INTRAUTERINE FETAL INFECTION - THE REALITIES OF DIAGNOSIS AND TREATMENT

Abstract

Іntroduction. Intrauterine infection of the fetus is oneof the most important problems in obstetrics. The absenceof adequate treatment leads to a number of complicationsthat develop during pregnancy, childbirth, and postpartumperiod. There are often situations when the consequences ofthe invasion of microorganisms are more important than thepresence of an infectious agent itself.The aim is to analyze the indicators of microcytosis ofthe vagina, cervical canal, the peculiarities of pregnancywith infection of the fetus, and the effectiveness of varioustreatment regimens.Material and methods. 20 healthy women withphysiological course of pregnancy (the control group) and62 pregnant women with signs of fetal infection (the maingroup) were examined using clinical, microbiological,bacteriological, serological methods, statistical analysis,and fetal ultrasound.Results. Depending on the trimester, pregnant womenof the main group were divided into two subgroups: thefirst subgroup - at 18-24 weeks (50 pregnant women), thesecond - at 28-34 weeks (12 pregnant women).The statistical analysis of changes in vaginalmicrocynosis was conducted depending on the term. Thesignificant difference regarding the effect of gram negativediplococci, morphologically similar to gonococcus,Streptococcus agalactiae in the third trimester was found outalong with Ureaplasma urealyticum, Chlamidia trahomatisin the second trimester and Trichomonas vaginalis andMycoplasma hominis regardless of trimester.Ultrasound in the first subgroup revealed a syndromeof fetal growth retardation in 20 % of women, an abnormalamount of amniotic fluid in 24 %, changes in the structureof the placenta in 14 %, enlargement of the pelvic system ofthe kidneys in 52 %, intestinal hyperechogenicity in 60 %,and hepatomegaly in 4 % of cases. In the second subgroup,the abnormal amount of amniotic fluid was found in 16.7 %of pregnant women, changes in the structure of the placentain 83,3 %, and progressive shortening of the cervix in 33.3% of cases.Pregnant women of the main group were offered acourse of specific antibacterial therapy.In case of positive dynamics within three days (reductionof pathological secretions, polyhydramnios and otherultrasound signs of fetal infection), treatment is continued.In case of negative dynamics or no effect within three daysantibacterial agent must be changed. If symptoms reoccur,a repeat course with a new antibacterial agent is prescribed.Conclusions. Disorders of vaginal microcynosis andcervical canal were found in 80.6% of pregnant women,the rest of them were diagnosed with the ultrasound signsof infection of the fetus without changes in vagina andcervical canal.The proposed regimens of antibacterial therapy areeffective in the second trimester of pregnancy, indicatingthe necessity of examination and treatment during thisperiod, and in case of structural changes in the cervix causedby gram-negative diplococci, morphologically similarto gonococcus and Trichomonas vaginalis. Antibacterialtherapy is not effective enough in case of the developmentof placental dysfunction, and the threat of premature birthin the third trimester.