Bacterial Vaginosis and Vulvovaginitis in Pregnant Women with Insuficiencia Istmicocervical. A Differentiated Approach to Drug Therapy
https://doi.org/10.31550/1727-2378-2022-21-5-81-86
Abstract
Objectivе of the Review: To study the modern methods of diagnosis and management of bacterial vaginosis (BV) and vulvovaginitis in pregnant women complicated with insuficiencia istmicocervical (IIC).
Key points. BV in pregnant women is a topical issue for obstetrician professionals since it can cause a number of unfavourable outcomes (miscarriage, premature delivery, antenatal infections). In case of impaired vaginal microbiocenosis in pregnant women complicated with IIC, it is preferable to use clinical scales, in particular Amsel’s criteria, with the vaginal pH being the main indicator. However, for a more complete diagnosis of vaginal dysbiosis, modern PCR-based methods are recommended. The review describes modern classification of vaginal biocenosis disorders. We discuss characteristics of differential therapy of BV and anaerobic vulvovaginitis with pН 4.5+, and the possibility of using metronidazoles and clotrimazoles in pregnant women for vagina sanitation before IIC correction.
Conclusion. One method for BV therapy in pregnant women is the use of a combined intravaginal product containing Metronidazole 50 mg, which is recommended both by international and Russian clinical protocols as a first line therapy, and Clotrimazole 100 mg, since BV in pregnant women is frequently associated with fungi, or they start proliferating very fast because of reduced vaginal pH during therapy, thus causing vulvovaginal candidiasis. This product can be recommended for the therapy of a mixed infection and in presence of pathological discharges in pregnant women in the second and third trimesters.
About the Authors
N. V. Spiridonova
Samara State Medical University of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
80 Polevaya Str., Samara, 443100
M. A. Kaganova
Samara State Medical University of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
80 Polevaya Str., Samara, 443100
O. O. Devyatova
N.I. Pirogov Samara Municipal Clinical Hospital No.1
Russian Federation
Russian Federation
80 Polevaya Str., Samara, 443100
A. A. Bezrukova
Panacea Consultative Clinic LLC
Russian Federation
Russian Federation
88 Tukhachevsky Str., Samara, 443082
References
1. Ilina I.Yu., Dobrokhotova Yu.E. Bacterial vaginosis. Possible solutions to the problem. Russian Medical Journal. 2020; 11: 75–8. (in Russian)
2. Ruiz-Perez D., Coudray M.S., Colbert B., Krupp K. et al. Effect of metronidazole on vaginal microbiota associated with asymptomatic bacterial vaginosis. Access Microbiol. 2021; 3(5): 000226. DOI: 10.1099/acmi.0.000226
3. Кira E.F., Rastorgueva L.I., Khalturina Yu.V., Pushkina V.V. Vaginal infections. Two-step treatment. Obstetrics and Gynegology. 2020; 4: 201–8. (in Russian) DOI: 10.18565/aig.2020.4.201-208
4. Pustotina O.A. Bacterial vaginosis: pathogenesis, diagnosis, treatment, and prevention. Obstetrics and Gynegology. 2018; 3: 150–6. (in Russian) DOI: 10.18565/aig.2018.3.150-156
5. Radzinsky V.E., Anufrieva V.G., Belinina A.A., Bespalay А.V. et al. Empirical therapy for vulvovaginitis in reproductive-aged women in routine clinical practice. Obstetrics and Gynegology. 2020; 2: 160–8. (in Russian) DOI: 10.18565/aig.2020.2.161-168
6. Crucitti T., Hardy L., van de Wijgert J., Agaba S. et al. Contraceptive rings promote vaginal lactobacilli in a high bacterial vaginosis prevalence population: a randomised, openlabel longitudinal study in Rwandan women. PLoS One. 2018; 13(7): e0201003. DOI: 10.1371/journal.pone.0201003
7. Bitsadze V.O., Radetskaya L.S. Experience of using the local combination product containing miconazole and metronidazole for the treatment of bacterial vaginosis and vulvovaginal candidiasis in pregnant women. Gynecology. 2016; 18(6): 56–60. (in Russian)
8. Amsel R., Totten P.A., Spigel C.A., Chen K.C. et al. Nonspecific vaginitis: diagnostic criteria and microbial and epidemiologic associations. Am. J. Med. 1983; 74(1): 14–22. DOI: 10.1016/0002-9343(83)91112-9
9. Donders G.G.G., Bellen G., Grinceviciene S., Ruban K. et al. Aerobic vaginitis: no longer a stranger. Res. Microbiol. 2017; 168(9–10): 845–58. DOI: 10.1016/j.resmic.2017.04.004
10. Padrul' M.M., Galinova I.V., Olina A.A., Sadykova G.K. Stratification of preterm birth risk: peculiari ties. Health Risk Analysis. 2020; 1: 165–76. (in Russian) DOI: 10.21668/health.risk/2020.1.17
