MICROBIOTIC DISORDERS OF THE VAGINAL MICROFLORA IN PREGNANT WOMEN WITH BACTERIAL VAGINOSIS

Abstract

The high prevalence of BV in pregnant women and related complications, such as spontaneous abortions, preterm labor, premature rupture of the amniotic fluid, fetal intrauterine infection, and postpartum purulent-septic complications make it an important public health problem.The purpose of the research is to study the state of the vaginal biocenosis in pregnant women with BV to optimize diagnosis, treatment and reduce the incidence of complications during pregnancy and the postpartum period.Materials and methods. 80 pregnant women with BV were examined. According to the results of the study, pregnant women with moderate and severe dysbiosis were identified. They were divided into I (n =56) and II (n = 24) clinical groups respectively. A bacteriosocopic and microbiological study of the qualitative and quantitative composition of vaginal bacteria was carried out by PCR. Bacteria from biofilms were visualized using in situ fluorescent hybridization. In order to eliminate pathogenic microflora and normalize the condition of the mucosa, vaginal irrigation was prescribed with the appointment of a broad-spectrum antiseptic and the combination of bacteria Lactobacillus reuteri RC-14 and Lactobacillus rhamnosus GR-1, 1 capsule orally 1 time a day with meals, 14 days. The results of the study. Biofilms were detected in 35 women (43,7%) of the main group. In all patients, the main component of the biofilm was bacteria belonging to the Gardnerella vaginalis in a concentration7.3 ±, 15 lg CFU / g, Atopobium vaginae - more than half of the patients and made up 11-60% of bacteria biofilms in concentration6.5 ± 0.13 lg CFU / g. In addition in the composition of the biofilm was determined Snethia spp. in concentration 5.3 ± 0.03 lg CFU / g. The combined therapy contributed to the elimination of pathogenic microflora and colonization of the vaginal mucosa by lactobacilli. However, in 12 pregnant women we were unable to improve the condition of the vaginal microbiota significantly, which indicates the persistence of disorders of the vaginal ecosystem.Conclusions. Snethia spp. in the vaginal contents can be considered a kind of biofilm marker. The biofilms were not identified in the presence of the community G. vaginalis and Megasphaera sp., thus the presence of Gadnerella vaginalis is not always accompanied by the formation of biofilms. The lack of effect of therapy in 12 (15%) pregnant women with bacterial vaginosis indicates the appearance of bacterial resistance (presence of biofilms) .Therefore, the need to revise the standards for the diagnosis and treatment of bacterial vaginosis is obvious. New antimicrobial agents that have the ability to selectively etiotropic affect vaginal pathogens of biofilms are needed.