EVALUATION OF THE EFFECTIVENESS OF THE USE OF NON-DRUG THERAPY FOR PRECONCEPTION PREPARATION OF WOMEN WITH BACTERIAL VAGINOSIS

Abstract

Bacterial vaginosis (BV) is one of the most common conditions in women of reproductive age. BV is detected in 80–87% of women with abnormal vaginal discharge, the incidence of the disease in pregnant women reaches 37–40% and is a risk factor for complications. The purpose of the research is to study the clinical and microbiological efficacy of a two-stage scheme for the correction of vaginal dysbiosis using cavitated low-frequency ultrasound (LUS) as an alternative method for preconception preparation in women with bacterial vaginosis. Materials and methods. The study involved 67 patients with BV aged 19 to 35 years who consulted an obstetrician-gynecologist in connection with pregnancy planning. The results of bacterioscopic and bacteriological studies, the state of vaginal microbiocenosis were evaluated by PCR with real-time detection of results (RT-PCR). All patients according to the state of microbiocenosis were divided into two groups: I-moderate dysbiosis with the content of Lactobacillus spp.from 20% to 80% (n=39) and II-pronounced dysbiosis with the content of Lactobacillus spp.less than 20% (n=28). A two-stage scheme was applied to correct vaginal dysbiosis. At the first stage, all women underwent vaginal treatment with cavitated NUS aqueous 0.05% chlorhexidine solution.At the second stage, a lyophilized culture of lactobacilli was used to normalize and renew the vaginal microflora. The results of the study. In women of group I with moderate dysbiosis, a decrease in the content of lactoflora below the value of 107/g was revealed. The proportion of Gardnerella vaginalis was 35.9% (n=14), Atopobiumvaginae 25.6% (n=10), Eubacterium 23.1% (n=9), Megasphera 17.9% (n=7), Mobiluncus spp.20.5% (n=8), Peptostreptococcus 8% (n=3), Snethia spp.20.5% (n=8), Lachnobacterium spp.15.3 (n=6). In group II of examined women with severe dysbiosis, the content of lactoflora was less than 105/g; in most cases, lactobacilli were not detected. The majority of patients had microbial associations of Gardnerella vaginalis and Atopobiumvaginae 67.8% (n=19), Eubacterium 17.8% (n=5), Megasphera 14.2% (n=4), Mobiluncus spp.25% (n=7), Peptostreptococcus 28.5% (n=8), Snethia spp. 32.1% (n=9), Lachnobacterium spp.25% (n=7). After the course of treatment, the positive dynamics of the state of microbiocenosis according to real-time PCR was noted after the completion of the course of vaginal irrigation. The proportion of women with severe anaerobic dysbiosis decreased from 41.8% (n=28) to 13.4% (n=9), with moderate dysbiosis - from 58.2% (n=39) to 19.4% (n=13) among all examined women. At the same time, in 61.2% (n=41) of women, the microbiocenosis was restored to normocenosis. Conclusions. The proposed scheme for the correction of vaginal dysbiosis demonstrates the high efficiency of the method: restoration of normocenosis was achieved in every second patient. Positive dynamics was noted due to an increase in the proportion of lactoflora content in almost all observed women.