Email this article Anamnestic and microbiological predictors of miscarriage
- Authors: Sinyakova A.A.1, Shipitsyna E.V.1,2, Budilovskaya O.V.1,2, Bolotskikh V.M.1,2,3, Savicheva A.M.1,2
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Affiliations:
- The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott
- Saint Petersburg State Pediatric Medical University
- Saint Petersburg State University
- Issue: Vol 68, No 2 (2019)
- Pages: 59-70
- Section: Original study articles
- URL: https://bakhtiniada.ru/jowd/article/view/12946
- DOI: https://doi.org/10.17816/JOWD68259-70
- ID: 12946
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Abstract
Hypothesis/aims of study. Miscarriage is a significant medical and social problem. The etiology of pregnancy losses is diverse and depends on many factors. It is believed that dysbiotic disorders of the vagina are one of the main causes of this pathology. While the etiopathogenesis of miscarriage is actively studied, many questions still remain open. The aim of the study was to investigate anamnestic and microbiological predictor factors of miscarriage.
Study design, materials, and methods. In a prospective cohort study, 159 pregnant women were examined in the first trimester of pregnancy: the anamnesis, course of pregnancy, vaginal microflora, and present pregnancy outcome were studied. The vaginal microflora was analyzed using microscopic, bacteriological and quantitative real-time PCR methods. Depending on the present pregnancy outcome, the patients were divided into two groups: those delivered at term and women with early and late miscarriage. The analysis of predictors of miscarriage of the ongoing pregnancy was performed depending on the period of delivery.
Results. The rate of miscarriage in women was 13%. The independent predictors of early miscarriage were chronic endometritis (OR 10.54; 95% CI 2.54 to 43.64), the dominance of Lactobacillus iners in the vaginal microflora (OR 8.52; 95% CI 2.07 to 35.05), and the prevalence of non-Lactobacillus species in microscopy of vaginal preparations (OR 4.50; 95% CI 1.02 to 19.69). The dominance of Lactobacillus crispatus was a significant protective factor of late miscarriage (OR 0.20; 95% CI 0.04 to 0.99).
Conclusion. The undertaken analysis revealed significant associations of a number of anamnestic and microbiological predictor factors with miscarriage, which will enable to substantiate approaches for predicting pregnancy outcomes at different gestational age and to develop methods of pre-conception care and treatment in women with different risk of miscarriage.
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##article.viewOnOriginalSite##About the authors
Anna A. Sinyakova
The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott
Author for correspondence.
Email: annakizeeva@yandex.ru
Post-Graduate Student
Russian Federation, Saint PetersburgElena V. Shipitsyna
The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; Saint Petersburg State Pediatric Medical University
Email: shipitsyna@inbox.ru
PhD, DSci (Biology), Leading Researcher. The Laboratory of Microbiology; Professor. The Department of Clinical Laboratory Diagnostics, the Faculty of Postgraduate and Additional Professional Education
Russian Federation, Saint PetersburgOlga V. Budilovskaya
The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; Saint Petersburg State Pediatric Medical University
Email: o.budilovskaya@gmail.com
Researcher. The Laboratory of Microbiology; Assistant. The Department of Clinical Laboratory Diagnostics, the Faculty of Postgraduate and Additional Professional Education
Russian Federation, Saint PetersburgVyacheslav M. Bolotskikh
The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; Saint Petersburg State Pediatric Medical University; Saint Petersburg State University
Email: iagmail@ott.ru
MD, PhD, DSci (Medicine), Deputy Director for Clinical Care; Associate Professor; Professor. The Department of Obstetrics, Gynecology, and Reproductive Sciences, Medical Faculty
Russian Federation, Saint PetersburgAlevtina M. Savicheva
The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; Saint Petersburg State Pediatric Medical University
Email: savitcheva@mail.ru
MD, PhD, DSci (Medicine), Professor, Honoured Scholar of the Russian Federation, the Head of the Laboratory of Microbiology; the Head of the Department of Clinical Laboratory Diagnostics. The Faculty of Postgraduate and Additional Professional Education
Russian Federation, Saint PetersburgReferences
- Айламазян Э.К., Кулаков В.И., Радзинский В.Е., Савельева Г.М. Акушерство. Национальное руководство. — М.: ГЭОТАР-Медиа, 2014. — 1200 с. [Aylamazyan EK, Kulakov VI, Radzinskiy VE, Savel’eva GM. Akusherstvo. Natsional’noe rukovodstvo. Moscow: GEOTAR-Media; 2014. (In Russ.)]
- Giakoumelou S, Wheelhouse N, Cuschieri K, et al. The role of infection in miscarriage. Hum Reprod Update. 2016;22(1):116-133. https://doi.org/10.1093/humupd/dmv041.
- Holst RM, Jacobsson B, Hagberg H, Wennerholm UB. Cervical length in women in preterm labor with intact membranes: relationship to intra-amniotic inflammation/microbial invasion, cervical inflammation and preterm delivery. Ultrasound Obstet Gynecol. 2006;28(6):768-774. https://doi.org/10.1002/uog.3837.
- McClure EM, Goldenberg RL. Infection and stillbirth. Semin Fetal Neonatal Med. 2009;14(4):182-189. https://doi.org/10.1016/j.siny.2009.02.003.
- Mendz GL, Kaakoush NO, Quinlivan JA. Bacterial aetiological agents of intra-amniotic infections and preterm birth in pregnant women. Front Cell Infect Microbiol. 2013;3:58. https://doi.org/10.3389/fcimb.2013.00058.
