Ocena wystepowania i wplywu patologicznej mikroflory drog rodnych kobiet ciezarnych we wczesnej ciazy na ryzyko wystapienia porodu przedwczesnego

• Autorzy: Kalinka J. , Laudanski T. , Hanke W. , Krzeminski Z. , Wasiela M.
• Języki publikacji: PL

Abstrakty

PL

Celem badania była ocena częstości występowania i wpływu zespołu objawów określanego jako bacterial vaginosis (BV) oraz zakażeń bakteryjnych dróg rodnych kobiet we wczesnej ciąży na ryzyko wystąpienia porodu przedwczesnego. BV stwierdzono u 51 (28,5%) ciężarnych. Odnotowano istotny wzrost odsetka porodów przedwczesnych w grupie kobiet z BV do 15,7% w porównaniu do grupy kobiet z prawidłową florą (9,1%). Spośród kobiet, które urodziły przedwcześnie u 38,1% stwierdzono BV, podczas gdy u kobiet rodzących po 37 tygodniu ciąży odsetek ten wyniósł 27,2% (OR=l,86). Infekcja C. trachomatis we wczesnej ciąży nie wiązała się ze wzrostem ryzyka wystąpienia porodu przedwczesnego.

EN

The main aim of this prospective study was to determine the prevalence and an association between pathological microflora of the lower genital tract diagnosed at early pregnancy and the risk of preterm delivery. The study group comprised 179 randomly selected pregnant women from Lodz region, between 8 and 16 week of pregnancy. For the qualitative and quantitative assessment of biocenosis of the lower genital tract vaginal and cervical swabs were collected from the pregnant women under study. The C. trachomatis antigen was detected by direct immunofluorescence assay. The vaginal swabs were tested for aerobic and anaerobic bacteria. Bacterial vaginosis was diagnosed by Gram stain according to Spiegel's criteria. To evaluate the risk factors odds ratios were calculated using EPI INFO software. 21 (11,7%) women delivered before 37"1 week of pregnancy. Bacterial vaginosis was diagnosed among 51 ( 28,5%) pregnant women while intermediate microflora was diagnosed by Gram stain in 62 (34,6%) women. The shortest mean gestational age at delivery was noted among women with BV The rate of preterm delivery in BV group was 15,7% comparing to 9,1% among women with normal microflora. Among women with preterm delivery BV was diagnosed in 38,1% (OR=1,86). Based on culture results only 84 (46,9%) women had normal microflora at early pregnancy. The pathological culture was associated with slightly increased preterm delivery rate (12,6%) as compare to 10,7% in control group. Positive culture for Bacteroides and Mobiluncus was connected with nonstatistical rise in the risk of preterm delivery. No association between C. trachomatis infection at early pregnancy and elevated risk of preterm delivery was found. Early pregnancy diagnosis of bacterial vaginosis and its treatment should lower the rate of prematurity in Poland.

Słowa kluczowe

PL

ciaza; wystepowanie; zakazenia wewnatrzmaciczne; kobiety ciezarne; porody przedwczesne; drogi rodne; mikroflora

• Wydawca: -
• Czasopismo: Medycyna Doświadczalna i Mikrobiologia
• Rocznik: 2003
• Tom: 55
• Numer: 3
• Opis fizyczny: s.277-284,tab.,bibliogr.

Twórcy

autor

Kalinka J.

• Instytut Ginekologii i Poloznictwa, Uniwersytet Medyczny, Lodz

autor

Laudanski T.

autor

Hanke W.

autor

Krzeminski Z.

autor

Wasiela M.

Bibliografia

• 1. Alger LS, Lovchik JC, Hebel J i inni. The association of Chlamydia trachomatis, Neisseria gonorrhoeae, and group В streptococci with preterm rupture of the membranes and pregnancy outcome. Am J Obstet Gynecol 1988; 159: 397-403.
• 2. Amsel R, Totten PA, Spiegel CA i inni. Nonspecific vaginitis: diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74:14-22.
• 3. Andrews WW, Goldenberg RL, Mercer В i inni. The Preterm Prediction Study: association of second-trimester genitourinary chlamydia infection with subsequent spontaneous preterm birth. Am J Obstet Gynecol 2000; 183: 662.
• 4. Cauci S, Monte R, Driussi S i inni. Impairment of the mucosal immune system: I gA and IgM cleavage detected in vaginal washings of a subgroup of patients with bacterial vaginosis. J Infect Dis 1998; 178: 1698-706.
• 5. Chokephaibulkit K, P Patamasucon, M List i inni. Genital Chlamydia trachomatis infection on pregnant adolescents in east Tennessee: a 7-year case-control study. J Pediatr Adolesc Gynecol 1997; 10: 95-100.
• 6. Cristiano L, Rampello S, Noris C, Valota V. Bacterial vaginosis: prevalence in an Italian population of asymptomatic pregnant women and diagnostic aspects. Eur J Epidemiol 1996; 12: 383-90.
• 7. Eschenbach DA, Gravett MG, Chen K.C.S. i inni. Bacterial vaginosis during pregnancy. An association with prematurity and postpartum complication. In: Mardh P.-A.,Taylor-Robinson D., eds: Bacterial Vaginosis. Stockholm, Almqvist and Wiksill. 1984: 213-22.
• 8. French JI, McGregor JA, Draper D i inni. Gestational bleeding, bacterial vaginosis, and common reproductive tract infections: risk for preterm birth and benefit of treatment. Obstet Gynecol 1999; 93: 715-24.
• 9. Gratacos E, Figueras F, Barranco i inni. Spontaneous recovery of bacterial vaginosis during pregnancy is not associated with an improved perinatal outcome. Acta Obstet Gynecol Scand 1998; 77: 37-40.
• 10. Gravett MG, Hummel D, Eschenbach DA i inni. Preterm labor associated with subclinical amniotic fluid infection and with bacterial vaginosis. Obstet Gynecol 1986; 67: 229-37.
• 11. Goldenberg RL, lams JD, Mercer BM i inni. The preterm prediction study: the value of new vs standard risk factors on predicting early and all spontaneus preterm births. NICHD MFMU Network. Am J Public Health 1998; 88: 233-8.
• 12. Hill GB. The microbiology of bacterial vaginosis. Am. J Obstet Gynecol 1993; 169: 450-54.
• 13. Hillier SL, Krohn MA, Rabe LK i wsp. The normal vaginal flora, H202-producing lactobacilli and bacterial vaginosis in pregnant women. Clin Infect Dis 1993; 16 (suppl. 4): S273-81.
• 14. Joesoef MR Hillier SL, Utomon В i inni. Bacterial vaginosis and prematurity in Indonesia: Association in early and late regnancy. Am J Obstet Genecol 1993; 169: 175-8.
• 15. Kovacs L, Nagy E, Berbik A i wsp. The frequency and the role of Chlamydia trachomatis infection in premature labour. Int J Gynecol Obstet 1998; 62: 47-54.
• 16. Krohn MA, Hillier SL, Eschenbach DA i inni. Comparison of methods for diagnosing bacterial vaginosis among pregnant women. J Clini Microbiol 1989; 27: 1266-71.
• 17. Kurki T, Sivonen A, Renkonen O-V i inni. Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol 1992; 80: 173-7.
• 18. Martinez de Tejada B, Coll O, de Flores M i inni. Prevalence of bacterial vaginosis in an obstetric population of Barcelona. Med Clin Bare 1998; 110: 201-4.
• 19. Martius J, Krohn M.A., Hillier S.L i inni. Relationship of vaginal Lactobacillus species, cervical Chlamydia trachomatis, and bacterial vaginosis to preterm birth. Obstet Gynecol 1988; 71: 89-95.
• 20. McGregor JA, French JI, Parker R i inni. Prevention of premature birth by sreening and treatment for common genital tract infections: Results of a prospective controlled evaluation. Am J Obstet Gynecol 1995; 173: 157-67.
• 21. McGregor JA, French JI. Bacterial vaginosis in pregnancy. Obstet Gynecol Surv 2000; 55, ( Suppl. 1): 1-19.
• 22. Meis P J, Goldenberg RL, Mercer i inni. National Intitute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The preterm prediction study: Significance of vaginal infection. Am J Obstet Gynecol 1995; 173: 1231-5.
• 23. Mikamo H, Sato Y, Hayasaki Y, i inni. Bacterial isolates from patients with preterm labour with an without preterm rupture of fetal membranes. Infect Dis Obstet Gynecol 1999; 7: 190-4.
• 24. Sherman DJ, J Tovbin, Lazarovich T i inni. Chorionamnionitis caused by gram-negative bacteria as an etiologie factor in preterm delivery. Eur J Clin Microbiol Infect Dis 1997; 16: 417-23.
• 25. Silver HM, Sperling R.S., St. Clair P.J. i inni. Evidence relating bacterial vaginosis to intraamniotic infection. Am J Obstet Gynecol 1989; 161: 808-12.
• 26. Spiegel CA. Bacterial vaginosis. Clin Microbiol Rev 1991; 4: 485-502.
• 27. Spiegel CA, Amsel R, Holmes KK. Diagnosis of bacterial vaginosis by direct Gram stain of vaginal fluid. J Clin Microbiol 1983; 18: 170-7.