Профілактика та лікування бактеріального вагінозу у вагітних із істміко-цервікальною недостатністю

Т. Г. Романенко; О. М. Суліменко

doi:10.18370/2309-4117.2020.51.32-36

Authors

Т. Г. Романенко P.L. Shupik NMAPE of the MoH of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0003-0157-6223
О. М. Суліменко P.L. Shupik NMAPE of the MoH of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0003-1948-8387

DOI:

https://doi.org/10.18370/2309-4117.2020.51.32-36

Keywords:

bacterial vaginosis during pregnancy, clindamycin, metronidazole, genital tract microbiocenosis, gestational complications

Abstract

Purpose of the study was to evaluate the effectiveness of clindamycin in combination with metronidazole and miconazole in complex therapy in pregnant women suffering from vaginal dysbiosis with ischemic-cervical insufficiency with threat of premature birth, which used an unloading obstetric pessary.

Materials and methods. 100 pregnant women with bacterial vaginosis in the III trimester of pregnancy with isthmic-cervical insufficiency, threat of premature birth and using of an obstetric pessary were examined. 50 women of group I (comparison) received therapy according to the orders of the Ministry of Health of Ukraine, and 50 women of group II (main) used the treatment and preventive measures proposed by study authors, which included Banbact® suppositories for 3 days, and then Gynex® Forte complex drug for 7 days, after which a probiotic of 7 days was prescribed.

Results of the study. The clinical effect of treatment in main group was achieved in 100% of cases. The amniotest was negative in all cases after treatment. In both groups was a slight shift to the alkaline side of the vaginal contents (pH 5.0–5.5), in the comparison group 2.5 times more often than in the main one. A significant decrease in the vaginal pH was observed in persons of group II after treatment at 37–38 weeks of pregnancy, no increase in pH >5.5 was detected; pH shift to the alkaline side was observed 3.5 times more often in group I.

Most pregnant women in both groups achieved normocenosis after treatment. However, in group I a moderately expressed leukocyte reaction, the prevalence of leukocytes over epithelial cells, and a decrease in normal vaginal flora were noted 2.4 times more often (p <0.05). In 10.0% of pregnant women in group I single spores and pseudo mycelium of fungi, coccal or mixed flora were revealed against the background of a moderate leukocyte reaction (p <0.05).

A pronounced leukocyte reaction was retained in 6 (12.0%) women of group II at 37–38 weeks, accompanied by a delay in the fetus development. Mixed flora persisted 3.7 times more often in women of group I. 22 species of microorganisms were identified in group I in the third trimester, while in pregnant women of group II – 14 species.

Conclusions. The study revealed the high efficiency of complex treatment for bacterial vaginosis and normalization of the genital tract microflora in the third trimester in pregnant women with isthmic-cervical insufficiency. This helped to reduce the frequency of the threat of abortion, development of placental insufficiency, and delayed fetal development. The clinical efficacy of Banact® and Ginex® Forte was combined with their good tolerance; therefore these drugs are safe during pregnancy, which allows them to be used in practical obstetrics.

