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How to treat bacterial vaginosis in pregnant women. The course of bacterial vaginosis. Pregnancy management and treatment

Bacterial vaginosis during pregnancy is the most common disease of the female genital organs, characterized by a change in the nature of vaginal discharge. It develops against the background of a decrease in the number of lactobacilli and the activation of representatives of conditionally pathogenic microflora.

The disease leads to dangerous consequences, therefore, it must be eliminated in a timely manner.

Reasons for development

There are many causes of bacterial vaginosis in pregnant women, the most common of which are:

Symptoms of bacterial vaginosis during pregnancy

Gardnerellosis during pregnancy has the following symptoms:

Diagnostics

To detect gardnerella vaginalis during pregnancy, the following research methods are used:

  1. Inspection. At this stage, the first symptom of the disease is detected - abundant thick discharge with a pungent odor. The condition of the mucous membranes of the vagina remains normal.
  2. Smear. stained sample helps to identify changes characteristic of bacterial vaginosis - the predominance of epithelial cells over leukocytes, a decrease in the number of Doderlein sticks and the presence of key cells covered with pathogenic microorganisms.
  3. PCR. Used to identify the causative agent of the infection, bacteriological culture in bacterial vaginosis is uninformative.
  4. Determination of the acidity of the vagina. With dysbacteriosis, this figure is more than 4.5.

Treatment

Treatment of gardnerellosis during pregnancy is aimed at eliminating the cause of its occurrence. Examination and treatment of the sexual partner is optional. Bacterial vaginosis responds well to therapy, but in most cases reappears after a while. How to treat vaginal dysbacteriosis:

During the treatment period, a special diet is observed. Confectionery and rich products are excluded from the diet, they eat as many dairy products, fresh vegetables and fruits as possible.

Why is gardnerella dangerous during pregnancy?

If left untreated, the following consequences occur:

  1. Inflammation of the amniotic membranes. Can lead to damage or complete rupture of the bladder. In the early stages of pregnancy, a miscarriage occurs, in the later stages - premature birth. Microtraumas in the fetal membranes lead to the penetration of infections that have a negative effect on the fetus. Complications are different - from developmental delay to intrauterine death.
  2. Leakage of amniotic fluid.
  3. Accession of other infectious diseases.
  4. Postpartum complications. The most common among them is considered.
  5. Decreased immunity. The body of a pregnant woman becomes more susceptible to viruses and bacteria, which is why even a cold can lead to dangerous complications.

Prevention

In order to prevent bacterial vaginosis caused by gardnerella vaginalis, barrier contraceptives are used during pregnancy. It is necessary to give up bad habits that multiply the risk of developing the disease. It is not recommended to use flavored and antiseptic intimate hygiene products. It is necessary to regularly visit a gynecologist and take tests to help determine the state of the vaginal microflora. Before pregnancy, sexually transmitted diseases are cured.

Bacterial vaginosis is a violation of the vaginal microecosystem with a sharp decrease or complete disappearance of lactic acid bacteria and a pronounced increase (hundreds and thousands of times) in the number of opportunistic microflora. Rarely manifested by inflammation. One of the most common diseases among women of reproductive age. It is accidentally diagnosed in 17-37% of cases, in women with profuse and prolonged leucorrhoea - in 95% of cases, and in pregnant women in 15-37% of cases.

What bacteria inhabit the vagina normally?

95-98% - lactobacilli. The vast majority are lactobacilli or Dederlein rods, but apart from them there are about 40 types of acidophilus bacteria that also perform a protective function.

2-5%2,3 is conditionally pathogenic flora, which normally does absolutely no harm to the female body. The number of species belonging to conditionally pathogenic microflora is huge, and each woman has her own “set”, but there are about a dozen microorganisms present in each, and they necessarily manifest themselves in dysbacteriosis. The main bacterium is Gardnerella vaginalis - it necessarily appears with all vaginosis in all women. It is considered a kind of marker and it is on it that many laboratory tests are based.


How should it be normal?

Normally, lactobacilli break down glycogen from the cells of the squamous epithelium lining the vagina to lactic acid and hydrogen peroxide, creating an acidic pH of up to 3.8 - 4.5. An acidic environment is optimal for the growth of lactic acid bacteria and detrimental to opportunistic flora. A constantly maintained pH level is the key to a clean vagina.

Colonies of lactobacilli, together with their waste products, form a biofilm - glycocalyx, which lines the inside of the vagina and protects it.

How does the ratio of good and bad bacteria change during pregnancy?

As mentioned above, lactobacilli break down glycogen from the cells of the squamous epithelium of the vagina, which performs a barrier function. But these cells have a certain lifespan associated with hormonal changes in a woman's body.

