Bacterial vaginosis during pregnancy

January 1, 2022 Adam 0 Comments

Treatment of bacterial vaginosis during pregnancy is a mandatory measure for every fourth woman. The disease causes not only psychological discomfort, but also provokes miscarriage, premature birth, contributes to infection of the placenta and birth canal.

The content of the article:

Infection, pathogens
Dangers and complications
Causes and risk factors
Signs, symptoms
Diagnostics
Treatment tactics

What is bacterial vaginosis – the prevalence of infection, pathogens

Bacterial vaginosis, or gardnerellosis, is an infection that is not characterized by an inflammatory process. Disease is inherent a decrease in the amount – or a complete absence – of lactoflora, which is replaced by harmful microorganisms (gardnerella, anaerobes).

The name “bacterial” arose due to the fact that a lot of pathogens are involved in the mechanism of infection development. At the same time, leukocytes that cause inflammation are not formed. Therefore, the second term is “vaginosis”.

Video: Bacterial vaginosis in pregnant women

According to statistics, gardnerellosis is the most common vaginal infection that occurs during the reproductive period. During pregnancy, dysbiosis is diagnosed in every fourth woman.

The researchers do not know the exact factors leading to the spread of the infection. But it was found that the disease develops more often in women who are sexually active. Therefore, a change in partner or the presence of several men with whom a woman has sex leads to the occurrence of gardnerellosis.

The appearance of bacterial vaginosis is facilitated by frequent douching, which violates the microflora. An imbalance in the vagina increases the risk of developing other infectious gynecological diseases.

The mechanism of development of dysbiosis is well understood.

In healthy women, 95% of the vaginal microflora consists of lactobacilli. The remaining 5% of the flora is inhabited by other types of microorganisms.
Thanks to the Doderlein sticks, an acidic environment is formed that protects the vagina and inhibits the growth of pathogens. The vital activity of lactic acid bacteria is due to their own secretion of lactic acid.
The pH level in healthy women is 3.8-4.5. The advantage of lactic acid microflora is that it inhibits the reproduction of pathogenic microbes. When the balance of positive and negative bacteria is disturbed, vaginal dysbiosis develops.
More than 200 varieties of microbes contribute to the appearance of gardnerellosis, which makes it difficult to identify a certain type of bacteria. Moreover, studies have proven that each woman has a different composition of microflora.
But in 90% of cases, dysbiosis provokes Gardnerella vaginalis. It is the most common pathogenic microbe of all types of bacteria that cause vaginosis.

Gardnerella makes it difficult to treat bacterial vaginosis during pregnancy. The pathogen promotes the production of cytotoxins, including vaginolysin. The bacterium forms a biofilm and exhibits the ability to adhere.

The danger of bacterial vaginosis for the expectant mother and baby during pregnancy

Dysbiosis is an insidious infection that often occurs without severe symptoms. Therefore, pregnant women do not go to the gynecologist with complaints – and in the meantime, the disease is rapidly progressing.

The greatest danger of vaginosis during gestation – the disease causes premature birth or miscarriage…

Other complications of gardnerellosis for pregnant women:

Increased likelihood of infection of the reproductive system.
Chorionamnionitis (infection of the amniotic fluid and the germ membrane).
The birth of a child with a low weight, not corresponding to the norm.
Endometritis, characterized by inflammation of the uterus after labor.
Purulent-septic diseases in a child.
Rupture of the membranes where the fetus develops.

Causes of bacterial vaginosis in pregnant women and risk factors

Many factors contribute to the appearance of gardnerellosis. This, for example, a change of sexual partner, frequent douching, prolonged use of vaginal suppositories.

Other causes of bacterial vaginosis during pregnancy:

Taking antibacterial agents.
Surgical manipulations.
Deterioration of immune function.
Wearing synthetic underwear.
Intestinal dysbiosis.
Hormonal adjustment.
Refusal from fermented milk products.
Infection of the genitals.
Contraceptive use before pregnancy.

