Aim: to assess the effect of Lactobacilli on vaginal microbiocenosis in pregnant women with its pre-existing disturbances manifested as an increase in vaginal pH levels (>4.5) and pathological vaginal discharge in the 1st trimester of pregnancy. Patients and Methods: a prospective study involved 261 pregnant women who registered their pregnancy before 14 weeks. Group 1 included 147 women with vaginal pH>4.5 and gray white smelling discharge, but no cornified squamous epithelial cells and negative whiff test. Group 2 included 114 pregnant women with vaginal pH 3.8–4.5 and no vaginal discharge. At 11–14 weeks, 18–21 weeks, 30–34 weeks, and before delivery (36–41 weeks), vaginal pH, the composition of opportunistic flora, and Lactobacilli count were evaluated. In group 1, intravaginal lyophilized culture of L. casei rhamnosus (LCR) Doderleini was prescribed after each screening and before the delivery (in total, 4 courses). Results: the use of LCR preparation throughout the gestation reduced vaginal pH from 4.9 (11–14 weeks) to 4.5 (36–41 weeks) (p=0.001). In group 2, vaginal pH increased from 4.35 to 4.7 (p=0.000). In group 1 (probiotic containing LCR Lactobacilli was prescribed), the percentage of women with isolated L. jensenii strain increased by 1.6 times (from 9.52% to 14.96%). Meanwhile, in group 2 (no probiotic was prescribed), the percentage of women with isolated L. jensenii strain reduced by 4.2 times (from 14.91% to 3,51%; p=0.000). In group 1, abnormal birth activity and premature rupture of membranes were reported significantly less common (р=0.0001 and р=0.0001, respectively). Conclusions: probiotic containing LCR is favorable in terms of reducing the rate of pregnancy and birth complications. This fact is of particular importance for women who are at risk of bacterial vaginosis. KEYWORDS: pregnancy, Lactobacilli, vaginal microbiocenosis, pH measurement, probiotics. FOR CITATION: Karakhalis L.Yu., Ivantsiv N.S. Prevention of labor complication via the improvement of vaginal microbiocenosis. Russian Journal of Woman and Child Health. 2021;4(1):31–35. DOI: 10.32364/2618-8430-2021-4-1-31-35.

Introduction: to investigate the possibility of using clindamycin and butaconazole in local therapy of moderate and severe dysbiosis in patients during the menopausal transition (early and late).Materials and methods: 107 women were examined. They were divided into two groups depending on their complains: the patients of group 1 (49.5%) had an early transition to menopause (44.7 ± 2.3 years); the patients of group 2 (50.5%) corresponded to a late transition to menopause (49.1 ± 1.5 years). The complains were evaluated. The levels of hormones (FSH, AMH, Inhibin B, estradiol) were determined. A study of the vaginal biotope was conducted by PCR ‘Femoflor 8. Statistical studies were conducted in the environment of STATISTICA 10 package (Tibco, USA). The difference in average values was considered statistically significant for p<0.05. Results: vegetative-vascular disorders were typically for patient in group 2 and detected in 74.1%. Mucosal dryness was 5.2 times more common in patients 2 group, as was dyspareunia (5.5 times more often), dysuria (14 times more often), itching in the vagina (3.5 times more often), discomfort (3.4 times often). All patient in group 2, and 51% of patient in group 1 had moderate and severe dysbiosis on the background of hypoestrogenia.Conclusion: The period of menopausal transition is characterized as a abnormalities of the vaginal biotope due to the activation of aerobes, anaerobes, and fungi of the genus Candida, and estrogen deficiency, that is more pronounced in patients with a late transition to menopause. Combined approach to the therapy these disorders allows to level out the clinical manifestation due to the consistent use of Clindacin B prolong and Ovipol Clio, but also improve the quality of life by individually selecting the duration estradiol therapy.

Background. Imbalances of vagina microbiota in pregnant women entail the development of bacterial vaginosis and candidal vulvovaginitis. Lactobacterial strains modulate pro-inflammatory epithelium responses to enhance resistance, which renders lactobacteria promising agents in pregnant women with elevated pH.Objectives. Assessment of the lactobacterial impact on vaginal microbiota and the course of gestation and labour.Methods. A total of 261 pregnant women were examined and separated by cohorts according to pH of vaginal fluid: ≥4.5 in cohort 1 (n = 147), <4.5 in cohort 2 (n = 114). Cohort 1 had age 29.9 (4.6) years, cohort 2 — 29.0 (4.6) years, p = 0.55. Screening: at weeks 11–14, 18–21, 30–34 and 36–41 of gestation we performed vaginal pH-metry, cervicometry, determined opportunistic pathogens and lactobacteria with mass spectrometry. Cohort 1 received lactobacteria. Statistical analyses were performed with Statistica 10.Results. In cohort 1 receiving lactobacteria, the number of women devoid of opportunistic flora increased from 31.29 to 43.53%. In cohort 2 not receiving lactobacteria, this number decreased from 53.51 to 35.09%. In cohort 1, L. jensenii (correlates with bacterial vaginosis rate) was primarily isolated in 9.52% women, and in 14.91% — in cohort 2. The rate of L. jensenii increased to 14.96% in cohort 1 (receiving lactobacteria) and decreased to 3.51% in cohort 2 (not receiving lactobacteria). A higher L. jensenii rate correlated with absent growth of opportunistic pathogens. Increasing the rate of L. crispatus (suppresses opportunistic pathogens) to 14.96% in cohort 1 lead to a 1.9-fold diminishing of active opportunistic flora. An increase of L. crispatus from 7.02 to 30.7% in cohort 2 supressed active opportunistic growth 3.9-fold at a normal baseline pH. Cervicometry values were invariant between the cohorts. Pregnancy complications were not observed under abundant lactobacterial growth. The risk of gestation loss occurred in 1.4% of women in cohort 1 and in 10.5% — in cohort 2. Abnormal labour and premature rupture of foetal membranes were more frequent in cohort 2.Conclusion. With a less favourable premorbid condition in cohort 1, vaginal changes with background lactobacterial therapy facilitate gestational health in pregnancy. Many “sterile” niches, especially the maternal generative passages, represent active low biomass environments inhabited by unique typical maternal microflora. Most remarkable is the correlation between health of vaginal microbiota and abnormal labour.

Besides the contraception the modern contraceptives have non-contraceptive effects. The ability to use the vaginal ring in patients with combined pathology as gynecological as somatic is important due to the micro-dosed of ethinyl estradiol and highly selective gestagen.