During pregnancy, under the influence of corpus luteum hormones, squamous epithelial cells become especially numerous. An almost endless supply of glycogen, the number of lactobacilli increases, the number of opportunistic microflora decreases, and the pH level becomes even lower. The body tries to do everything possible so that by the time the child is born, the birth canal is as clean as possible, and he gets acquainted with a healthy lactic acid flora, which will settle in his intestines.

It would seem that everything should be fine, but in fact, a highly acidic environment stimulates the growth of some forms of transient infections (opportunistic pathogens) in 30% of cases, such as Candida yeast-like fungi, mycoplasma, ureaplasma, etc4,5.

What happens in bacterial vaginosis?

When exposed to one of the triggers, the number of lactobacilli in the vagina decreases. The level of lactic acid drops rapidly, pH rises, opportunistic microflora begins to multiply, primarily gardnerella, which further inhibits the vital activity of lactic acid bacteria. It turns out a "vicious circle", the result of which is either the complete death of lactobacilli, or their presence is not more than 30%. The rapid development of Gardnerella vaginalis creates favorable conditions for the growth of a mass of other pathogenic microorganisms, each of which gives some of its own specific symptoms.

Thus, bacterial vaginosis is a disease caused by many forms of microbes, not just gardnerella, as was thought until recently. Although Gardnerella vaginalis is the dominant infectious agent. By itself, bacterial vaginosis does not pose a threat to women's health, but over the years, accumulating a large number of opportunistic microflora, creates conditions for the development of inflammatory processes in the pelvic organs. Women with vaginosis are more easily infected with sexually transmitted diseases, including HIV infection, they have a hard time carrying a pregnancy and often.

Symptoms of bacterial vaginosis in pregnancy

· Profuse leucorrhoea, sometimes grey. If the disease continues for years, they may acquire a greenish-yellow color. Foamy, sticky and viscous.

· A characteristic fishy odor that intensifies after sexual intercourse, in particular after contact with semen.

· Dyspareunia is pain during intercourse.

· Pain in the lower abdomen, in the absence of any other inflammatory processes in the pelvic organs and uterine hypertonicity.

· Itching, burning, urination disorders are extremely rare, so the disease is diagnosed late and manages to deliver a number of unpleasant moments.

What causes bacterial vaginosis

· Decreased immunity

· Systemic and local antibiotic therapy

· Endocrine diseases, most often diabetes mellitus

· Treatment with hormonal and cytostatic drugs

· Malformations of the genital organs

· Anemia of various origins

· Neglect of basic hygiene rules

· The hypothesis of the transmission of bacterial vaginosis by sexual partners is not clinically confirmed and unproven.

Features of the course of bacterial vaginosis in pregnant women

Bacterial vaginosis during pregnancy is very insidious and fraught with many pitfalls. In a vaginal discharge smear, pathogenic microorganisms that exceed the permissible level can be detected, but at the same time, a woman may not present absolutely any complaints characteristic of vaginosis. Recently, it has been considered that it is not worth treating such women, but simply observing the dynamics of development. It is likely that the microecosystem of the vagina with the help of pregnancy hormones will recover itself without medical intervention. But such women are temporarily at high risk due to the possibility that they should visit the gynecologist more often and have a home

The second category of women - with abundant vaginal discharge. The most difficult in terms of diagnosis. First of all, because during pregnancy, physiological secretions increase, which can cause unreasonable anxiety and treatment. With abundant leucorrhea during pregnancy, a differential diagnosis should be made between bacterial vaginosis, candidiasis, and Since leakage in the vast majority of cases is the result of bacterial vaginosis, women at risk should have a test system at home to monitor the integrity of the amniotic membranes in order to exclude this pathology first as the most dangerous. The only home system recommended by the European Association of Obstetricians and Gynecologists today is its accuracy of 99.8% and surpasses many laboratory diagnostic methods.


If it is excluded, and this was not the cause of the sudden increase in discharge, you should consult a gynecologist and conduct an amine test for the detection of gardnerella, confirming bacterial vaginosis and take a smear to identify candida that causes thrush. When confirming the diagnosis, treatment is mandatory, since there is a huge risk of complications.

Complications of pregnancy with bacterial vaginosis

Treatment of bacterial vaginosis

Treatment is individual. It should be prescribed only by a doctor after all diagnostic measures have been taken. You can not use drugs to treat bacterial vaginosis on your own, as this can only aggravate the situation, prolong treatment in the future and increase the number of complications.

