Clinical and Microbiological Characteristics of the State of Vaginal Biocenosis among Patients with Preterm Labor

Relevance. Premature birth (PR) in the etiopathogenetic relationship is a clinical syndrome characterized by polyetiology, a chronic course of the process, the participation of the fetus in pathogenesis, a variety of clinical symptoms, and the involvement of genetic and environmental factors. The infectious factor is considered as the leading risk for the development of PR. According to the literature, more than 40% of PR is due to the presence of an infectious process. The most significant are intrauterine and cervical vaginal infections. Purpose of the study was a clinical and microbiological assessment of the state of the vaginal biotope in women with various options for spontaneous preterm birth.

Materials and methods. The diagnostic complex included bacterioscopic, bacteriological, and also molecular genetic studies. The object of the study was pregnant women with timely physiological delivery and with various types of preterm birth, who were hospitalized in specialized medical organizations of the Nizhny Novgorod region. A total of 260 patients were examined, and 1000 studies were conducted. Material for research was the contents of the vagina and cervical canal.

Results. The state of the vaginal biocenosis was characterized by pronounced irregularity in patients with different variants of spontaneous preterm birth. In women with premature rupture of the membranes, a local inflammatory process with the prevalence of conditionally pathogenic microflora over lactic acid bacteria was significantly frequent. Lactoflora prevailed among patients with true PR and with timely physiological labor in the composition of the vaginal biotope. In women with preterm labor with isthmic-cervical insufficiency, there were mixed disorders of the vaginal biocenosis.

Conclusions. The risk of developing spontaneous preterm birth is reliably determined by the state of the vaginal biocenosis.

1. Savel'eva GM, Sukhikh GT, Serova VN, Radzinskiy VE, ed. Akusherstvo. Natsional'noe rukovodstvo. M.: GEOTAR-Media;2015 (In Russ).

2. Knyazeva TP. Causes and risk factors of premature rupture membranes. Dal'nevostochnyy meditsinskiy zhurnal. 2016. № 2. S. 128 -135 (In Russ).

3. Romero R. Mechanisms of Preterm Labor and Preterm Premature Rupture of the Membranes. 2nd ed. Jaypee Brothers Medical Publishers. 2015. https://doi.org/10.3109/9781439814697-144.

4. Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection. N Engl J Med. 2014; 370 (23): 2211-18. https://doi.org/10.1056/nejmra1213566

5. Cappelletti M, Della BS, Ferrazzi E et al Inflammation and preterm birth. J Leukoc Biol; 2016; 99 (1): 67-78. https://doi.org/10.1189/jlb.3mr0615-272rr.

6. Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science. 2014; 345 (6198): 760-65. https://doi.org/10.1126/science.1251816.

7. Kurnosenko IV, Dolgushina VF, Sandakova EA. Infektsionnaya patologiya reproduktivnogo trakta u beremennykhzhenshchin. Chelovek. Sport. Meditsina. 2017; 17 (1): 46-56 (In Russ). https://doi.org/10.14529/hsm170105.

8. Keelan JA, Payne MS. Vaginal microbiota during pregnancy: Pathways of risk of preterm delivery in the absence of intrauterine infection? Proc Natl Acad Sci USA. 2015; 112 (47): Е6414. https://doi.org/10.1073/pnas.1517346112

9. Kuz'min VN, Murrieva GA. Rol' nespetsificheskikh urogenital'nykh infektsiy v patogeneze samoproizvol'nykh prezhdevremennykh rodov. Lechashchiy vrach. M.: Otkrytye sistemy. 2013;; 6:. 60 (In Russ).

10. Mesic Dogic L, Lucic N, Micic D et al. Correlation between cervical infection and preterm labor. Med Glas (Zenica). 2017; 14 (1): 91-97.

11. Dolgushina VF, Kurnosenko IV. Vnutrimatochnaya infektsiya u beremennykh s razlichnymi formami infektsionnoy patologii vlagalishcha isheyki matki. Prakticheskaya meditsina. 2016; 1 (93): 68-71 (In Russ).

12. Tyutyunnik VL, Kurchakova TA, Kan NE et al. The local immune profile of the woman and different scenarios of preterm delivery. Akusherstvo i ginekologiya. 2016; 10:59-63 (In Russ).. https://doi.org/10.18565/aig.2016.10.59-63

13. Bakhareva IV. Modern pregravid preparation: an integrated approach. Russkiy meditsinskiy zhurnal. 2017; 12:889-893 (In Russ).

14. Driul L, Londero AP, Adorati-Menegato A et al. Therapy side-effects and predictive factors for preterm delivery in patients undergoing tocolysis with atosiban or ritodrine for threatened preterm labour. J Obstet Gynaecol. 2014; 34 (8): 684-89. https://doi.org/10.3109/01443615.2014.930094/