The microflora of the reproductive tract in women during intrauterine interventions

The species compositions and persistence factors of the vaginal and cervical microflora of the reproductive tract of women in cases of intrauterine interventions (medical abortion, intrauterine contraception) were studied. Women with inflammatory complications following intrauterine interventions were found to have the same species of bacteria in their vaginal and cervical microflora. In addition, an increase in the values of the persistence factors of vaginal microflora was registered in women practicing intrauterine contraception and a decrease in the persistence potential of vaginal microflora was registered after abortion.     

Bacterial vaginosis: etiopathogenetic aspects

Current microbiological data on the vaginal microecology in healthy women and in patients with bacterial vaginosis are presented in the article. Problems of formation of colonization resistance of vaginal microbiocenosis were discussed. Etiologic role of certain microorganisms and their associations in the pathogenesis of bacterial vaginosis was considered. Pathophysiological processes leading to development of vaginal disbiosis, features of local immune status and molecular specificity of intercellular interactions in the development of adaptive immune response were characterized.     

Microbiologicaland immunological criteria for estimation of ureaplasmosis treatment efficacy in women

The role of surface and parietal vaginal microbiocenosis and immunoglobulins in development of infectious process, in prediction of resistance of causative microorganism to antibiotics and treatment efficacy was demonstrated on group of women with ureaplasmosis. Evaluation of anaerobic part of vaginal microbiota contemporary with its aerobic part reliably increased informative value of microbiological test in women with urogenital diseases. There are reasons to include interferon preparations into the complex therapy of ureaplasmosis.     

The use of biological preparations for correction of microbial status in pregnant women

15 pregnant women with pregnancy lasting 28-32 weeks, whose medico-laboratory data (the positive result of the amino test, high pH value and the detection of "key" cells) suggested the presence of bacterial vaginosis, were placed under observation. The bacteriological study of vaginal microflora in all these women revealed pronounced disturbances simultaneously with the development of intestinal dysbacteriosis. The local application of the bacterial preparation "Zhlemik" containing freeze-dried live lactic acid bacteria of vaginal origin and the oral administration of lactic acid bifidumbacterin containing live bifidobacteria of intestinal origin permitted the successful restoration of vaginal and intestinal microbiocenosis. The capacity of biotherapeutic preparations for inducing non-specific immunostimulation led to a significant rise in the levels of IgA, IgM and IgG in vaginal secretions.     

Role of neutrophils in the regulation of the reproductive tract microbiocenosis in women

The influence of neutrophils and their secretory products on the microflora of the vaginal contents in healthy women and in women having dysbiotic processes in the vagina was studied. The secretory products of neutrophils were found to produce a bactericidal effect on the representatives of the opportunistic bacteria, this effect being less pronounced with respect to lactic-acid bacteria. The established effect of neutrophils on bacteria is regarded as one of the mechanisms of microbiocenosis formation, ensuring colonization resistance.     

Changes in vaginal microbiocenosis in patients with chronic pelvic inflammatory diseases following antibiotic therapy

The species composition of the vaginal microorganisms in healthy women and in patients with chronic pelvic inflammatory diseases before and after treatment in a gynecological hospital was studied. The study revealed that antibiotic therapy did not lead to complete clinical convalescence. During bacteriological investigation of patients changes in vaginal microbiocenosis, manifested by a decreased number of microbial species, an increased proportion of Escherichia coli, the occurrence of Staphylococcus aureus, a decreased number of Lactobacillus ssp., were observed. Antibiotic therapy aggravated the dysbiotic microbial picture of the vagina.     

Dynamics of some characteristics of humoral immunity,vaginal interferon status in pregnant women with the relapse of chronic pyelonephritis

65 pregnant women with the exacerbation of chronic pyelonephritis in the III trimester of gestation and 34 healthy pregnant women were examined. The quantitative content of immunoglobulins, the activity of interferon in cervico = vaginal washings and the composition of the vaginal microflora were determined. All patients with the relapse of chronic pyelonephritis exhibited disturbances in the normal microbiocenosis of the genitals and the dysfunction of the local immunity of the genital system, accompanied with a decrease in serum and secretory IgA, an increase in the amount of IgG and IgM, increased interferon activity. Pregnant women with the relapse of chronic pyelonephritis received, in addition to traditional therapy, local treatment with Kipferon suppositories, an immunomodulating preparation. The study revealed that the use of this preparation normalized the characteristics of local immunity, the composition of the microflora' of the genitals and led to the disappearance of the clinical symptoms of the disease.     