Bacterial vaginosis is a non-inflammatory disease of the vagina associated with changes in its microflora. This condition is extremely widespread among women of childbearing age (20-45 years), its occurrence in this group reaches 80%. That is, out of ten women, 8 suffer from bacterial vaginosis at least once in their lives. The disease does not pose a danger to the patient herself, but may adversely affect her reproductive function. Bacvaginosis often causes miscarriages, intrauterine infection of the fetus, complications after childbirth, abortions and invasive interventions on the genitals. How the disease is transmitted and how to get rid of it, read on.

How does bacterial vaginosis develop?

Human existence is inseparable from the activities of various microorganisms. Those of them that in the process of evolution have adapted to productive cooperation with people are called normal microflora / biocenosis. Its composition is permanent: some microorganisms are found only on the skin, others - in the oral cavity, in the intestines. In their habitat, they perform the most important functions: they protect the host body from pathogenic bacteria, produce vitamins, and stimulate the immune response.

Normally, the vagina is inhabited by lactobacilli - short thick sticks. They break down glycogen, which is rich in vaginal epithelial cells with the formation of lactic acid. Thus, in the lower genital tract of a woman, an acidic environment is constantly maintained, which prevents the fixation and growth of pathogenic microflora. To maintain normal conditions and the protective function of the vagina, a large number of lactobacilli are needed, so their share in its biocenosis is 95-98%.

Due to various reasons listed below, lactic acid bacilli are displaced and replaced by other microorganisms. This situation facilitates the colonization of the vagina by pathogenic microorganisms - the causative agents of sexually transmitted infections, but in most cases there is a change to nonspecific microflora. It includes bacteria that live on the skin of the perineum, perianal folds, in the lower urethra. They freely occupy a new habitat, multiply intensively, but cannot perform the functions of normal microflora. Their enzyme system differs from that of lactobacilli and does not break down glycogen to form lactic acid.

Nonspecific microflora causes a number of disorders in the metabolic and immune processes of the vagina as a whole. The level of production of protective immunoglobulin A decreases, which prevents pathogenic agents from attaching to the vaginal epithelium. Epithelial cells partially adsorb opportunistic bacteria on their surface and exfoliate intensively, which is associated with the appearance of secretions in bacterial vaginosis. Lactobacilli are replaced mainly by anaerobes - bacteria that function without oxygen. Some of their metabolic products - volatile fatty acids and amino acids - are broken down in the vagina into volatile amines, which have a characteristic fishy odor.

These changes lead to a shift in vaginal pH from acidic to alkaline. This entails progressive changes in the protein, carbohydrate, mineral and lipid metabolism of epithelial cells. Their production and mucus production increase, which is clinically manifested as abundant discharge - the main symptom of bacterial vaginosis. It should be noted that there is no inflammatory reaction in the walls of the vagina and all changes are only functional.

What causes disease?

Bacterial vaginosis does not belong to sexual infections and does not have a single pathogen, so it is also called nonspecific vaginosis. The root cause is a change in the vaginal environment, which entails disturbances in the microbiocenosis. The microflora that replaces lactobacilli can be very different and is most often represented by associations of opportunistic bacteria. Among them there are:

  • bacteroids;
  • peptococci;
  • peptostreptococci;
  • megaspheres;
  • leptotrichous;
  • atopobium;
  • gardnerella;

Their growth, as a rule, is excessive and the number of bacteria in the vaginal secretion reaches 10 10 per 1 ml. However, comfortable conditions for their reproduction arise only after the influence of certain factors of the external or internal environment of the body.

The main causes of bacterial vaginosis are divided into 2 large groups:

Internal (endogenous):

  1. hormonal imbalance with a predominance of progesterone;
  2. atrophy of the vaginal mucosa;
  3. intestinal dysbiosis;
  4. immune disorders in the body.

External (exogenous):

  1. long-term antibiotic treatment;
  2. drug immunosuppression - taking cytostatics, glucocorticoids;
  3. radiation therapy of tumors;
  4. foreign objects in the vagina (hygienic tampons, pessary, contraceptive diaphragm, ring);
  5. use of spermicides, frequent douching;
  6. non-compliance with the rules of personal hygiene.

All of these factors in one way or another disrupt the normal functioning of the vaginal mucosa or cause the death of a large number of lactobacilli. Thus, a niche is vacated for opportunistic microflora and it immediately occupies it.

Bacterial vaginosis during pregnancy among the main causes is a change in the hormonal status of a woman: for the normal bearing of a child, high doses of progesterone are required, which reduces the glycogen content in epithelial cells. The lack of a nutrient substrate for lactobacilli leads to alkalization of the vaginal environment and the reproduction of nonspecific microflora. In addition, progesterone reduces the activity of the immune defense, which facilitates the growth of bacterial colonies.

How does bacterial vaginosis manifest itself?

