Uticaj bakterijske vaginoze na nedelju završetka porođaja i biohemijske markere inflamacije u serumu

  • Ana Jakovljević Center for Laboratory Medicine, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Mirjana Bogavac Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Department of Obstetrics and Gynecology, Clinical Center of Vojvodina, Novi Sad, Serbia
  • Aleksandra Nikolić Center for Laboratory Medicine, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Mirjana Milošević Tošić Center for Laboratory Medicine, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Zoran Novaković Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Zoran Stajić Clinical of Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
DOI: https://doi.org/10.2298/4256
Ključne reči: pregnancy||, ||trudnoća, vaginosis, bacterial||, ||vaginoza, bakterijska, premature birth||, ||porođaj, prevremeni, risk factors||, ||faktori rizika, biological markers||, ||biološki pokazatelji,

Sažetak


Uvod/Cilj. Prevremeni porođaj predstavlja jednu od najčešćih akušerskih komplikacija, i kod 75–80% slučajeva uzročnik je neonatalnog mortaliteta. Bakterijska vaginoza smatra se značajnim faktorom rizika od prevremenog porođaja, prevremene rupture plodovih ovojaka i pobačaja. Nastaje kao posledica redukcije laktobacila koji proizvode protektivni H2O2, sa preovladavanjem anaerobnih, gram-negativnih i drugih nepovoljnih bakterija. Cilj ovog rada bio je da se utvrdi da li bakterijska vaginoza kod trudnica ima uticaja na nedelju završetka porođaja kao i na biohemijske markere inflamacije u serumu. Metode. Studija je obuhvatila ukupno 186 trudnica, između 16. i 19. nedelje gestacije. Ispitanice su bile podeljene na grupu sa dokazanom bakterijskom vaginozom po Amselovim i Njudžentovim kriterijumima (n = 76) i kontrolnu grupu sa normalnom bakterijskom florom (n = 110). Svim trudnicama je urađen ultrazvučni pregled, uzet bris vaginalnog sekreta i uzorak krvi za određivanje biohemijskih markera inflamacije kolorimetrijskim metodama. Rezultati. Nedelja završetka porođaja bila je statistički značajno kraća kod trudnica sa bakterijskom vaginozom u odnosu na kontrolnu grupu, dok su biohemijski markeri inflamacije, C-reaktivni protein i fibrinogen, bili statistički značajno viši u ispitivanoj grupi nego u kontrolnoj grupi. Takođe, vrednosti mokraćne kiseline i ukupnih leukocita bile su više u ispitivanoj u odnosu na kontrolnu grupu. Zaključak. Naša istraživanja ukazuju na znatno raniji završetak porođaja kod trudnica sa bakterijskom vaginozom, kao i na to da više vrednosti biohemijskih markera inflamacije u serumu ispitivane grupe, slično drugim istraživanjima, sugerišu da se patofiziološki procesi odgovorni za prevremeni porođaj mogu javiti vrlo rano u trudnoći.

Biografije autora

Ana Jakovljević, Center for Laboratory Medicine, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
asistent katedre za patolosku fiziologiju Medicinskog fakulteta u Novom Sadu, specijalizant nuklearne medicine, centra za laboratorijsku medicinu Klinickog centra Vojvodine
Mirjana Bogavac, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Department of Obstetrics and Gynecology, Clinical Center of Vojvodina, Novi Sad, Serbia
Professor on department of Gynecology and Obstetrics, Specialist in Gynecology and Obstetrics.
Aleksandra Nikolić, Center for Laboratory Medicine, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Assistant professor department of biochemistry, Specialist in biochemistry.
Mirjana Milošević Tošić, Center for Laboratory Medicine, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Assistent  Professor Departmet of biochemistry, Specialist in biochemistry
Zoran Stajić, Clinical of Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Assistent Professor, Clinic of Cardiology

Reference

Leitich H, Kiss H. Asymptomatic bacterial vaginosis and inter-mediate flora as risk factors for adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 2007; 21(3): 375−90.

Klebanoff MA, Hillier SL, Nugent RP, MacPherson CA, Hauth JC, Carey CJ, et al. Is bacterial vaginosis a stronger risk factor for preterm birth when it is diagnosed earlier in gestation. Am J Obstet Gynecol 2005; 192(2): 470−7.

Carey JC, Klebanoff MA. Is a change in the vaginal flora asso-ciated with an increased risk of preterm birth. Am J Obstet Gynecol 2005; 192:1341−6; discussion 1346-7.

Nelson DB, Macones G. Bacterial vaginosis in pregnancy: current findings and future directions. Epidemiol Rev 2002; 24(2): 102−8.

Donders GG, Bosmans E, Dekeersmaecker A, Vereecken A, van Bulck B, Spitz B. Pathogenesis of abnormal vaginal bacterial flora. Am J Obstet Gynecol 2000; 182(4): 872−8.

Bogavac M, Brkić S, Simin N, Grujić Z, Bozin B. Do bacterial va-ginosis and chlamydial infection affect serum cytokine level. Srp Arh Celok Lek 2010; 138(7−8): 444−8.

Guerra B, Ghi T, Quarta S, Morselli-Labate AM, Lazzarotto T, Pilu G, et al. Pregnancy outcome after early detection of bacterial vaginosis. Eur J Obstet Gynecol Reprod Biol 2006; 128(1−2): 40−5.

Oakeshott P, Hay P, Hay S, Steinke F, Rink E, Kerry S. Associa-tion between bacterial vaginosis or chlamydial infection and miscarriage before 16 weeks' gestation: prospective community based cohort study. BMJ 2002; 325(7376): 1334.

