Vol 65, No 4 (2016)
- Year: 2016
- Articles: 11
- URL: https://journals.rcsi.science/jowd/issue/view/339
- DOI: https://doi.org/10.17816/JOWD654
Articles
Woman’s microbiota and pregnancy outcomes
Abstract
A local inflammatoMicrobial invasion of amniotic cavity and subsequent infection process are the leading cause of adverse pregnancy outcomes. Intra-amniotic infection can be caused by both pathogenic and opportunistic microorganisms and viruses, but in the vast majority of cases intra-amniotic infection is associated with the normal microflora of different body sites – the vagina, intestines, mouth and respiratory tract. In the paper, current views about the role of infection factor in the adverse pregnancy outcomes, sources and mechanisms of intra-amniotic infection are summarized.
Audit of quality of care in critical conditions in obstetrics (“near miss”)
Abstract
The article presents material about critical states in obstetric and gynecologic practice (“near miss”), obtained on the basis of their own research, as well as the data of domestic and foreign authors. It is shown that the main factor determining the outcome of the pregnancy and birth, is the quality of medical care provided to the woman. The characteristics of “near miss”, indicated the risk factors for its occurrence. A measure of the health care until serious complications of pregnancy and childbirth, as well as possible ways to reduce the frequency of their development.
Cytomegalovirus infection and reproductive health of women
Abstract
The article presents material about critical states in obstetric and gynecologic practice (“near miss”), obtained on the basis of their own research, as well as the data of domestic and foreign authors. It is shown that the main factor determining the outcome of the pregnancy and birth, is the quality of medical care provided to the woman. The characteristics of “near miss”, indicated the risk factors for its occurrence. A measure of the health care until serious complications of pregnancy and childbirth, as well as possible ways to reduce the frequency of their development.
Current views on vaginal lactobacilli in women of reproductive age
Abstract
The vaginal microbiota in the first trimester of pregnancy in women having history of pregnancy loss
Abstract
Introduction. Abnormal vaginal microflora in the first trimester of pregnancy is a risk factor for miscarriage. Opportunistic microorganisms predominate among microorganisms causing microflora disturbance.
Aim. The aim of the study was to evaluate the vaginal microflora in the first trimester of pregnancy in women having history of pregnancy loss.
Matherials and Methods. Real-time polymerase chain reaction, microscopic and cultural methods were used to examine 60 pregnant women having history of pregnancy loss and 10 pregnant women with uncomplicated obstetric history.
Results. Disorders of the vaginal microflora were observed only in women having history of pregnancy loss. The lactoflora in both groups was shown to consist most frequently of 3 Lactobacillus species: Lactobacillus crispatus, L. jensenii, and L. iners. However, the species L. iners were detected only in the group of women with history of pregnancy loss. Non-Lactobacillus microbiota was significantly more often observed in pregnant women having history of pregnancy loss. Facultative and obligate anaerobes were detected in both groups. The concentration of Ureaplasma spp. and Mycoplasma hominis in women in both groups had no significant differences.
Conclusions. The results of this study indicate that abnormal microbiota is more often observed in women having history of pregnancy loss.
of pregnancy in women having history of pregnancy loss. Matherials and Methods. Real-time polymerase chain reaction, microscopic and cultural methods were used to examine 60 pregnant women having history of pregnancy loss and 10 pregnant women with uncomplicated obstetric history. Results. Disorders of the vaginal microflora were observed only in women having history of pregnancy loss. The lactoflora in both groups was shown to consist most frequently of 3 Lactobacillus species: Lactobacillus crispatus, L. jensenii, and L. iners. However, the species L. iners were detected only in the group of women with history of pregnancy loss. Non-Lactobacillus microbiota was significantly more often observed in pregnant women having history of pregnancy loss. Facultative and obligate anaerobes were detected in both groups. The concentration of Ureaplasma spp. and Mycoplasma hominis in women in both groups had no significant differences. Conclusions. The results of this study indicate that abnormal microbiota is more often observed in women having history of pregnancy loss.Evaluation of significant bacteriuria in pregnant women using quantitative real-time PCR
Abstract
Introduction. Urinary tract infections are the most common infections in obstetrics and gynecology. Bacteriological method to investigate urine is laborious and time-consuming, therefore development of accurate and rapid methods for the detection of significant bacteriuria is important.
Objective. Evaluation of quantitative real-time PCR based approach for the detection of significant bacteriuria in pregnant women.
Material and methods. A retrospective investigation of mid-stream urine samples obtained from pregnant women was performed. Urine culture was performed using quantitative method, and a case was considered as significant bacteriuria if ≥ 105 CFU/ml were detected. Urine samples were analyzed for main uropathogens / groups of uropathogens using quantitative multiplex real-time PCR. Diagnostic characteristics of PCR were computed relative to the results of urine culture.
Results. In total, 896 urine samples were tested. Of them, significant bacteriuria was found in 28 cases (3%). The frequency of detection of Escherichia coli was 50%, Enterococcus spp. — 25%, Klebsiella spp. — 7%, Proteus spp. and S. saprophyticus 4% each, Streptococcus spp. — 14%. Sensitivity and specificity of the detection of significant bacteriuria using quantitative real-time PCR for the majority of bacterial species / groups were 99% to 100%. Sensitivity and specificity of the quantitative real-time PCR based method were 96% and 98%, respectively.