Despite the fact that the disease does not apply to sexual infections, often its occurrence is associated with sexual intercourse, especially when changing partners. Signs of bacterial vaginosis in women develop on average one day after intercourse if it occurred without a condom. If the cause of the disease was the intake of antibiotics and other drugs, a change in the hormonal background (climax), then the symptoms of bacterial vaginosis develop regardless of sexual activity.

Acute vaginosis manifests itself:

  • secretions from the genital tract: they have a grayish-white color, a homogeneous consistency, an unpleasant "fishy smell". Their number can be different, as a rule, they become more abundant after menstruation, intercourse, the use of irritating detergents;
  • pain during intercourse;
  • discomfort, itching and burning in the genitals. These signs are usually mild or absent;
  • rarely, a woman has pain, pain when urinating, a stomach ache in the suprapubic region.

Chronic bacterial vaginosis is a continuous course of the disease for more than 2 months, despite ongoing treatment. As a rule, it is combined with hormonal imbalance and atrophy of the vaginal mucosa.

Diagnostics

The diagnosis is established by a gynecologist after collecting the patient's history, studying her complaints, examining her on the gynecological chair and obtaining laboratory data. In favor of bacterial vaginosis they say:

  • age - sexually active women of reproductive age are most often ill;
  • relationship with a change of partner, treatment of other diseases, surgery;
  • moderate or mild severity of clinical signs of the disease.

On examination, the doctor evaluates the condition of the vagina, cervix, and external genitalia. With nonspecific changes, the mucous membrane is pink, not inflamed, unevenly covered with secretions. In acute bacvaginosis, they are white-gray, with an unpleasant odor. If the disease has passed into the chronic stage and lasts for several years, then the discharge changes its color to yellowish-green, becomes thicker, viscous, resembles cottage cheese or has a frothy appearance. During the examination, the gynecologist measures the pH of the vagina with an indicator strip: with bacterial vaginosis, its value is above 6.

There is a simple but informative test for express diagnosis of bacterial vaginosis. The doctor places a small amount of secretions on a glass slide and mixes it with a 10% solution of caustic potassium. With a positive reaction, the unpleasant odor intensifies and resembles rotten fish.

Laboratory diagnosis of bacterial vaginosis consists of microscopy of stained smears from the vagina. Key cells are found in them - epithelial cells of the mucous membrane with microbial bodies adhered to their surface. The cell acquires a granular appearance, its boundaries become fuzzy, dotted. Also, with microscopy, a sharp decrease in the number of lactobacilli is established, up to complete disappearance from the population. Instead, nonspecific microflora is found: single cocci, streptococci, small rods.

Bacteriological culture of secretions is carried out in rare cases when it is necessary to accurately determine the composition of the altered microflora. The PCR method searches for the most common pathogens of sexual infections (mycoplasma,), as they often join the opportunistic microflora.

How does the disease affect conception and pregnancy?

Since bacterial vaginosis is a pathology of women of childbearing age, many of them are concerned about the question: is it possible to get pregnant with a similar diagnosis? A change in the microflora of the vagina does not entail inflammatory changes in the genital tract, therefore, it does not pose a problem for conceiving a child. Sperm normally has an alkaline environment and when it enters the vagina, with a changed pH upwards, the spermatozoa are in comfortable conditions for them.

What is the danger of bacterial vaginosis in this case? Nonspecific microflora often penetrates the pregnant uterus and affects the developing child. This condition is called intrauterine infection of the fetus and entails consequences in the form of a lack of body weight, its developmental delay. In some cases, the infection leads to spontaneous miscarriage, premature rupture of amniotic fluid, and the birth of a premature baby. With bacvaginosis, the risk of sepsis and purulent complications in parturient women increases, especially after cesarean section.

Treatment

Treatment of bacterial vaginosis is carried out by a gynecologist, if necessary, the patient is additionally observed by an endocrinologist and a gastroenterologist. Hospitalization for this disease is not required, since it does not disturb the woman's well-being, does not threaten her life and is not contagious to others. The therapy is aimed at sanitizing the vagina from opportunistic microflora, colonizing it with lactobacilli and correcting the provoking factors of the disease. Acute bacterial vaginosis recurs in 35-50% of women in the first six months after one-stage treatment, so it must be carried out in stages, observing the timing of each stage.