Risk factors include climate change and background processes occurring in the cervix… Bacterial vaginosis causes stress and the use of processed condoms 9-nonoxynol…

To avoid the appearance of dysbiosis, it is important to exclude factors leading to infection:

A woman cannot uncontrollably use antibiotics, contraceptives and put vaginal suppositories without the appointment of a gynecologist.
It is better to exclude douching altogether.
It is necessary to observe the culture of sexual life and be periodically examined by a gynecologist.
During the gestation period, it is recommended to wear underwear made from natural fabrics.

Before pregnancy, doctors advise to be tested for genital infections. If diseases are detected, full antibiotic therapy should be carried out. Then the patient is prescribed drugs to restore the vaginal microflora.

With frequent relapses, it is possible to use special vaccine (Solco Trihovac)… Vaccination promotes the growth of lactobacilli and prevents the re-development of dysbiosis. The effect is noted after 20 days after injection.

Signs and symptoms of bacterial vaginosis during pregnancy

The incubation time for gardenerellosis takes 3-10 days…

During this period, the pregnant woman has gray-white discharge that has a “fishy” smell.
After sexual intercourse, secretion increases. Discharge foams and is easily removed from the surface of the mucous membrane with ordinary cotton wool.
Other symptoms of bacterial vaginosis are swelling and redness of the vaginal walls, the outer part of the genitals. Itching is a sign that rarely appears with dysbiosis.
With gardnerellosis, the internal genital organs are sometimes inflamed. The condition is characterized by pulling pains in the lower abdomen.

But in most women, there are no pronounced signs with bacterial dysbiosis. Therefore, it is possible to notice the disease only by the characteristic white-gray discharge…

Note!

With the development of such a symptom of a pregnant woman, it is necessary to consult a gynecologist. Timely treatment prevents the chronic course of the disease, the therapy of which is not always effective and takes a lot of time.

Diagnosis of bacterial vaginosis in a pregnant woman – what will the doctor do?

To determine the disease, the gynecologist conducts inspection… If the patient has a light secret from the vagina that has a “fishy” smell, then the doctor takes smears on flora…

The diagnosis is confirmed if tests show the presence of “key cells” in the sample. These are particles of the vaginal epithelium covered with microscopic gardnerella (rods).

When difficulties arise with the diagnosis, the gynecologist prescribes PCR analysis… The study is based on the identification of the pathogen’s DNA.

Sometimes differential diagnostics is carried out, confirming or excluding the presence of the following diseases or conditions:

Other genital infections
Candidiasis
Trichomoniasis
The presence of a foreign body in the vagina (condom, tampon)
Inflammatory processes in the genital tract.

Treatment tactics for bacterial vaginosis during pregnancy

The main task of therapy is to restore the natural vaginal flora and eliminate the signs of the disease. Treatment of bacterial vaginosis during pregnancy, even in the absence of severe symptoms, is a mandatory measure, since there is a high risk of complications for the fetus. For this reason, self-therapy of the disease is unacceptable!

Bacterial vaginosis is often asymptomatic. To identify it, you must regularly undergo a routine examination by a gynecologist and take smeardetermining the composition of the flora.

When a fetus is forming, systemic therapy is contraindicated. In the first three months of pregnancy, use is indicated local preparations…
Complex treatment of bacterial vaginosis is possible in the second half of the gestation period. For the restoration of flora, it is shown intravaginal use of live probioticscontaining lactobacilli and symbionts. In almost 90% of women, the vaginal microflora is restored after 7 days of intravaginal use of tampons.
Starting from the 20th week of pregnancy, the gynecologist can prescribe to the patient antibacterial drugs (Ornidazole, Trichopolum, Metronidazole)… A number of studies have shown that these drugs do not have a teratogenic effect, and they are safe for the fetus.
During the gestation period, admission is allowed Clindamycin-based products… Often, antibacterial treatment of bacterial vaginosis in pregnant women is complemented by the use of immunocorrecting and antiallergenic agents.

During gestation, there is no need to treat the sexual partner. In order to prevent relapse and prevent the development of candidiasis, 20-30 days after antibacterial therapy, the pregnant woman is prescribed control analysis of microflora…

If gardinerella or candida is not found in smears, then the patient is shown to restore the fermented milk environment vaginal and oral administration of probiotics…

And for a speedy recovery it is recommended enrichment of the diet with fermented milk products and foods containing fiber.