Integral assessment of markers of the local infectious and inflammatory process in women with preterm birth in multiple pregnancies

Abstract

Hypothesis/Aims of study. Premature birth in multiple pregnancies remains an important object of research, since it is the main factor in poor perinatal outcomes, and their heterogeneous mechanisms determine the ineffectiveness of prediction and prevention methods. In the pathogenesis of premature birth, as is known, one of the leading links is inflammation caused by infections of the lower genital tract (40%). In multiple pregnancies, which in most cases occur as a result of assisted reproductive technology treatment (70%) and are mainly accompanied by complications, pregravid preparation and antenatal observation include more careful control and correction of local infectious and inflammatory processes. In this regard, the persisting high rate of premature birth in multiple pregnancies (about 54%) demonstrates the ambiguity of the opinion about the suppressive role of the infectious factor in the induction of premature birth and determines the need for studying its contribution to multifactorial genesis. The aim of this study was to conduct an integral assessment of markers of the local infectious and inflammatory process in women with PB in multiple pregnancies.
 Study design, materials and methods. We performed a comprehensive study of the bacteriological composition of the lower genital tract discharge using microscopic, bacteriological, and molecular biological methods (Femoflor 16 test) and assessed the local inflammatory status (ImmunoQuantex test) in 30 pregnant women with dichorionic diamniotic twins. The main group consisted of women with premature birth (n = 13), the control group comprising those with term birth (n = 16), while patients with induced premature birth (n = 2) were not included in the comparative analysis.
 Results. This study was the first to determine the features of vaginal microbiocenosis and the local immune status in women with premature birth in multiple pregnancies. In general, the study cohort had a low inflammatory status and normal or intermediate types of vaginal biotope. The most common disruptions (24.1%) were vaginal dysbiosis, expressed in a small amount of Lactobacillius spp., and non-specific vaginitis associated with Mycoplasma hominis. The local immune status of women with premature birth was characterized by a relative decrease in the mRNA expression of such innate immunity genes as IL1B, TNF, TLR4, and GATA3. An integrated assessment of the studied parameters based on the data obtained allowed us to build a mathematical model for predicting premature birth with the probability of 87.6%.
 Conclusion. The integral assessment of infectious and inflammatory markers is important from the standpoint of not only their possible identification as predictors, but also a general understanding of the genesis of premature birth.