Initially, a woman is prescribed antibiotics: they have a detrimental effect on non-specific bacteria and cleanse the vaginal mucosa from them. The drugs of choice are Metronidazole, Tinidazole, Clindamycin, as they are active against anaerobes. Local use of antibiotics is preferable to avoid systemic side effects, but in some cases the gynecologist is forced to resort to tablet forms. The treatment regimen is selected individually:

  • Metronidazole in the form of a 0.75% gel is injected into the vagina once a day for 5 days;
  • cream with 2% content of Clindamycin is injected into the vagina 1 time per day for 7 days;
  • Tinidazole 2.0 in the form of tablets is taken orally 1 time per day for 3 days;
  • suppositories with Clindamycin 100 mg are injected into the vagina 1 time per day for 3 days;
  • Metronidazole 2.0 tablets is taken orally once.

In pregnant women with bacterial vaginosis, the use of antibiotics is possible starting from the second trimester. They are prescribed in the form of tablets, the course of treatment lasts no more than 7 days.

For the duration of antibiotic therapy and the day after its completion, it is necessary to exclude alcohol intake, even in minimal doses. The drugs disrupt the metabolism of ethyl alcohol in the body, due to which the accumulation of toxic metabolites occurs and severe intoxication develops. In its course, it resembles a severe hangover: a woman experiences severe weakness, limbs tremble, blood pressure rises, a severe throbbing headache occurs, excruciating nausea and vomiting develop.

Clindamycin cream contains fat and may damage condoms or latex contraceptive membranes. All local forms of drugs are administered immediately before bedtime to prevent them from running down the walls of the vagina.

In case of intolerance to antibiotics or the presence of contraindications to their use, the first stage of treatment is carried out with local antiseptics:

  • Hexicon 1 suppository is administered 2 times a day for 7-10 days;
  • Miramistin in the form of a solution irrigates the vagina once a day for 7 days.

Preparations for bacterial vaginosis used in the second stage of treatment contain lactobacilli and create favorable conditions for the restoration of the vaginal microflora. They are used 2-3 days after the completion of antibiotic therapy:

  • Atsilakt 1 suppository 2 times a day is injected into the vagina for 5-10 days;
  • Bifiliz 5 doses are taken orally 2 times a day for 5-10 days.

Antifungal suppositories for bacterial vaginosis are usually not prescribed. The need for them arises if a fungal infection joins the conditionally pathogenic microflora. In this case, clotrimazole suppositories are prescribed 1 time per day intravaginally for 6 days.

Self-treatment at home is not recommended, since an incorrectly selected dose of the drug or the duration of the course leads to the development of resistance in bacteria. In the future, it will be extremely difficult to cure such an infection and there will be a high risk of its chronic course. How to treat bacterial vaginosis in each case is best determined only by a specialist - a gynecologist.

How to prevent?

Despite the negative answer to the question "is bacvaginosis sexually transmitted", the influence of changing sexual partners and unprotected sex on the development of the disease is clearly seen. Therefore, the main prevention is the use of barrier contraception - a condom, which can be supplemented with local antiseptics. Douching with Miramistin should be carried out no later than 2 hours after sexual intercourse. In addition, preventive measures include the timely treatment of chronic diseases, the use of antibiotics strictly according to the doctor's prescription, and the correction of hormonal disorders.

Bacterial vaginosis (sometimes the term "gardnerellosis" is used) is a violation of the vaginal microflora in the direction of reducing the number of lactic acid bacilli. Under these conditions, another, often pathogenic flora is activated, which can harm a developing baby in utero. Why does bacterial vaginosis occur, why is it dangerous for a pregnant woman and how to treat it correctly and safely?

Read in this article

Causes of bacterial vaginosis in the early stages

Often, bacterial vaginosis occurs unnoticed by a woman even before pregnancy. And if she did not undergo thorough preparation and examination the day before, there are many reasons why the pathology will be revealed only during gestation.

Bacterial vaginosis can develop in two cases:

  • In the absence of sexual infection. Often in such situations, a woman has other diseases that provoke this condition, for example, diabetes mellitus, hypothyroidism, and others.
  • Against the background of some sexual infection. At the same time, signs of STIs may be absent or be minimal and not attract attention.

During gestation, the activity of a woman's immunity decreases. This is necessary for the successful growth and development of a baby that is half alien in terms of genetic material. However, this leads to an increase in the likelihood of various infectious diseases, exacerbation of chronic pathology in women.

Under the influence of this, the number of Dederlein sticks in the vagina is somewhat reduced. Namely, they are the main "guardians" of normal flora and protection against infections. Therefore, during gestation, some women so often experience episodes or bacterial vaginosis. But you can never rule out the presence of some latent sexual infection.

The following factors can trigger the development of bacterial vaginosis during pregnancy:

  • Chronic diseases of the intestines, endocrine organs, urinary system and others. It is important that during gestation all of them are in a compensated state, otherwise it will be difficult for the body to cope with increased stress.

Especially often, bacterial vaginosis appears when (including with a latent course), when the thyroid gland (hypothyroidism) is disrupted, when there is a change in the work of the adrenal cortex and some others.

  • If antibacterial drugs are prescribed during pregnancy, this can also provoke a change in the vaginal flora. The result is thrush or bacterial vaginosis. Therefore, for prophylactic purposes, it is necessary to prescribe funds simultaneously with antibiotics to maintain the vaginal flora.
  • If there are any diseases of the cervix (erosion, ectopia, etc.).
  • With promiscuity, as well as oral, anal and other not quite traditional types of intimate relationships. Flora from these areas enters the vagina and immediately disturbs the delicate balance that exists there.
  • With excessive intimate hygiene, when beneficial microbes are simply “washed away”.
  • If you regularly wear synthetic underwear.
  • Also, the risk of getting sick is higher with the omission of the genital organs, even a slight one. Normally, the labia minora should cover the entrance to the vagina. This is a kind of protection. When the vaginal wall prolapses, it can come into contact with the environment, "absorbing" all microbes.

Symptoms in the expectant mother

If bacterial vaginosis in a girl is not associated with a sexual infection, then all the symptoms are quite meager. Most often, the pathology in this case is detected at the next examination after taking smears. But if you closely monitor your own health, you can notice the following:

  • Unpleasant "fishy" smell. Normally, vaginal discharge has a slightly sour tint.
  • Increasing whites. In this case, the discharge remains mucous, but can become whitish, viscous.
  • Beli can irritate the external genitalia, the inner surface of the skin of the thigh. This will lead to itching, burning in these places.

If bacterial vaginosis occurs against the background of some kind of sexual infection, then, among other things, the following may also be observed:

  • Leucorrhea can be yellowish, milky, greenish and frothy.
  • Against this background, pulling pains in the lower abdomen may appear as a symptom of a threat during an infection.
  • Pain during intercourse.
  • Discomfort, pain during urination, increased urge.

What is dangerous vaginosis of mother and baby

Timely diagnosis and treatment of bacterial vaginosis will not bring much danger to mother and baby. Also, in most cases, an independent recovery of the body occurs when the provoking factors are eliminated. For example, after a period of time after a course of antibiotics, etc.

Of particular danger are forms of vaginosis in the presence of any STI. In addition, every day of delay in treatment can be the cause of the following conditions:

  • non-developing pregnancy at different times;
  • and premature birth;
  • leakage of amniotic fluid ahead of schedule;
  • and fetal hypoxia;
  • chorioamnionitis - inflammation of the membranes and many others.

Therefore, it is important to carry out timely and complete diagnosis for subsequent effective treatment.

Watch the video about bacterial vaginosis:

Diagnosis during pregnancy

Diagnosis of the disease includes laboratory methods and traditional examinations. The following is done:

  • Standard gynecological examination. At the same time, the doctor notes the abnormal nature of the discharge, their special “fishy” smell. Informative conduct aminotest. To do this, put some vaginal discharge on a glass slide and add potassium hydroxide. The “fishy” smell will intensify many times over.
  • Sampling of material from the posterior fornix of the vagina for microscopic examination. This is a normal smear on the flora. With bacterial vaginosis, the following changes occur in it: a normal or increased content of leukocytes, the appearance of gardnerella and often key cells, a decrease in the number of Dederlein sticks, abundant mucus, possibly fungi.
  • PCR diagnostics to clarify the presence/absence of other infections, since often vaginosis is just a "background" for more serious diseases.
  • Sowing the contents of the vagina on the flora, taking into account the sensitivity of pathogens to antibacterial drugs. So it will be possible to find out which microbes have violated the normal biocenosis of the vagina and how it is most rational to get rid of them.

Early treatment

Therapy for bacterial vaginosis in early pregnancy should be selected in such a way as to cause minimal impact on the still developing baby.

The first trimester in this regard is the most difficult, since it is undesirable to use many drugs.

First of all, you should try to identify the factors provoking the disease. If it is diabetes mellitus, it is more difficult to control the level of blood glucose, in case of disruption of the intestines, monitor stools, nutrition, and similarly treat all chronic pathologies.

Secondly, it is necessary to use topical drugs. Most often, these are suppositories or vaginal tablets and capsules. In a hospital setting, baths with hydrogen peroxide, chlorhexidine and other safe agents can be used.

In the first trimester, it is harmless and effective to use the following drugs:

  • based on chlorhexidine;
  • iodine-based suppositories - Povidone-iodine, Betadine and others.

Classical treatment of bacterial vaginosis based on metronidazole is allowed only from the second trimester of pregnancy.

If this treatment does not help, and if an additional infection is detected according to the test results, therapy should be expanded with antifungal agents. The following are often used:

  • candles Ginezol, Pimafutsin to combat yeast fungi;
  • tablets Azithromycin, Josamycin, Ampicillin and others, taking into account sensitivity and safety.

You should also use drugs for the general normalization of the microflora in the vagina and intestines. It can be suppositories, tablets or solutions. Bioflor, Laktozhinal, Vaginorm, Atsilakt and others are popular.

Preventive treatment in case of detection of STIs should also be given to the sexual partner.

Prevention of the appearance

It is not always possible to prevent the occurrence of vaginosis during pregnancy. The main thing is to diagnose and treat it in time. The main recommendations are:

  • Pregnancy should be planned and undergo a comprehensive examination the day before.
  • It is useful to monitor the work of the intestines, eat more vegetables, less - sweets, fast foods, etc.
  • It is better to wear underwear only from natural fabrics. After all, many bacteria die on contact with atmospheric air.
  • During treatment with serious, in particular, antibacterial drugs, one should not wait for the development of dysbiosis, but carry out its prevention in advance.
  • Useful all the techniques to increase the body's defenses during gestation.

Pregnancy after bacterial vaginosis

Timely detection, comprehensive examination and competent treatment will minimize any further complications of pregnancy. Sometimes a woman without any consequences can go through this problem several times during the entire period of gestation.

But if treatment is delayed or incomplete, the likelihood of infectious complications during pregnancy increases.

During gestation, women often have to deal with bacterial vaginosis and thrush. These are the first signals of a decrease in local immunity, activation of opportunistic flora and exacerbation of chronic pathology. Correct diagnosis and treatment will help avoid pregnancy complications and get rid of problems.

Bacterial vaginosis occurs in every 2-3 pregnant women. This pathology is infectious non-inflammatory in nature. The disease must be treated even if there are no symptoms, as it can lead to unpleasant consequences during pregnancy.

What is bacterial vaginosis?

This disease is also called gardnerellosis or vaginal dysbacteriosis. With bacterial vaginosis, the microflora of the vagina is disturbed, namely, the number of beneficial lactic acid bacteria decreases. This state provides a favorable environment for the reproduction of pathogenic microbes - gardnerella and anaerobes.

With bacterial vaginosis, one or more types of microorganisms can develop - in total, more than 200 of them are isolated with such a disease. Such a variety does not always allow us to identify the exact type of bacteria.

You should know that in each case of bacterial vaginosis, the microflora is unique in composition, but gardnerella are almost always detected - the most common pathogenic microorganisms.

Causes of bacterial vaginosis in pregnant women

Bacterial vaginosis begins for a single reason - a change in the microflora. Many factors can cause this phenomenon:

  • drug therapy: most often a change in the microflora associated with the use of antibiotics, hormonal drugs, antifungal and antimicrobial agents;
  • hormonal changes that occur during pregnancy;
  • problems with the endocrine system;
  • antimicrobial intimate hygiene products containing triclosan;
  • wearing synthetic underwear (especially thongs);
  • vaginal douching (especially with soda or antiseptics);
  • non-compliance with intimate hygiene;
  • intestinal dysbacteriosis;
  • severe or chronic stress;
  • climate change;
  • the course of pregnancy with complications;
  • entry into the vagina of a foreign body;
  • new sexual partner;
  • inflammatory process in the reproductive system (currently or earlier);
  • high sexual activity;
  • unhealthy diet and bad habits.

Symptoms

The main symptom of bacterial vaginosis is a moderate (sometimes large) amount of vaginal discharge accompanied by an ammonia smell. It is usually characterized as the smell of rotten fish.

The first months the disease is manifested by liquid secretions of white or grayish color. On gynecological examination, the vaginal mucosa has a normal pink color. In rare cases, individual red dots can be found.

If bacterial vaginosis has been occurring for many months, then its symptoms become more pronounced:

  • discharges change in consistency: they can be cheesy or mucous;
  • the color of the discharge also changes, becoming yellow-green;
  • uniform distribution of secretions along the walls of the vagina: they are quite thick and sticky, they can foam;
  • secretions become much larger in volume: at a rate of 2-4 ml, their number can even increase 10 times;
  • bacterial vaginosis that has begun for a long time leads to burning, itching in the vagina, but these unpleasant sensations may be absent altogether or appear periodically;
  • pain may occur during intercourse;
  • sometimes the process of urination is upset (it becomes more frequent and becomes painful);
  • with bacterial vaginosis during pregnancy, pain in the lower abdomen may occur.