- Плясунова М.П., Хлыбова С.В. Хронический эндометрит как одна из актуальных проблем в современной гинекологии // Вятский медицинский вестник. — 2013. — № 1. — С. 44–53. [Plyasunova MP, Khlybova SV. Chronic endometritis as one of current problems in modern ginecologyrasprostranennost’ osteoporoticheskikh perelomov sredi zhiteley respubliki Buryatiya 40 let i starshe. Medical newsletter of Vyatka. 2013;(1):44-53. (In Russ.)]
- Семенцова Н.А. Клинико-морфологические аспекты ранних репродуктивных потерь: Дис. … канд. мед. наук. — М., 2013. [Sementsova NA. Kliniko-morfologicheskie aspekty rannikh reproduktivnykh poter’. [dissertation]. Moscow; 2013. (In Russ.)]
- Cicinelli E, Ballini A, Marinaccio M, et al. Microbiological findings in endometrial specimen: our experience. Arch Gynecol Obstet. 2012;285(5):1325-1329. https://doi.org/10.1007/s00404-011-2138-9.
- Cicinelli E, De Ziegler D, Nicoletti R, et al. Poor reliability of vaginal and endocervical cultures for evaluating microbiology of endometrial cavity in women with chronic endometritis. Gynecol Obstet Invest. 2009;68(2):108-115. https://doi.org/10.1159/000223819.
- Donders GG, Van Calsteren K, Bellen G, et al. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG. 2009;116(10):1315-1324. https://doi.org/10.1111/j.1471-0528.2009.02237.x.
- Macklaim JM, Gloor GB, Anukam KC, et al. At the crossroads of vaginal health and disease, the genome sequence of Lactobacillus iners AB-1. Proc Natl Acad Sci U S A. 2011;108 Suppl 1:4688-4695. https://doi.org/10.1073/pnas.1000086107.
- Lamont RF, Taylor-Robinson D. The role of bacterial vaginosis, aerobic vaginitis, abnormal vaginal flora and the risk of preterm birth. BJOG. 2010;117(1):119-120. https://doi.org/10.1111/j.1471-0528.2009.02403.x.
- Donders GGG, Vereecken A, Bosmans E, et al. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG. 2002;109(1):34-43. https://doi.org/10.1111/j.1471-0528.2002.00432.x
- Donders G, Bellen G, Rezeberga D. Aerobic vaginitis in pregnancy. BJOG. 2011;118(10):1163-1170. https://doi.org/10.1111/j.1471-0528.2011.03020.x.
- Агаджанова A.A. Современные методы терапии с привычным невынашиванием беременности // РМЖ. — 2003. — № 1. — С. 3–6. [Agadzhanova AA. Sovremennye metody terapii s privychnym nevynashivaniem beremennosti. RMZh. 2003;(1):3-6. (In Russ.)]
- Garland SM, Nı́ Chuileannáin F, Satzke C, Robins-Browne R. Mechanisms, organisms and markers of infection in pregnancy. J Reprod Immunol. 2002;57(1-2):169-183. https://doi.org/10.1016/s0165-0378(02)00018-9.
- Andrews WW, Goldenberg RL, Hauth JC, et al. Endometrial microbial colonization and plasma cell endometritis after spontaneous or indicated preterm versus term delivery. Am J Obstet Gynecol. 2005;193(3 Pt 1):739-745. https://doi.org/10.1016/j.ajog.2005.02.128.
- Сидельникова В.М. Невынашивание беременности — современный взгляд на проблему // Российский вестник акушера-гинеколога. — 2007. — Т. 7. — № 2. — С. 62–65. [Sidel’nikova VM. Miscarriage: the present view of the problem. Rossiiskii vestnik akushera-ginekologa. 2007;7(2):62-65. (In Russ.)]
- Цыпурдеева Н.Д. Оптимизация лечения хронического эндометрита пациенток с неэффективными протоколами экстракорпорального оплодотворения в анамнезе: Автореф. дис. … канд. мед. наук. — СПб., 2018. [Tsypurdeeva ND. Optimizatsiya lecheniya khronicheskogo endometrita patsientok s neeffektivnymi protokolami ekstrakorporalnogo oplodotvoreniya v anamneze. [dissertation]. Saint Petersburg; 2018. (In Russ.)]
- Аржанова О.Н., Кошелева Н.Г. Этиопатогенез невынашивания беременности // Журнал акушерства и женских болезней. — 2004. — Т. 53. — № 1. — С. 37–41. [Arzhanova ON, Kosheleva NG. Etiopatogenez nevynashivaniya beremennosti. Journal of Obstetrics and Women’s Diseases. 2004;53(1): 37-41. (In Russ.)]
- Macklaim JM, Gloor GB, Anukam KC, et al. At the crossroads of vaginal health and disease, the genome sequence of Lactobacillus iners AB-1. Proc Natl Acad Sci U S A. 2011;108 Suppl 1:4688-4695. https://doi.org/10.1073/pnas.1000086107.
- Petricevic L, Domig KJ, Nierscher FJ, et al. Characterisation of the vaginal Lactobacillus microbiota associated with preterm delivery. Sci Rep. 2014;4:5136. https://doi.org/10.1038/srep05136.
- Rampersaud R, Planet PJ, Randis TM, et al. Inerolysin, a cholesterol-dependent cytolysin produced by Lactobacillus iners. J Bacteriol. 2011;193(5):1034-1041. https://doi.org/10.1128/JB.00694-10.
- Kindinger LM, Bennett PR, Lee YS, et al. The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk. Microbiome. 2017;5(1):6. https://doi.org/10.1186/s40168-016-0223-9.
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