Medicine / 1. Obstetrics and gynecology
L.M.Yuryeva
Bukovinian
State Medical University, Chernivtsi, Ukraine
CONTEMPORARY APPROACH TO CORRECT
VAGINAL DYSBIOSIS DURING PREGNANCY
TOPICALITY. The problem of intra-amnionic infection is one of the
most topical in modern perinatology. Besides infectious factor, the main
pathogenetic mechanisms of fetal functional disorders in case of intrauterine
infection are dysfunction of the fetoplacental complex and immune disorders of
the mother and fetus, as well as microbiocenotic changes of the genitalia,
including bacterial vaginosis (BV). The latter is one of the most frequent
infectious diseases of the lower portion of the reproductive system and it is diagnosed
in 20-26% of the pregnant [1, 2]. Bacterial vaginosis as a separate disease
does not constitute a direct menace to the health of a pregnant woman.
Although, in case of BV in the lower portions of the reproductive system an
extremely high concentration of opportunistic microorganisms is being
accumulated and stored, resulting in the increase of such complications of
pregnancy as miscarriage, placental dysfunction, intrauterine infection of the
fetus, premature labour, premature rupture of the amniotic sac,
chorioamnionitis, postnatal septic complications [3].
Today the objective of BV
treatment is restoration of the normal vaginal microbiocenosis, the therapy
should be etiotropic and pathogenetically based, and the medicines administered
should be effective and targeted. During pregnancy and lactation medicines with
topical action are preferable, as they do not have a systemic effect. While
choosing the agent to treat vaginal infection during pregnancy, doctors should
consider its ingredients, their dosage and safety concerning the fetus.
The most effective means to
treat BV beginning from the I trimester of gestation are the agents active
against anaerobes, 5-nitroimidazole (5-NIAZ) derivatives, recommended by the
WHO International Protocols and the Orders and Clinical Protocols of the
Ministry of Public Health of Ukraine [4]. It is Terzhynan (France) that
is an original medicine of a topical action containing 200 mg of Ternidazole
(5-NIAZ derivative), 100 mg of Neomycin, 100 000 UN of Nystatin, 3mg of
Prednisolone. The combination of 5-NIAZ with Neomycin, a 1st
generation aminoglycoside, increases its antibacterial action. The combination
of Ternidazole and Nystatin is rather advantageous, because first of all,
candidiasis infection becomes 60% activated against the background of 5-NIAZ
administration, and secondly, today bacterial-fungal associations prevail in
the structure of infectious diseases. To achieve quick clinical
anti-inflammatory effect the medicine is added by the glucocorticoid Prednisolone
in the microdose of 3 mg, which is ten times less of the dose having a systemic
action. Carnation and geranium oils intensify anti-inflammatory action of the
ingredients and possess reparation properties.
Objective of our study was to
estimate the efficacy of Terzhynan administration, a complex medicine of a
topical action, in the treatment of bacterial vaginosis in pregnant women.
MATERIALS AND METHODS. 62 pregnant women in the II and III trimester of
gestation with bacterial vaginosis were observed, they were treated with
Terzhynan. The control group included 24 patients parity by their age and
social position, treated with other antibacterial means for their bacterial
vaginosis. The
diagnosis of vaginal dysbiosis was made on the basis clinical data obtained
(cream-like vaginal discharge), bacterioscopic and bacteriological examination,
positive amine test.
RESULTS AND DISCUSSION. The analysis of Terzhynan administration to correct
vaginal dysbiosis revealed the absence of allergic reactions and individual
intolerance to it.
The research conducted found
that clinical signs of bacterial vaginosis in the main group disappeared 4-6
days after the treatment, and in the control group – 7-10 days respectively. 2
weeks after the therapy with Terzhynan was completed, BV laboratory signs were
absent in 98.0% of the pregnant, vaginal pH was normalized. Genital
microbiocenosis in the 1st group in comparison with the 2nd
one was characterized by reliable greater amount of lactobacilli (over 106
/mL) (1st group – 48.0%, the 2nd one – 62.0%),
bifidobacteria (38.0% and 68.0% respectively), lactic acid streptococci (30.0%
and 46.0%), with simultaneous decrease of Gardnerella strain (72.0% and 30.0%),
Candida strain (62.0% and 46.0%) and other opportunistic microorganisms.
Dynamic observation of the
groups found that during 3-6 months the recurrence frequency of vaginal
dysbiosis after the treatment with Terzhynan in the 1st groups was
16.6% (7 cases) and in the control group – 40.9% (9 cases). None of the
patients was complicated by mycotic colpitis after the treatment of vaginal
dysbiosis, and due to this fact there was no need to use additional drugs.
Clinical evidence of the above
mentioned peculiarities is the fact, that topical administration of Terzhynan
allowed 2.2 times decrease of intrauterine infection, and 2 times – perinatal
loss.
CONCLUSIONS. The research conducted demonstrated that bacterial
vagonosis during pregnancy can be treated with antibacterial means not
influencing the level of lactobacilli in the vagina.
Topical administration of
Terzhynan during pregnancy results in quick reduction of acute signs of
bacterial vaginosis, and effective prevention of possible relapse and
complications of pregnancy.
Literature.
1.Centers
for Disease Control and Prevention (2010). Diseases characterized by vaginal discharge section of
Sexually transmitted diseases treatment guidelines. MMWR, 59 (RR-12): 1–110.
2. McDonald HM, et al. (2007). Antibiotics for treating bacterial vaginosis
in pregnancy. Cochrane Database of Systematic Reviews (1).
3. Screening for bacterial vaginosis in pregnancy to
prevent preterm delivery: U.S. Preventive Services Task Force recommendation
statement. Annals of Internal Medicine, 148(3): 214–220.
4. Yoon BH, Romero R, Moon JB, Shim S-S, Kim M, Kim G, Jun JK. Clinical significance of intra-amniotic inflammation in patients with preterm labor and intact membranes. American journal of obstetrics and gynecology 2001;5:1130-1136.