Репродуктивная эндокринология (Apr 2019)
The role of vaginal microflora in the genesis of miscarriage
Abstract
Microbiocenosis plays an important role in maintaining homeostasis and is an essential component of the homeostatic system due to its participation in the immunological and endocrine regulation. As an organism’s microflora is a functional complex for supporting homeostasis due to metabolic activity and quantitative relationships, which not only directly affects the immunological status, but also indirectly impacts the reproductive system, the imbalance of the vaginal flora is considered as one of the important causes of a complicated pregnancy. The aim of the study was to evaluate the vaginal microbiocenosis in women with complicated pregnancy and to study the effectiveness of the treatment scheme with using natural micronized progesterone Urozhestan® and the vaginal probiotic Lactoginal®LP for threatened miscarriage against the background of bacterial vaginosis. 67 pregnant women with complicated pregnancy up to 22 weeks of gestation prospectively were examined. Clinical signs of threatening miscarriage were aching pain in the lower abdomen with hemorrhagic secretions from the genital tract and without them, signs of myometrial hypertonus with ultrasound with retrochorial hematoma and without it, shortening of the cervix with the opening of the internal pharynx and cervical canal and without them. The effectiveness of the vaginal microbiocenosis correction was determined by assessing the dynamics of clinical symptoms and the quantitative and qualitative composition of the vaginal biotope. It is proved that in in 70.1% patients with a threatened miscarriage changes in the vaginal biotope in the form of bacterial vaginosis are observed. Analysis of the clinical manifestations of the threatened miscarriage against the prescribed treatment has shown positive dynamics. The presented study results prove the effectiveness of the Lactoginal®LP in combination with natural micronized progesterone Utrogestan® in women with threatened miscarriage against the background of bacterial vaginosis. The frequency of vaginal probiotics use and the possibility of choosing the administration route for progestogen simplifying and individualizing treatment regimens.
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