Donders GG. Definition and classification of abnormal vaginal flora. Best Pract Res Clin Obstet Gynaecol 2007; 21(3): 355−73.

Krupa FG, Faltin D, Cecatti JG, Surita FG, Souza JP. Predictors of preterm birth. Int J Gynaecol Obstet 2006; 94(1): 5−11.

Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med 2000; 342(20): 1500−7.

Goldenberg RL, Goepfert AR, Ramsey PS. Biochemical markers for the prediction of preterm birth. Am J Obstet Gynecol 2005; 192: 36−46.

Odendaal HJ, Popov I, Schoeman J, Smith M, Grové D. Preterm la-bour - is bacterial vaginosis involved. S Afr Med J 2002; 92(3): 231−4.

de Seta F, Sartore A, Piccoli M, Maso G, Zicari S, Panerari F, et al. Bacterial vaginosis and preterm delivery: an open question. J Reprod Med 2005; 50(5): 313−8.

Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bac-terial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991; 29(2): 297−301.

Manns-James L. Bacterial vaginosis and preterm birth. J Midwi-fery Womens Health 2011; 56(6): 575−83.

Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis: Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74(1): 14−22.

Donders GG, Van BB, Caudron J, Londers L, Vereecken A, Spitz B. Relationship of bacterial vaginosis and mycoplasmas to the risk of spontaneous abortion. Am J Obstet Gynecol 2000; 183(2): 431−7.

Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, Martin DH, et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal In-fections and Prematurity Study Group. N Engl J Med 1995; 333(26): 1737−42.

Thorsen P, Vogel I, Olsen J, Jeune B, Westergaard JG, Jacobsson B, et al. Bacterial vaginosis in early pregnancy is associated with low birth weight and small for gestational age, but not with spon-taneous preterm birth: A population-based study on Danish women. J Mat Fetal Neon Med 2006;19(1): 1−7.

Donders GG, Van Calsteren K, Bellen G, Reybrouck R, Van den Bosch T, Riphagen I, 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): 1315−24.

Ugwumadu AH. Bacterial vaginosis in pregnancy. Curr Opin Obstet Gynecol 2002; 14(2): 115−8.

Carey CJ, Klebanoff MA. What have we learned about vaginal in-fections and preterm birth. Semin Perinatol 2003; 27(3): 212−6.

Balu RB, Savitz DA, Ananth CV, Hartmann KE, Miller WC, Thorp JM, et al. Bacterial vaginosis, vaginal fluid neutrophil defensins, and preterm birth. Obstet Gynecol 2003; 101(5 Pt 1): 862−8.

Simhan HN, Caritis SN, Krohn MA, Hillier SL. The vaginal in-flammatory milieu and the risk of early premature preterm rupture of membranes. Am J Obstet Gynecol 2005; 192(1): 213−8.

Subtil D, Denoit V, Le GF, Husson M, Trivier D, Puech F. The role of bacterial vaginosis in preterm labor and preterm birth: a case-control study. Eur J Obstet Gynecol Reprod Biol 2002; 101(1): 41−6.

Daskalakis G, Papapanagiotou A, Mesogitis S, Papantoniou N, Ma-vromatis K, Antsaklis A. Bacterial vaginosis and group B strep-tococcal colonization and preterm delivery in a low-risk popu-lation. Fetal Diagn Ther 2006; 21(2): 172−6.

Donders GG, Spitz B, Vereecken A, van Bulck B, Cornelis A, De-keersmaeker A, et al. The ecology of the vaginal flora at first prenatal visit is associated with preterm delivery and low birth weight. Open Infect Dis J 2008; 2: 45−51.

Simhan HN, Caritis SN. Prevention of preterm delivery. N Engl J Med 2007; 357(5): 477−87.

Leitich H, Bodner-Adler B, Brunbauer M, Kaider A, Egarter C, Hus-slein P.Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol 2003; 189: 139−47.

Romero R, Chaiworapongsa T, Kuivaniemi H, Tromp G. Bacterial vaginosis, the inflammatory response and the risk of preterm birth: a role for genetic epidemiology in the prevention of pre-term birth. Am J Obstet Gynecol 2004; 190(6): 1509−19.

Bogavac M, Lakic N, Simin N, Nikolic A, Sudji J, Bozin B. Bacterial vaginosis and biomarkers of oxidative stress in amniotic fluid. J Matern Fetal Neonatal Med 2012; 25(7): 1050−4.

Hirnl L, Malolepsza-Jarmolowska K, Kubis AA, Hirnle P. Evalua-tion of Bacterial Vaginosis Therapy in Pregnant Women with Vaginal Tablets Containing Lactic Acid Complexed with Eu-dragit® E−100 which Undergo Gelation at the Site of Appli-catio. Adv Clin Exp Med 2006; 15(4): 645−51.

Riggs MA, Klebanoff MA. Treatment of vaginal infections to prevent preterm birth: a meta-analysis. Clin Obstet Gynecol 2004; 47(4): 796−807; discussion 881−2.

Mitchell CM, Hitti JE, Agnew KJ, Fredricks DN. Comparison of oral and vaginal metronidazole for treatment of bacterial vagi-nosis in pregnancy: impact on fastidious bacteria. BMC Infect Dis 2009; 9: 89.

Menard JP, Bretelle F. Bacterial vaginosis and preterm delivery. Gynecol Obstet Fertil 2012; 40(1): 48−54. (French)

Objavljeno
2015/04/24
Broj časopisa
Vol. 71 Br. 10 (2014)
Rubrika
Originalni članak