Diagnostics

To confirm bacterial vaginosis, three stages of diagnosis are sufficient:

  1. Inspection. At this stage, vaginosis is suspected if there is a foul-smelling discharge. But in some cases they may be missing.
  2. Smear. A microscopic (bacterioscopic) examination of a Gram-stained smear is carried out. The vaginosis specimen shows a predominance of epithelial cells over leukocytes, a decrease in the volume of Doderlein rods, and visualization of specific cells. They are called key - it is on them that pathogenic microbes are found.
    Bakposev (cultural study) on Gardnerella vaginalis is not informative; in difficult cases, it is possible to carry out only a PCR analysis for gardnerella.
  3. Acidity. This stage of diagnosis means determining the pH of the environment in the vagina. If the pH is greater than 4.5, then bacterial vaginosis occurs.

The main direction of treatment of the disease is a course of antibiotics. It is usually assigned only from the second trimester of pregnancy, since in the first months the fetus is especially susceptible to all kinds of medicines. Typically, bacterial vaginosis is treated with one of the following medications:

  • metronidazole (Klion or Trichopol tablets) - 250 mg 2 times a day for 7 days;
  • ornidazole (Tiberal) - 250 mg 2 times a day for 5 days.

Antibiotics may not completely kill opportunistic bacteria. It should be borne in mind that their presence (a small percentage) is the norm for every woman.

To recreate a normal vaginal environment, special vaginal capsules are prescribed (Vaginorm, Acilact, Lactobacterin, Laktozhinal, Bifikol or Bifidumbacterin, for example).

You need to know that you need to treat bacterial vaginosis only under the supervision of a doctor. In the course of timely therapy, it is important to restore the normal microflora of the vagina.

They also restore the intestinal microflora with the help of bifidus and lactobacilli.

When diagnosed with bacterial vaginosis, it must be remembered that the prescribed treatment must be continued to the end, even if there were no symptoms of the disease initially or they disappeared during therapy.

Pregnant women in the first trimester if necessary, prescribe drugs in the form of candles. Their advantage is in local action - the active components do not have a systemic effect on the body, as happens when taking medications orally.

For the treatment of bacterial vaginosis, not only drug therapy is important, it is important to pay attention to your diet. It is necessary to add fermented milk products to it. Sugar and products containing it will have to be abandoned for a while.

Sexual contact during treatment, the doctor usually prohibits or recommends barrier contraception (condoms).

The danger of untreated vaginosis for pregnant women

If bacterial vaginosis is not detected in a timely manner and correct therapy is not carried out, then there is a significant risk for both the mother and the fetus:

  • Inflammation of the fetal bladder (chorioamnionitis). The inflammatory process can lead to a micro-rupture or even a complete rupture of the bladder. This can result in miscarriage or premature birth.
  • When a microrupture appears in the fetal bladder, there is a risk of infection entering the amniotic fluid. This can lead to infection of the fetus. The consequences in this case are unpredictable - from the developmental delay of the fetus to the spread of sepsis and fetal death.
  • If a “crack” appears in the fetal bladder, then amniotic fluid may leak - this is detrimental to the unborn baby.
  • Against the background of undertreated dysbacteriosis, another inflammatory infection may develop.
  • If bacterial vaginosis is not completely cured, then complications may arise during childbirth, and it is impossible to predict their nature in advance (most often women who have refused treatment or have not gone through it completely and conscientiously suffer from postpartum metroendometritis).
  • Reduced immunity in vaginal dysbacteriosis makes the body more susceptible to many diseases. Even a common cold can result in severe complications.

Can you get pregnant with bacterial vaginosis?

Conception in the presence of bacterial vaginosis is a controversial issue. On the one hand, this disease changes the microflora of the vagina. Spermatozoa in it can die rapidly, so the possibility of conception is reduced.

On the other hand, there are many cases where such a disease did not prevent conception in the least. Thus, we can say that the possibility of conception with bacterial vaginosis is an individual matter.

It is important to know that bacterial vaginosis itself is not particularly dangerous, unlike the complications it causes. It can be various diseases, up to infertility.

It is possible to conceive with bacterial vaginosis, but you should not do this. It is best to treat the disease first, and then plan to replenish the family. Treatment during pregnancy is complicated by the fact that most drugs cannot be used in the first months. Meanwhile, the development of the disease can lead to various complications, including those of the fetus, if intrauterine infection occurs.

Every woman planning a pregnancy must first undergo a comprehensive examination, pass various tests, and cure existing diseases. Only this will be the key to a normal pregnancy.

Video about bacterial vaginosis during pregnancy

The obstetrician tells about the possible danger, the causes of development, diagnosis and treatment of the disease during pregnancy in this video:

Bacterial vaginosis is a fairly common disease. It is necessary to contact a specialist at the first symptoms, and the prescribed treatment should be completed to the end.