A history of vaginal microbiocenosis in pregnant women with various types of infertility

Abstract

The characteristic of vaginal microbiocenosis in pregnant women who had a history of endocrine and inflammatory infertility was given; the principles of bacteriological diagnosis are described.

Purpose — to study the history of vaginal microbiocenosis in pregnant women with a history of endocrine and inflammatory infertility.

Materials and methods. We studied the state of microflora during pregnancy in 420 women. The basis of the distribution of pregnant women into groups was infertility factor: group I — 100 pregnant women who had a history of endocrine infertility, group II — 200 pregnant women who had an inflammatory history of infertility, group III — 60 pregnant women who had combined infertility: inflammatory with endocrine, group IV (control) — 60 healthy pregnant women who did not have a history of infertility. During pregnancy, all women underwent pH determination of vaginal contents, bacterioscopic, bacteriological examination of vaginal discharge. They did a bacterioscopy of vaginal smears and stained them according to Gram. Bacteriological studies were carried out using a set of selective differential diagnostic nutrient media.

Results. Studying the spectrum of vaginal microflora in women with various types of infertility in the anamnesis, we see a significant spread of pathogenic and facultative anaerobic bacteria in the examined pregnant women with a combination of inflammatory and endocrine factors (group III) and an inflammatory factor of infertility in history (group II). Moreover, the identified pathogens were mainly in associations. Among facultative anaerobic bacteria, these women were more often seeded: gram-positive cocci — coagulase-negative staphylococci, green streptococci, and α- and γ-hemolytic — in 12 (20%) pregnant women of group III, in 37 (18.5%) patients of group II and in 8 (8%) of the examined group I, in the control group — in 2 (3.3%) women. Pathogenic cocci: Staphylococcus aureus, β-hemolytic species of the genus Streptococcus (S. pyogenes, S. agalactia) were most common in 15 (25%) pregnant women of group III, 50 (25%) of patients of group II and 12 (12%) examined group I, in the control group — in 2 (3.3%) women. Intestinal flora: E. coli and other bacteria of the genus Enterobacteriaceae were found in 23 (38.3%) pregnant women of group III, in 95 (47.5%) patients of group II and in 27 (27%) of the examined group I, in the control group — in 2 (3.3%) women. Enterococcus spp. was found in 17 (28.3%) pregnant women of group III, in 55 (27.5%) patients of group II and 10 (10%) of the examined group I, in the control group — in 2 (3.3%) women. Candida fungi were detected in 30 (50%) pregnant women of group III, in 90 (45%) patients of group II and 30 (30%) of the examined group I, in the control group — in 5 (8.3%) women. Gardnerella vaginalis was found in 10 (16.7%) pregnant women of group III, 30 (15%) patients of group II and 10 (10%) of the examined group I, in the control group — in 2 (3.3%) women. Mycoplasma hominis was found in 7 (11.7%) pregnant women of group III, in 9 (4.5%) patients of group II and in 2 (2%) of the examined group I. Ureaplasma urealiticum was found in 8 (13.3%) pregnant women of group III, in 10 (5%) patients of group II, and in 2 (2%) women of group I. Trichomonas vaginalis was found in only 1 (1.7%) women of group III and in 2 (1%) patients of group II. In the control group, microorganisms, such as: Mycoplasma hominis, Ureaplasma urealiticum, Trichomonas vaginalis were not found.

Conclusions. In pregnant women with various types of infertility in history, associative forms of bacterial contamination of the birth canal are recorded, which are manifested by various variants of the pathology of microbiocenosis. Such conditionally pathogenic microorganisms are revealed in them: Staphylococcus aureus and epidermidis, Escherichia coli, yeast of the genus Candida, Corynebacterium, Mycoplasma hominis, Ureaplasma urealiticum; and pathogenic — Trichomonas vaginalis. Since a violation of the normal microbiocenosis of the vagina leads to infectious and inflammatory diseases of the genital tract and, consequently, to complications of pregnancy and childbirth, infection of newborns; therefore, it is necessary to timely identify the infectious process and conduct pathogenetic treatment.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies.