HEALTH OF WOMAN. 2018.1(127):85–88; doi 10.15574/HW.2018.127.85

Skrypchenko N. Y. , Pavlova O. M. , Shameeva O. V. , Mogilevska S. I.
SI «Institute of Pediatrics, Obstetrics and Gynecology, NAMS of Ukraine», Kiev

The objective: to study the peculiarities of microbiocenosis in pregnant women with adenomyosis, to develop new and to systematize and improve existing methods of diagnosis, treatment and prevention of complications and reproductive losses.
Materials and methods. 90 pregnant women (pregnancy term of 32.1±2 weeks) were divided into three groups: 30 healthy pregnant women as a control group (average age 29.3±2.1); the comparison group – 30 pregnant women (average age – 31.8±2.2) with adenomyosis, whose vaginal biota was examined and treatment prescribed in the case of any complaints, in the case of premature birth risk we prescribed progesteron therapy according to the protocol of the Ministry of Health; the main group – 30 pregnant women with adenomyosis, with routinely examined vaginal biota, sanitation of the genital tract and prescription of probiotic, women received progesterone and diet, the average age was 31.2±2.1. Treatment was prescribed after detection of the titre and sensitivity of the pathogen by bacterioscopy of excretions on the glass and bacterial culturing of vaginal excretions. In the case of pathological flora detection, a more extensive survey was prescribed.
Results. The frequency of premature birth risk in group 1 was 6.7%, in comparison and main groups the indicator was 26.7% and 23.4%; bacterial vaginosis in combination with Candida colpitis was observed in groups as 6.7%, 23.4% and 26.7% (most often the association included staphylococcus epidermal and E. coli, Staphylococcus Epidermalis and Candida). The revealed violations of the vagnal biota only in half of the cases were accompanied by women’s subjective complaints, but the treatment was needed due to pathogens and their titers. After the treatment, an additional examination was held to check the treatment effectiveness. Violation of feto-placental complex in the control group was 3.3%, in the comparison group 33.3% and in the main group 10%, fetal growth retardation in 3.3%, 20.0%, 10.0% respectively, preterm labor occured in 6.7%, 33.3%, 6.7% cases, PRAM has happened in 6.7%, 33.3% and 13.3%, the VTI was not noticed in the first group, but in the other two groups it occured in 10% and 3.3% cases.
Conclusions. Routine biota examination and treatment in combination with diet are necessary, as infrequently the disease runs asymptomatic, resulting in severe consequences. The application of the proposed complex in women with adenomyosis significantly reduces the risk of a feto-placental complex violation and, as a result, FGR, reduces the probability of preterm labor, PRAM, minimizes labor tract trauma and significantly reduces the risk of VTI in fetus, reduces time spent in hospital by woman.
Key words: adenomyosis, pregnancy, vaginal biocenosis, diet, association of microorganisms, probiotics, Enterobacteria, Staphylococcus, Streptococcus, fungi of the genus Candida.

REFERENCES

1. Juang СМ, Chou P, Yen MS. 2017. Adenomyosis and risk of preterm delivery. BJOG. 114;2:165–169.

2. Kunz G, Beil D, Huppert P. 2015. Adenomyosis in endometriosis: prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum. Reprod. 20;8:2309–2316.

3. Demirov MM. 2013. Adenomioz: klinika, diagnostika i lechenie. M, Tver:88–89.

4. Kunz G, Herbertz M, Beil D. 2017. Adenomyosis as a disorder of the early and late human reproductive period. Reprod. Biomed. Online 15;6:681–685.

5. Healy DL, Breheny S, Halliday J et al. 2013. Prevalence and risk factors for obstetric haemorrhage in 6730 singleton births after assisted reproductive technology in Victoria Australia. Hum. Reprod. 25;l:265–274.

6. Hamdan M, Omar SZ, Dunselman G. 2015. Influence of endometriosis on assisted reproductive technology outcomes: a systematic review and meta-analysis. Obstet. Gynecol. 125;l:79–88.

7. Curtis KM, Hillis SD, Marchbanks PA. 2014. Disruption of the endometrial-myometrial border during pregnancy as a risk factor for adenomyosis. Am. J. Obstet. Gynecol. 187;3:543–544.

8. Senchuk AIa, Chermak II. 2002. Deiaki osoblyvosti vnutrishnoho endometriozu. Tezy dopovidei IX konhresu svitovoi Federatsii Ukrainskoho likarskoho tovarystva. K:133.

9. Sharma A, Satyam A, Sharma J. 2014. Leptin, IL-10 and inflammatory markers (TNF-alpha, IL-6 and IL-8) in pre-eclamptic, normotensive pregnant and healthy non-pregnant women. Am. J. Reprod. Immunol. 58;1:21–30.

10. Ventskivska IB. 2000. Vybir taktyky likuvannia pry henitalnomu endometriozi. Likar. sprava 1:85–86.

11. Davey МА, Watson L, Rayner JA. 2014. Risk scoring systems for predicting preterm birth with the aim of reducing associated adverse outcomes. The Cochrane Collaboration in The Cochrane Library 14:16.

12. Roberts D, Dalziel SR. 2015. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst. Rev. 3: CD004454.

13. Koppan A, Hamori J, Vranics I, Garai J, Kriszbache I, Bodis J, Rebek-Nagy G, Koppan M. 2010. Pelvic pain in endometriosis: painkillers or sport to alleviate symptoms? Acta Physiol Hung. 97(2):234–239.

14. Parazzini F, Vigano P, Candiani M, Fedele L. 2013. Diet and endometriosis risk: a literature review. Reprod Biomed Online. 26(4):323–336. https://doi.org/10.1016/j.rbmo.2012.12.011; PMid:23419794

15. Curtis KM, Hillis SD, Marchbanks PA. 2014. Disruption of the endometrial-myometrial border during pregnancy as a risk factor for adenomyosis. Am. J. Obstet. Gynecol. 187;3:543–544.