Schuruk N. Markers of infection and correction of violations of biocenosis of the vagina in the treatment of the threat of miscarriage of pregnancy

The dissertation presents a theoretical generalization and proposes a new solution to the current scientific problem of modern obstetrics and gynaecology - improvement of obstetric and perinatal consequences in pregnant women with threat of miscarriage and disorders of vaginal microbiota by development and implementation of differential diagnosis, examination of vaginal microbiota status, cytokine profile and infection markers. New aspects of the pathogenesis of pregnancy miscarriage in inflammatory and dysbiotic vaginal processes are presented. Clarified scientific data on the state of the microbiota of the vagina in first- and repeat-pregnant women with miscarriage at different gestational times. New scientific data on markers of infection in women with miscarriage are obtained, among which the high general infectious index, frequent recurrences of bacterial vaginosis, premature rupture of fetal membranes during previous pregnancy, dysbiosis in the first trimester of gestation, imbalance of pro-and anti-inflammatory cytokines. The dependence of frequency and terms of development of the threat of abortion on the nature of disorders of the vaginal microbiota has been established. Bacterial vaginosis has been shown to be associated with late reproductive loss, mixed and aerobic vaginitis increase the risk of first-trimester miscarriage. The feasibility and effectiveness of the use of oral and topical probiotic therapy in women with a difficult anamnesis of pregnancy are scientifically substantiated starting from the pre-gravid stage. The algorithm of diagnostic and treatment-and-prophylactic measures at pre-conceptual and early gestational stages for women with a miscarriage of anamnesis is improved and implemented. The findings have expanded the data on the relationship between inflammatory and dysbiotic processes of the lower genitalia with the development of pregnancy miscarriage, deepening and expanding the current understanding of the role of vaginal microbiota in the development of pregnancy risk. Application from the stage of preconception of therapeutic and prophylactic measures using probiotic therapy allows to achieve normocenosis of the vagina in 92.7% of patients, which leads to normalization of the balance of pro- and anti-inflammatory cytokines, prevents the development of placental dysfunction, and decreases the frequency of threat 2.5 times, and unauthorized termination of pregnancy 2.3 times, premature birth 4.1 times, premature rupture of the fetal membranes 2.75 times, allows to ensure the delivery of pregnancy those up to 39-40 weeks in 97.1% of pregnant women with a reduction in the incidence of fetal distress during pregnancy and childbirth 3.6 times, soft birth trauma 2.5 times and surgical delivery 2.5 times. Improving the effects of pregnancy in women with obstetric obstetric history and dysbiotic vaginal processes is achieved more successfully when carrying out a complex of therapeutic and prophylactic measures from the stage of preconception, which, due to the impact on various pathogenetic units of obstetric care vagina at 92.7% and pregnancy reporting up to 39-40 weeks at 97.1% while reducing the incidence of pregnancy complications, childbirth and surgical delivery.