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PL
Celem badania była ocena częstości występowania i wpływu zespołu objawów określanego jako bacterial vaginosis (BV) oraz zakażeń bakteryjnych dróg rodnych kobiet we wczesnej ciąży na ryzyko wystąpienia porodu przedwczesnego. BV stwierdzono u 51 (28,5%) ciężarnych. Odnotowano istotny wzrost odsetka porodów przedwczesnych w grupie kobiet z BV do 15,7% w porównaniu do grupy kobiet z prawidłową florą (9,1%). Spośród kobiet, które urodziły przedwcześnie u 38,1% stwierdzono BV, podczas gdy u kobiet rodzących po 37 tygodniu ciąży odsetek ten wyniósł 27,2% (OR=l,86). Infekcja C. trachomatis we wczesnej ciąży nie wiązała się ze wzrostem ryzyka wystąpienia porodu przedwczesnego.
EN
The main aim of this prospective study was to determine the prevalence and an association between pathological microflora of the lower genital tract diagnosed at early pregnancy and the risk of preterm delivery. The study group comprised 179 randomly selected pregnant women from Lodz region, between 8 and 16 week of pregnancy. For the qualitative and quantitative assessment of biocenosis of the lower genital tract vaginal and cervical swabs were collected from the pregnant women under study. The C. trachomatis antigen was detected by direct immunofluorescence assay. The vaginal swabs were tested for aerobic and anaerobic bacteria. Bacterial vaginosis was diagnosed by Gram stain according to Spiegel's criteria. To evaluate the risk factors odds ratios were calculated using EPI INFO software. 21 (11,7%) women delivered before 37"1 week of pregnancy. Bacterial vaginosis was diagnosed among 51 ( 28,5%) pregnant women while intermediate microflora was diagnosed by Gram stain in 62 (34,6%) women. The shortest mean gestational age at delivery was noted among women with BV The rate of preterm delivery in BV group was 15,7% comparing to 9,1% among women with normal microflora. Among women with preterm delivery BV was diagnosed in 38,1% (OR=1,86). Based on culture results only 84 (46,9%) women had normal microflora at early pregnancy. The pathological culture was associated with slightly increased preterm delivery rate (12,6%) as compare to 10,7% in control group. Positive culture for Bacteroides and Mobiluncus was connected with nonstatistical rise in the risk of preterm delivery. No association between C. trachomatis infection at early pregnancy and elevated risk of preterm delivery was found. Early pregnancy diagnosis of bacterial vaginosis and its treatment should lower the rate of prematurity in Poland.
EN
Both prolonged and shortened pregnancies carry the risk of increased mortality of the offspring. The main causes of early delivery are genetic factors, bacterial and viral infections, corpus luteum insufficiency and pathologies of the placenta. Antepartum luteolysis is due to the activity of prostaglandin F2α. A decrease in the progesterone concentration activates the sensitivity of the uterine muscles to oxytocin. Calcium ions move into the myocytes and bind to calmodulin, starting enzymatic reactions necessary for muscle contraction. Oxytocin promotes prostaglandin F2α release. Cholesterol and magnesium stimulate the binding of oxytocin to its receptors. A premature delivery is caused by a disorder of the balance between contractility and relaxation of the myometrium, which is regulated by many signalling pathways. Birth in humans can be postponed by the use of many different tocolytic medications, β-adrenergic drugs (ritodrine, hexoprenaline, fenoterol, terbutaline), magnesium salts, prostaglandin synthesis inhibitors (indomethacin, naproxen), pentoxifylline, metoprolol, calcium antagonists – calcium channel blockers (nifedipine), oxytocine antagonists (atosiban), nitric oxide donors (nitroglycerin) as well as progesterone and its synthetic analogs. In dogs and cats, in the presence of endogenous hormone deficiency, progesterone and its derivatives (gestagens) are recommended. In small animals with the risk of premature delivery, terbutaline has successfully been used. Premature delivery is a serious problem in both human and veterinary medicine, and experience from human medicine is being gradually introduced into veterinary practice.
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