11. Goncharova M.A., Tsipinov R.S., Petrov Yu.A. Non-extension of pregnancy during isthmic-cervical insufficiency. Modern Problems of Science and Education. 2018; 6: 150. (in Russian)
12. Siniakova A.A., Shipitsyna E.V., Budilovskaya O.V., Bolotskikh V.M. et al. The efficiency of treatment of vaginal infections in women with a history of miscarriage. Journal of Obstetrics and Women's Diseases. 2019; 68(5): 63–74. (in Russian) DOI: 10.17816/JOWD68563-74
13. Dobrokhotova Yu.E., Borovkova E.I., Zalesskaya S.A., Nagaitseva E.A. et al. Diagnosis and management patients with cervical insufficiency. Gynecology. 2018; 20(2): 41–5. (in Russian) DOI: 10.26442/2079-5696_2018.2.41-45
14. Care A., Jackson R., O'Brien E., Leigh S. et al. Cervical cerclage, pessary, or vaginal progesterone in high-risk pregnant women with short cervix: a randomized feasibility study. J. Matern. Fetal Neonatal Med. 2021; 34(1): 49–57. DOI: 10.1080/14767058.2019.1588245
15. Petrov Yu.A., Ozdoeva I.M-B. Istmiko-cervical insufficiency as an etiological factor of premature birth. Scientific Review. Medical Sciences. 2019; 2: 26–30. (in Russian)
16. Mamedaliyeva N.M., Kim V.D., Mustafazade A.T., Zhunusova D.E. et al. Cervical insufficiency: modern aspects of diagnostics and tactics of management. Vestnik KazNMU. 2018; 2: 10–13. (in Russian)
17. Khryanin A.A., Knorring G.Yu. Modern understanding of bacterial vaginosis. Gynecology. 2021; 23(1): 37–42. (in Russian) DOI: 10.26442/20795696.2021.1.200680
18. Savicheva A.M., Tapilskaya N.I., Shipitsyna E.V., Vorobyeva N.E. Bacterial vaginosis and aerobic vaginitis as major vaginal microflora balance disorders: Diagnostic and therapeutic characteristics. Obstetrics and Gynegology. 2017; 5: 24–31. (in Russian) DOI: 10.18565/aig.2017.5.24-31
19. De Seta F., Campisciano G., Zanotta N., Ricci G. et al. The vaginal community state types microbiome-immune network as key factor for bacterial vaginosis and aerobic vaginitis. Front. Microbiol. 2019; 10: 2451. DOI: 10.3389/fmicb.2019.02451
20. Saraf V.S., Sheikh S.A., Ahmad A., Gillevet P.M. et al. Vaginal microbiome: normalcy vs dysbiosis. Arch. Microbiol. 2021; 203(7): 3793–802. DOI: 10.1007/s00203-021-02414-3
21. Talibov O.B. Clinical pharmacology of drugs in their intravaginal administration. Obstetrics and Gynegology. 2020; 12: 194–8. (in Russian) DOI: 10.18565/aig.2020.12.194-198
22. Kahwati L.C., Clark R., Berkman N., Urrutia R. et al. Screening for bacterial vaginosis in pregnant adolescents and women to prevent preterm delivery: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2020; 323(13): 1293–309. DOI: 10.1001/jama.2020.0233
23. Pestrikova T.Yu., Yurasova E.A., Kotelnikova A.V., Strelnikova N.V. et al. Clinical and laboratory evaluation of the effectiveness of a personified approach to treating bacterial vaginosis and its concurrence with vulvovaginal candidiasis. Obstetrics and Gynegology. 2020; 3: 198–202. (in Russian) DOI: 10.18565/aig.2020.3.198-202
24. Bebneva T.N., Dikke G.B. Current features of vulvovaginal candidiasis and selection of rational therapy in pregnant and nonpregnant women. Russian Journal of Woman and Child Health. 2018; 1(1): 49–56. (in Russian) DOI: 10.32364/2618-8430-2018-1-1-49-56
25. Schwebke J.R., Lensing S.Y., Sobel J. Intravaginal metronidazole/ miconazole for the treatment of vaginal trichomoniasis. Sex. Transm. Dis. 2013; 40(9): 710–14. DOI: 10.1097/01.olq.0000431069.38601.d5
26. Spiridonova N.V., Kaganova M.A., Devyatova O.O., Bezrukova A.A. Cervical canal microbiota features in second trimester of pregnancy in insuficiencia istmicocervical with clinical signs of vulvovaginitis depending on vaginal discharge рH. Doctor.Ru. 2021; 20(6): 12–19. (in Russian) DOI: 10.31550/1727-2378-2021-20-6-12-19
27. Bayar E., Bennett P.R., Chan D., Sykes L. et al. The pregnancy microbiome and preterm birth. Semin. Immunopathol. 2020; 42(4): 487–99. DOI: 10.1007/s00281-020-00817-w
28. Fuhler G.M. The immune system and microbiome in pregnancy. Best Pract. Res. Clin. Gastroenterol. 2020; 44–45: 101671. DOI: 10.1016/j.bpg.2020.101671
29. Dobrokhotova Yu.E., Ivanova I.I. Using a combination of metronidazole and miconazole in correcting vaginal dysbiosis. Russian Journal of Woman and Child Health. 2018; 1(1): 82–7. (in Russian) DOI: 10.32364/2618-8430-2018-1-1-82-87
Review
For citations:
Spiridonova N.V., Kaganova M.A., Devyatova O.O., Bezrukova A.A. Bacterial Vaginosis and Vulvovaginitis in Pregnant Women with Insuficiencia Istmicocervical. A Differentiated Approach to Drug Therapy. Title. 2022;21(5):81-86. (In Russ.) https://doi.org/10.31550/1727-2378-2022-21-5-81-86
Views:
15
Email this article 