Novel management paradigms for urogenital infections in pregnancy

Abstract

S.A. Gasparyan1, A.A. Khazhbiev1,2, T.I. Derevyanko1 1Stavropol State Medical University, Stavropol, Russian Federation 2Nevinnomyssk City Hospital, Nevinnomyssk, Russian Federation In the last decade, our knowledge on normal vaginal microbiome has evolved greatly. Species composition of normal vaginal microflora of women of reproductive age is diverse and is in a dynamic equilibrium. The representation of various microbes in female urogenital tract is affected by various factors, i.e., genetic and environmental factors, general health, age, and hormonal profile. During pregnancy, compositional shift in vaginal microecosystem occurs with Candida spp. predominance thus resulting in higher rate of vulvovaginal candidiasis. When Candida albicans is identified in pregnant and non-pregnant women, azoles are recommended. When other fungi species are identified, polyene drugs as well as topical azoles (which are highly safe for fetus) are recommended. Nearly every tenth pregnant woman has asymptomatic bacteriuria. The lack of the treatment for asymptomatic bacteriuria in pregnant women is associated with higher (up to 30%) risk of pyelonephritis which threatens  the health of both the mother and the child. In Russia, screening for asymptomatic bacteriuria in pregnant women after 14 weeks of pregnancy and etiological treatment for excessive bacterial colonization are recommended by clinical protocols. Short-course antibiotic treatment which provides minimum effects on fetus is preferable. Keywords: vagina, microbiota, pregnancy, vulvovaginal candidiasis, Candida, asymptomatic bacteriuria, antibiotic treatment. For citation: Gasparyan S.A., Khazhbiev A.A., Derevyanko T.I. Novel management paradigms for urogenital infections in pregnancy. Russian Journal of Woman and Child Health. 2019;2(4):296–300.