Репродуктивная эндокринология (Jun 2024)
Vaginal microbiota and its changes due to the stress in women who had a medical abortion
Abstract
Objective of the study: to explore the impact of medical abortion on infections, stress, and the vaginal microbiota, providing essential insights into the associated risks and the need for comprehensive care. Materials and methods. A total of 120 patients were examined, divided into groups: 50 women who underwent medical abortion, 50 women underwent surgical abortion and 20 women with no abortions as the control group. Additionally, the women were categorized based on stress levels into high stress group (29 women), medium stress group (54 women), and low stress group (17 women). Bacteriological studies were conducted to assess the species composition and quantitative composition of the vaginal microbiota in women post-abortion and with varying levels of stress. Results. The study found significant alterations in the vaginal microbiota of women post-abortion, differentiated by the type of abortion and stress levels. Women who underwent medical abortions exhibited higher levels of S. epidermidis, including strains with hemolytic properties, compared to those who had surgical abortions. The concentration of S. epidermidis in the medical abortion group was significantly higher than in healthy women, suggesting a potential link between medical abortion and increased susceptibility to opportunistic infections. Additionally, higher concentrations of E. coli, particularly hemolytic strains, were found in both abortion groups, with a slightly higher prevalence in the medical abortion group, highlighting an increased risk of post-abortion infections. The level of stress significantly affects the composition of the vaginal microbiota. Women experiencing high stress post-abortion showed a more pronounced dysbiosis compared to those with moderate or low stress levels. High-stress individuals had significantly elevated levels of pathogenic microorganisms, including S. aureus, S. agalactiae, and various Enterobacteriaceae, and a marked deficiency in protective Lactobacillus spp. The study also identified a higher incidence of mixed infections in high-stress women, often involving bacterial and viral pathogens such as G. vaginalis, C. trachomatis, U. urealyticum, and herpes simplex virus. Comparative analysis revealed that both types of abortion are associated with microbiota disruptions; however, medical abortions had a more substantial impact on certain pathogenic bacteria. For instance, the levels of Candida spp. were significantly higher in the medical abortion group compared to the surgical group, indicating a higher risk of fungal infections. Conversely, the concentration of Lactobacillus spp. was notably lower in women who underwent surgical abortions, suggesting a more severe impact on beneficial microbiota from surgical procedures. Conclusions. The findings underscore the importance of monitoring and managing the vaginal microbiota in women post-abortion, particularly those undergoing medical abortions and those experiencing high stress levels. Prophylactic and therapeutic measures, including the use of probiotics, should be considered to mitigate the risk of infections and restore the balance of protective bacteria.
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