Особенности микробиоты цервикального канала во втором триместре беременности при истмико-цервикальной недостаточности с клиникой вульвовагинита в зависимости от рH влагалищного содержимого

Abstract

Study Objective: To study the microbiological composition of cervical canal in insuficiencia istmicocervical (IIC) in patients with vulvovaginitis depending on vaginal discharge рH. Study Design: perspective study. Materials and Methods. The study included 67 patients of reproductive age with clinical signs of vulvovaginitis and IIC. Where vaginal discharge рН was > 4.5, patients were prescribed empirical Metrogil Plus; these women comprised the study group (n = 40). Where vaginal discharge рН was ≤ 4.5, patients were prescribed empirical Tergynan; these women were controls (n = 27). Baseline anthropometric, social, clinical and anamnestic data, pregnancy characteristics and parity were recorded; then women underwent examination, and samples were collected for analysis (bacterioscopy, vaginal discharge рН measurement, bacteriological test). On day 9–11 of hospitalisation, patients had another speculum examination; clinical symptoms dynamics, pH and bacterioscopic test results were evaluated. Satisfaction with therapy, compliance and therapy-related arverse events were recorded. Study Results. Various Staphylococcus spp. were the most prevalent cause of the conditions in the study group (n = 17; 42.5%). In controls this value was 12 (44.4%). Staphylococcus spp. were mostly opportunistic saprophytic flora and usually were not pathogens, except for Staphylococcus haemolyticus, which was found in 11 (27.5%) patients in the study group and in 3 (11.1%) controls. Lactobacillus spp. Was diagnosed more often in controls than in the study group: 12 (44.4%) vs. 9 (22.5%) (р = 0.05). The control group was diagnosed only with Lactobacillus crispatus, Lactobacillus jensenii; they also prevailed in the study group, together with Lactobacillus gasseri, Lactobacillus paracasei. At рН > 4.5, cervical canal culture was characterised with a variety of opportunistic pathogens and normal flora. After the therapy, patients in both groups did not complain of vaginal discharges. Physical examination demonstrated normal vaginal wall colour and moderate discharges. Vaginal discharge pH was significantly lower in the study group and was normal in controls. Conclusion. The majority of patients with vulvovaginitis and IIC in the second trimester of pregnancy had lower prevalence as well as lower absolute and relative amount of Lactobacillus spp. in their cervical canal discharge. At the same time, increase in vaginal рН is associated with changes in the quality ratio of lactic acid bacilli. Keywords: cervical canal microbiota, insuficiencia istmicocervical, vaginal discharge рH, vulvovaginitis