Author Biographies

Т. Г. Романенко, P.L. Shupik NMAPE of the MoH of Ukraine, Kyiv

MD, professor, Department of Obstetrics and Gynecology No. 1

О. М. Суліменко, P.L. Shupik NMAPE of the MoH of Ukraine, Kyiv

Postgraduate student of the Department of Obstetrics and Gynecology No. 1

References

Bespalova, O.N., Sargsyan, G.S. “The effectiveness of the obstetric pessary in threatening preterm birth and short cervix.” Meditsynskiy sovet 13 (2017).
Belousova, V.S., Bogomazova, I.M. “Analysis of perinatal outcomes in preterm births.” Proceedings of the XVII All-Russian Scientific and Educational Forum “Mother and childe – 2016”. Moscow. MEDI Ekspo (2016): 10–1.
Levakov S.A., Borovkova, E.I., Sheshukova, N.A., Borovkov, I.M. “Management of patients with ischemic-cervical insufficiency.” Akusherstvo, ginekologiya i reproduktsiya 10.2 (2016): 64–9.
Romero, R., Dey, S.K., Fisher, S.J. “Preterm labor: one syndrome, many causes.” Science 345.6198 (2014): 760–5. DOI: 10.1126/science.1251816
Rundell, K., Panchal, B. “Preterm labor: Prevention and management.” Am Fam Physician 95.6 (2017): 366–72.
Romero, R., Espinoza, J., Kusanovic, J.P., et al. “The preterm parturition syndrome.” BJOG 113 Suppl 3 (2011): 17–42.
Aylamazyan, E.K. Obstetrics: a textbook for medical higher educational establishments. Moscow. GEOTAR-Media (2015).
Brown, R., Gagnon, R., Delisle, M.F. “Cervical insufficiency and cervical cerclage.” J Obstet Gynaecol Can 35 (2013): 1115–27.
Vovk, I.B., Kondratiuk, V.K., Trokhymovych, O.V., Kovalenko, O.I. “Modern views on the etiology, pathogenesis, diagnosis and treatment of the threat of termination of pregnancy at early pregnancy.” Zdorovya Ukrainy 1 (2012): 20–3.
Zhabchenko, I.A., Oleshko, V.F. “The algorithm of obstetrical actions in case of Isthmic-cervical deficiency.” Health of woman 6.102 (2015): 76–8.
Tovstanovskaya, V.A., Mikitenko, N.N., Parsai Farakak. “Bacterial vaginosis: a modern view of the problem.” Health of woman 4.100 (2015): 32–40.
Mönckeberg, M., Valdés, R., Kusanovic, J.P., et al. “Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis.” J Perinat Med 47.5 (2019): 500–9. DOI: 10.1515/jpm-2018-0388
Brown, R., Gagnon, R., Delisle, M.F. “No. 373-Cervical Insufficiency and Cervical Cerclage.” J Obstet Gynaecol Can 41.2 (2019): 233–47.
Koullali, B., Westervelt, A.R., Myers, K.M., House, M.D. “Prevention of preterm birth: Novel interventions for the cervix.” Semin Perinatol 41.8 (2017): 505–10.
Zolotukhin, M.S., Matsynin, O.M., Krasnykh, N.V. “The state of microbiocinosis of the genital tract in women with isthmicocervical insufficiency after applying different methods of correction.” Bulletin of Scientific Research 2 (Suppl) (2002): 163–4.
Voroshilina, E.S., Tumbinskaya, L.V., Donnikov, A.E., et al. “Biocenosis of the vagina in terms of quantitative PCR: changes and correction during pregnancy.” Infections in gynaecology. 2010; 68 (3): 108–11.
Usova, M.A. “Clinical and diagnostic aspects of vaginal dysbiosis and bacterial vaginosis therapy in women during early pregnancy.” Thesis for PhD degree. Samara (2010).
Roberts, C.L., Morris, J.M., Rickard, K.R., et al. “Protocol for a randomised controlled trial of treatment of asymptomatic candidiasis for the prevention of preterm birth.” BMC. Pregnancy Childbirth 11 (2011): 19.
Abezivanova, M.P., Uzdenova, Z.Kh., Shogenova, F.M., et al. “The role of dysbiotic disorders of the vagina in the development of infectious and inflammatory complications of newborns.” In: Materials of the X All-Russian Congress “Outpatient help at the epicenter of women`s health”. Moscow (2013): 375–6.
Maysuradze, L.V., Magaeva, F.Y., Alborov, D.K. “The influence of bacterial vaginosis on pregnancy, the condition of the fetus and newborn.” Meditsynskiy vestnik 6.148 (2014).
Kira, E.F. “Infections and reproductive health.” Journal of obstetrics and womans diseases. – 1999. – issue. 2. – vol. XVII. – P. 71–78.
Kira, E.F. Bacterial vaginosis. St. Peterburg. Neva-Lux (2001): 363 p.