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FEATURES OF MICROBIOCENOSIS OF THE VAGINA IN WOMEN OF REPRODUCTIVE AGE WITH GENITAL PROLAPSE
Nasimova Nigina Rustamovna, assistant of Samarkand State Medical Institute E-mail: [email protected]
FEATURES OF MICROBIOCENOSIS OF THE VAGINA IN WOMEN OF REPRODUCTIVE AGE WITH GENITAL PROLAPSE
Abstract: The results of the preoperative examination show high contamination of the cervical canal and vagina in women with genital prolapse with opportunistic and pathogenic microflora, which creates a high risk of postoperative complications and requires appropriate preoperative preparation. Keyword: genital prolapse, biocenosis, bacteriological studies.
For many years, the omission and loss of internal genitals in women is a fairly common gynecological disease [1; 2; 4], often in need of surgical correction. The peak incidence (56.3%) about the collapse of the genitals accounts for the age of 50 years. However, recently there is a tendency to "rejuvenation" of this pathology. Women under the age of 45 years are 30-37, 5% ofpatients with genital prolapse, and women under 30 years 10.1-12.3%. In recent years, there has been a predominance of severe forms of the disease and the involvement of adjacent organs in the process with a violation of their function [5].
Purpose. The study of biocenosis of the vagina in women with genital prolapse before surgery.
Material and methods. The study was based on clinical and laboratory examination of -126 patients with various forms of genital prolapse of varying degrees, who were admitted to the gynecological Department of the maternity complex № 3 in the city of Samarkand in the period from 2012 to 2016.
Microscopy the study was subjected to a discharge from the urethra, the Church-kalinago canal and the posterior fornix of the vagina before surgery, before and after the sanitation of the vagina. Mucus from the urethra and cervical canal was collected with tweezers after pre-drying of the vaginal mucosa of the cervix with a dry sterile swab. From the posterior vaginal vault detachable climbed with a spatula. The resulting material is deposited on a glass slide, stained by Gram. Bakta-bioskopi conducted a simple light microscope.
Results and discussion. We conducted all the bacteriological examination. The method of choice for assessing vaginal biocenosis is currently considered to be the microscopy of a Gram-stained vaginal smear. The sensitivity and specificity of the method are close to 100%. The evaluation criteria were the following indicators: the average number of leukocytes in the field of view, the type of flora, the abundance of flora (table. 1).
Degree purity s Comparison group (n=46) Main group (n=80) X2 P
abc % abc %
1 degree 9 19.6 10 12.5 1.14 > 0.05
2 degree 15 32.6 23 28.8 0.21 > 0.05
3 degree 21 45.7 45 56.3 1.32 > 0.05
4 degree 1 2.2 2 2.5 0.01 > 0.05
1 the degree of purity was observed in 9 (19.6%) women of the comparison group and 10 (12.5%) of the main group. The majority of women in both groups were identified 2 and 3 degree, indicating a large role of infections in the development of genital prolapse.
All patients underwent bacteriological examination of the contents of the cervical canal with identification of flora and determination of sensitivity to antibiotics before the operation (table. 2).
Table 2.- Results of bacteriological examination
Comparison group (n = 46) Main group (n = 80) X2 P
abc % abc %
1 2 3 4 5 6 7
Staphylococcus Epidermidis 7 15.2 18 22.5 0.97 > 0.05
Staphylococcus aureus 6 13.0 15 18.8 0.68 > 0.05
Table 1.- The results of bacterioscopy of vaginal smear in the examined women's
Medical science
1 2 3 4 5 6 7
Escherichiacoli 17 37.0 28 35.0 0.05 > 0.05
Candida albicans 7 15.2 4 5.0 3.83 > 0.05
Association 4 8.7 7 8.8 0.00 > 0.05
There is no growth 5 10.9 8 10.0 0.02 > 0.05
In 7(15.2%) patients of the comparison group, Staphylococcus Epidermidis was sown, in 18(22.5%) patients of the main group, Staphylococcus aureus - in 6(13.0%) and 15(18.8%), Escherichiacoli - in 17(37.5%) and 28(35.0%), respectively, in groups. 4(8.7%) pain-tion of the comparison group and in 7(8.8 per cent) are the major groups discovered the Association of microorganisms: Escherichiacoli +Entero-bacter, Staphylococcus aureus + Escherichiacoli, Staphylococcus aureus + Enterobacter. The absence of growth of microorganisms occurred in 5(10.9%) and 8(10.0%) patients, respectively, in groups.
Bacterial vaginosis was established in 6(13.0%) of the comparison group and in 10(12.5%) patients of the main group on the basis of amine test, measurement Of vaginal pH content and detection of "key cells" under vaginal co-holding microscopy. The diagnosis was established in the presence of two positive signs out of three. The average vaginal Ph was 5.65 ± 1.5.
Given that the operations performed by vaginal access are conditionally clean, patients are shown to conduct preoperative antibacterial prevention. The results of the preoperative examination show a high OSCE-mennost cervical canal and vagina in women with pelvic organ prolapse opportunistic and pathogenic microflora, which creates a high risk of postoperative complications and requires appropriate preoperative preparation. For vaginal sanitation in the detection of nonspecific vaginosis and vaginitis used 2% cream Clindacin,
5 g(single dose) once a day at night intravaginally for 6 days plus metronidazole 2.0 g once. In specific vaginitis, treatment was performed with antibiotics depending on the results of bacteriological examination. If necessary, after treatment of the complement of the hygiene of the vagina of a 0.02% solution of decamethoxin (deosan). The course of treatment is 7-14 days.
The indicators ofthe vaginal flora ofpatients before surgery were characterized by SNI zheniem content bifidoflora have 69.72% of lactobacilli at 56.88% against high co-ionizatsii representatives of facultative microflora (up to 105 CFU/swab). On the 5th and 10th day of treatment, patients had a significant increase in the incidence of obligate microorganisms in comparison with patients who did not receive the drug: bifidoflora by 1.7 times and 2.4 times, respectively; lactoflora by 1.8 and 2.2 times, as well as a significant reduction of facultative microorganisms by 1.3-2 times.
The study of microflora features as a risk factor for postoperative infectious and inflammatory complications in women with genital prolapse reveals its normal state only in 21.1% of them before treatment.
Summary. The results of the preoperative examination show high contamination of the cervical canal and vagina in women with pelvic organ prolapse with opportunistic and pathogenic microflora, which creates a high risk of postoperative complications and requires appropriate preoperative preparation.
References:
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