Conclusions. Prevalence of significant bacteriuria among pregnant women is 3%. Half of the uropathogens isolated from pregnant women with bacteriuria are E. coli. Sensitivity and specificity of quantitative PCR for the detection of significant bacteriuria are 96% and 98%, respectively.
Vaginal microbiocenosis in women with trichomoniasis
Abstract
Background. Trichomoniasis is accompanied by substantial colonization of the genital tract by various opportunistic microorganisms and reduced amount of lactobacilli. Both processes have a negative impact on the reproductive health and fetal development. Today, however, in the treatment of trichomoniasis insufficient attention is paid to the restoration of the normal vaginal microflora.
Aim. An attempt was made to assess the vaginal microbiocenosis of patients with trichomoniasis using traditional and novel molecular methods.
Matherials and Methods. Archived vaginal samples from 37 women with trichomoniasis were used, which were placed on slides, fixed in the flame and stained according the Gram method and by methylene blue and stored in boxes within last 15 years. The preparations were evaluated using microscopy and the nucleic acid amplification based test Femoflor and tests for the detection of DNA of sexually transmitted agents.
Results. According to the microscopic examination, disorders of the vaginal microbiocenosis were detected in 89.2% of patients with trichomoniasis. C. trachomatis was detected in 8.1% of the samples. Obligate anaerobic microorganisms were determined in all samples, accounting for 8% to 100% of the total bacterialthe majority of the women. Facultative anaerobic microflora was also found in all the patients. Lactobacilli were detected in 8.1% of the women, and mycoplasma – in 37.8%.
Conclusions. It was shown that in women with trichomoniasis there are often disturbances of the normal vaginal flora, manifested as the presence of a variety of opportunistic bacteria, accompanied by an inflammatory response. Almost half of the preparations showed bacterial vaginosis. Noteworthy, there was high prevalence of Mycoplasma hominis. For the first time, a technique of DNA testing in the materials placed on glass slides after prolonged storage was applied.
The role of bacterial biofilms in the development of chronic pathological processes in the vagina and endometrium
Abstract
Microbial biofilms are a problem in many areas of medicine. When the vaginal ecological system is disturbed, well-structured polymicrobial biofilm, covering the vaginal epithelium and consisting of anaerobic bacteria, is formed, which may lead to the development of recurrent bacterial vaginosis. During an ascending infection and the development of chronic endometritis, bacterial biofilms are detected in the endometrium. Biofilms formed by bacteria residing in the urogenital tract of woman, may result in dysfunctions of the reproductive system, in-vitro fertilization failures, complications of pregnancy, adverse pregnancy outcomes. In the paper, literature data regarding causes of of biofilm formation, methods of detection and treatment of biofilm infections are reviewed.
Comparison of diagnostics of bacterial vaginosis according to clinical signs with results of laboratory investigations
Abstract
Introduction. Bacterial vaginosis (BV) is associated with a number of reproductive health disorders, therefore timely and accurate diagnosis of this condition is exceedingly important.
Objective.Comparison of effectiveness of clinical and laboratory diagnostics of BV in women with vaginal discharge.
Material and methods. In total, 318 patients addressing gynecological clinics with complaints about vaginal discharge participated in the study. Clinical diagnostics of BV was performed in the clinics participating in patient enrollment in accordance with their clinical practice. For laboratory diagnostics, microscopy of Gram stained smears according to the Nugent method and quantitative real-time PCR were used. Sensitivity and specificity of clinical diagnostics of BV and the molecular method were evaluated using the Nugent method as reference standard.
Results. With the Nugent method, BV was diagnosed in 27% of women, with real-time PCR — in 37% of women. Using clinical signs of BV, the condition was diagnosed in 91% women. Sensitivity and specificity of the real-time PCR were 97% and 87%, respectively. Sensitivity of clinical diagnostics was 100%, but specificity was only 17%.
Conclusions. Diagnostics of BV based only on the presence of vaginal discharge leads to false positive results and requires laboratory confirmation. The molecular method has a high sensitivity and satisfactory specificity for BV diagnosis and can be used as an alternative to the Nugent method.
Susceptibility to antibiotics in escherichiae isolated in a multidisciplinary medical centre
Abstract
Relevance. Antimicrobial resistance in nosocomial strains currently presents a very important problem.
Aim of the study: Study of antibiotic resistance in Escherichia coli, isolated in a multidisciplinary centre.
Materials and Methods. Susceptibility of 151 E. coli strains to 15 antibiotics was studied by microdilution method.
Results. The majority of the studied strains were resistant to antibiotics, including: ampicillin (57.0%), ciprofloxacin and moxifloxacin (42.4% each), III and IV generation cephalosporins (37.1% and 34.4%, respectively) and gentamycin (29.1%). The highest activity against E. coliwas shown for carbapenems (resistance to erthapenem – 2.6%, meropenem – 0.7%), in particular, for imipenem – no strains resistant to this drug were isolated. Resistance to amikacin and phosphomycin was low: 3.3% and 1.3% respectively. Wide diversity of antibiotic resistance spectra was revealed in studied strains, with a high level of multidrug resistance (48.0%).
Conclusion. Study of susceptibility to antimicrobial agents in E. coli, isolated in a multidisciplinary centre, showed predominance of resistant strains with a high level of multidrug resistance. The appearance of carbapenem-resistant strains in a multidisciplinary centre presents a rising problem.