HIV and the Risk of Direct Obstetric Complications: A Systematic Review and Meta-Analysis

Background

Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy. Clinicians practicing in such settings have reported a high incidence of direct obstetric complications among HIV-infected women, but the evidence supporting this is unclear. The aim of this systematic review is to establish whether HIV-infected women are at increased risk of direct obstetric complications.

Methods and findings

Studies comparing the frequency of obstetric haemorrhage, hypertensive disorders of pregnancy, dystocia and intrauterine infections in HIV-infected and uninfected women were identified. Summary estimates of the odds ratio (OR) for the association between HIV and each obstetric complication were calculated through meta-analyses. In total, 44 studies were included providing 66 data sets; 17 on haemorrhage, 19 on hypertensive disorders, five on dystocia and 25 on intrauterine infections. Meta-analysis of the OR from studies including vaginal deliveries indicated that HIV-infected women had over three times the risk of a puerperal sepsis compared with HIV-uninfected women [pooled OR: 3.43, 95% confidence interval (CI): 2.00–5.85]; this figure increased to nearly six amongst studies only including women who delivered by caesarean (pooled OR: 5.81, 95% CI: 2.42–13.97). For other obstetric complications the evidence was weak and inconsistent.

Conclusions

The higher risk of intrauterine infections in HIV-infected pregnant and postpartum women may require targeted strategies involving the prophylactic use of antibiotics during labour. However, as the huge excess of pregnancy-related mortality in HIV-infected women is unlikely to be due to a higher risk of direct obstetric complications, reducing this mortality will require non obstetric interventions involving access to ART in both pregnant and non-pregnant women.     

阴道菌群结构分析在 宫腔粘连患者中的临床意义

目的对宫腔粘连患者菌群结构进行评价,探讨阴道微生态在宫腔粘连中的临床意义。方法选取2014年8月至2016年8月在我院计划生育病区诊断为宫腔粘连的患者100例为试验组,同期门诊100例健康体检者为对照组。对其阴道分泌物进行湿片镜检及微生态学检测,比较两组研究对象的阴道微生态情况。结果宫腔粘连组与对照组在阴道分泌物的多样性、密集度、优势菌、pH、清洁度和病原体检出率等方面比较差异有统计学意义(Ps0.05)。宫腔粘连组阴道微生态失调检出率(48%)高于对照组(31%),差异有统计学意义(P0.05)。结论宫腔粘连患者阴道微生态失调发生率明显增高,阴道微生态失调可能与宫腔粘连的发生有关。     

Antilactoferrin activity of microorganisms

The detection rate of the antilactoferrin sign and the level of its manifestation in 165 strains of different microbial species, isolated from patients with inflammatory diseases and intestinal dysbacteriosis, were analyzed. The detection rate of antilactoferrin activity was 43 - 90% for Escherichia coli strains, 20 - 86% for Staphylococcus aureus, 60 - 100% for Klebsiella pneumoniae, 76 - 78% for Candida albicans, isolated from different biotopes of man. Most frequently and with high levels of manifestation this sign was registered in strains isolated from the reproductive tract of women. The detection rate of this sign and the level of its manifestation in bacteria of the vaginal and cervical microbiocenosis, isolated from patients, were higher in comparison with healthy persons. The inverse dependence between the level of the antilactoferrin activity of microflora and the content of lactoferrin during the inflammatory process in women was established.     

Vaginal microbial flora in normal young women.

Vaginal swabs were taken from 1498 women attending a family planning clinic. The flora was assessed in the absence of any information about the women to whom the swabs related. Yeasts and fungi were present in 311 women (21%) and were no more prevalent among "pill" users than others. Candida albicans was significantly associated with vulval itching and with a vaginal discharge described as heavier than normal or curdy on clinical examination, though these abnormalities were present in only a minority of women with the organism. Trichomonas vaginalis was found in 14 women (1%) and was associated with abnormalities of vaginal discharge in all but one. Gram-negative anaerobic bacilli were significantly more common in women with a troublesome vaginal discharge and those who used an intrauterine device than others. No associations were found between fungi other than C albicans or the other bacteria sought and either symptoms or clinical abnormalities of vaginal discharge.     

