et al. “Influence of manufacturing processes on in vitro properties of the probiotic strain Lactobacillus rhamnosus Lcr35 Regn.” Journal of Biotechnology. DOI: 10.1016/j.jbiotec.2012.04.005
Soliman, S., Daya, S., Collins, J., Hughes, E.G. “The role of luteal phase support in infertility treatment: a meta-analysis of randomized trials.” Fertil Steril 61 (1994): 1068–76.
Pritts, E.A., Atwood, A.K. “Luteal phase support in infertility treatment: a meta-analysis of the randomized trials.” Hum Reprod 17 (2002): 2287–99. DOI: 10.1093/humrep/17.9.2287
Nosarka, S., Kruger, T., Siebert, I., Grove, D. “Luteal phase support in in vitro fertilization: meta-analysis of randomized trials.” Gynecol Obs Invest 60 (2005): 67–74. DOI: 10.1159/000084546
Tournaye, H., et al. “A Phase III randomized controlled trial comparing the efficacy, safety and tolerability of oral dydrogesterone versus micronized vaginal progesterone for luteal support in in vitro fertilization.” Hum Reprod 32.5 (2017): 1019–27.