Microecology and humoral immunity characteristics of the vagina in women with nonspecific inflammatory diseases of the genitals

The complex cytological, microbiological and immunological examination of 90 female patients with nonspecific inflammatory diseases of the genital tracts and 30 clinically healthy women (the control group) was carried out. The examination revealed significant microbiocenosis changes in the lumen and the parietal area of the vagina, depending on the severity of the infectious process: a decrease in the level of lactobacilli, an increase in the content of opportunistic facultative anaerobic microorganism in the lumen and obligate anaerobic bacteria in the parietal area. Pronounced correlation between the content of opportunistic microorganisms and the levels of IgM and IgA, as well as secretory IgA and free secretory component in vaginal secretions in patients in patients with non-specific inflammatory diseases of the genital tracts has been revealed.     

Cervical Mucus Properties Stratify Risk for Preterm Birth

Background

Ascending infection from the colonized vagina to the normally sterile intrauterine cavity is a well-documented cause of preterm birth. The primary physical barrier to microbial ascension is the cervical canal, which is filled with a dense and protective mucus plug. Despite its central role in separating the vaginal from the intrauterine tract, the barrier properties of cervical mucus have not been studied in preterm birth.

Methods and Findings

To study the protective function of the cervical mucus in preterm birth we performed a pilot case-control study to measure the viscoelasticity and permeability properties of mucus obtained from pregnant women at high-risk and low-risk for preterm birth. Using extensional and shear rheology we found that cervical mucus from women at high-risk for preterm birth was more extensible and forms significantly weaker gels compared to cervical mucus from women at low-risk of preterm birth. Moreover, permeability measurements using fluorescent microbeads show that high-risk mucus was more permeable compared with low-risk mucus.

Conclusions

Our findings suggest that critical biophysical barrier properties of cervical mucus in women at high-risk for preterm birth are compromised compared to women with healthy pregnancy. We hypothesize that impaired barrier properties of cervical mucus could contribute to increased rates of intrauterine infection seen in women with preterm birth. We furthermore suggest that a robust association of spinnbarkeit and preterm birth could be an effectively exploited biomarker for preterm birth prediction.     

Effect of vaginal Lactobacillus metabolites on biological properties of Staphylococcus epidermidis and Escherichia coli

The influence of supernatants and cell extracts of vaginal lactic acid bacilli on the growth, catalase, antilysozyme and anticomplementary activity of S. epidermidis and E. coli was studied. Changes observed in the persistence characteristics of these microorganisms were found to develop in different directions: in S. epidermidis a decrease in antilysozyme activity was mainly observed, while in E. coli the suppression of anticomplementary activity was registered. The modifying influence of lactic acid flora, revealed in this investigation, is regarded as one of the mechanisms facilitating the formation of microbiocenosis and ensuring colonization resistance.     

Prostaglandin-induced pregnancy termination: further studies using gemeprost (16,16 dimethyl-trans-delta 2-PGE1 methyl ester) vaginal pessaries in the early second trimester

The use of gemeprost (16,16 dimethyl-trans-delta 2-PGE1 methyl ester) vaginal pessaries for the termination of pregnancy in the early second trimester has been further investigated. Of 113 women between 12 and 16 weeks gestation, 93 (82%) aborted within 24 hours of the administration of 4.4 +/- 0.1 1 mg gemeprost pessaries. The mean induction-abortion interval was 881 +/- 31 minutes. Successful abortion was achieved in 16 of the remaining 20 women after a second course of gemeprost pessaries without the need for oxytocin supplementation. There were no serious complications. Crampy abdominal pain and vaginal bleeding started after 275 and 756 minutes respectively. Twenty-two (19%) patients did not require pain relief during treatment, but 90 (80%) required parenteral opiates. Vomiting and diarrhoea occurred in 16 (14%) and 23 (20%) cases respectively. The safe induction of therapeutic abortion in 96% of women using vaginal prostaglandin alone offers an acceptable alternative to surgical evacuation in the early second trimester.     

A new era of the vaginal microbiome: advances using next-generation sequencing

Until recently, bacterial species that inhabit the human vagina have been primarily studied using organism-centric approaches. Understanding how these bacterial species interact with each other and the host vaginal epithelium is essential for a more complete understanding of vaginal health. Molecular approaches have already led to the identification of uncultivated bacterial taxa associated with bacterial vaginosis. Here, we review recent studies of the vaginal microbiome and discuss how culture-independent approaches, such as applications of next-generation sequencing, are advancing the field and shifting our understanding of how vaginal health is defined. This work may lead to improved diagnostic tools and treatments for women who suffer from, or are at risk for, vaginal imbalances, pregnancy complications, and sexually acquired infections. These approaches may also transform our understanding of how host genetic factors, physiological conditions (e.g., menopause), and environmental exposures (e.g., smoking, antibiotic usage) influence the vaginal microbiome.     

双胎妊娠一胎宫内死亡18 例临床分析

目的:探讨双胎妊娠中一胎宫内死亡的原因、对母亲和存活胎儿的影响及临床处理方法。方法:对2001年1月至2011年10月分娩的双胎妊娠之一胎宫内死亡的18例产妇临床资料进行回顾性分析。结果:双胎妊娠一胎宫内死胎的发生率占双胎的1.08%,其中单绒毛膜双羊膜囊双胎(monochorionic-diamniotic twin,MCDA)11例(61.11%),双绒毛膜双羊膜囊双胎(dichorionic-diamniotic twin,DCDA)7例(38.89%)。胎儿死因:胎盘脐带因素3例(16.67%),胎儿畸形1例(5.56%),妊娠并发症3例(16.67%),双胎输血综合征(twin-twin transfusion syndrome,TTTs)3例(16.67%),宫内感染3例(16.67%),不明原因5例(27.78%)。另一胎选择剖宫产者13例,阴道分娩3例。双胎一胎死亡后对母体的凝血功能影响不大(P>0.05)。结论:单绒毛膜双胎较双绒毛膜双胎母儿结局存在差别;双胎一胎宫内死亡对母体及存活儿有一定影响。对于孕周小,胎儿尚不成熟的病例,可严密监测存活胎儿宫内情况,行期待治疗延长孕龄至足月再分娩。     

Vaginal mechanical contraceptive devices.

The alleged adverse effects of oral contraceptives and intrauterine devices have led to increased consumer and physician demand for vaginal contraceptive devices. The efficacy and the advantages and disadvantages of vaginal sponges, cervical caps and diaphragms are discussed and compared in this article.     

Prostaglandin-induced pregnancy termination: Further studies using gemeprost (16, 16 dimethyl-trans-Δ-PGE1 methyl ester vaginal pessaries in the early second trimester

The use of gemeprost (16, 16 dimethyl-trans-Δ²-PGE₁ methyl ester) vaginal pessaries for the termination of pregnancy in the early second trimester has been further investigated. Of 113 women between 12 and 16 weeks gestation, 93 (82%) aborted within 24 hours of the administration of 4.4 ± 0.1 1mg gemeprost pessaries. The mean induction — abortion interval was 881 ± 31 minutes. Successful abortion was achieved in 16 of the remaining 20 women after a second course of gemeprost pessaries without the need for oxytocin supplementation. There were no serious complications. Crampy abdominal pain and vaginal bleeding started after 275 and 756 minutes respectively. Twenty-two (19%) patients did not require pain relief during treatment, but 90 (80%) required parenteral opiates. Vomiting and diarrhoea occured in 16 (14%) and 23 (20%) cases respectively. The safe induction of therapeutic abortion in 96% of women using vaginal prostaglandin alone offers an acceptable alternative to surgical evacuation in the early second trimester.     

Influence of Bacillus cereus on microbiocenosis of gastrointestinal tract in rats

The modifying effect of Bacillus cereus on intestinal microbiocenosis was investigated in eubiotic and disbiotic female rats. Qualitative and quantitative characteristics of gut and mucosal microflora from different parts of rats' intestine were studied before and after intragastral application of B. cereus suspension. The single application of B. cereus suspension resulted in appearance of this bacterium in feces and in parietal mucin from all parts of the intestine. In eubiotic rats compared with disbiotic, B. cereus adhere to parietal mucin much more efficiently and supplanted indigenous microflora. During disbiosis B. cereus sometimes had stimulating effect on the intestinal microbiocenosis. Gut microbiocenosis appeared to be more resistant to B. cereus invasion than mucosal. This fact was considered to be the evidence of higher sensitivity of mucosal microbiocenosis to short-term influence of exogenous microbial factor.