Bacterial vaginosis during pregnancy: first signs and danger to the fetus

Bacterial vaginosis can be observed quite often during pregnancy.
This diagnosis is made in 37% of cases, and can sometimes extremely frighten a woman carrying a child. In order to avoid panic, it is enough to simply know what this disease is, what its symptoms are and how it can be treated. Changes occur in the vagina of a pregnant woman due to hormonal changes occurring in her body. At the same time, the pH becomes lower and the number of lactobacilli increases. It seems that everything should be fine, but at some point a failure may occur and the balance will be disrupted. The acidity will increase, and lactobacilli will begin to die. It is the acidic environment that can provoke increased growth of opportunistic microflora. First of all, the number of gardnerella increases, and they create excellent conditions for the growth of a mass of other harmful microorganisms. This condition is called bacterial vaginosis, which can be observed in pregnant women.

Why is the disease dangerous specifically for women carrying a child?

The diagnosis of “vaginosis of bacterial origin” can be dangerous for a pregnant woman for a number of reasons:

Rupture of the membranes may occur ahead of schedule.
There is a risk of premature birth.
The child will be born with low weight, even if he is born at the right time.
After the baby is born, some uterine infections may develop.
Some doctors claim that there is a direct relationship between miscarriage and bacterial vaginosis. The risk increases in the second trimester.
Infection of the fetus while it is in the womb. This can happen even when the integrity of the fetal membrane is not broken. In an acidic environment, its throughput potential increases, and bacteria easily penetrate through the thinned wall. In this case, a lot of complications can arise, including sepsis in the newborn.
If vaginosis is left untreated both during pregnancy and after childbirth, there is an increased risk of contracting an STD. These include: HIV, chlamydia, gonorrhea.

These risks make it necessary to be careful about the occurrence of vaginosis in pregnant women. Although in some cases the disease may go away on its own, more often it still requires therapeutic intervention. However, due to the fact that the woman is pregnant, standard regimens may not be suitable and treatment of bacterial vaginosis will be more selective.

What symptoms help to suspect vaginal dysbiosis in a pregnant woman?

Sometimes the disease in a pregnant woman can be completely asymptomatic. But in most cases, the disease manifests itself with the following symptoms:

White discharge with some shade of gray appears. As bacterial vaginosis progresses, they may take on a greenish tint.
There is a characteristic smell of missing fish. It intensifies significantly after sexual intercourse.
Sometimes a pregnant woman may experience itching. More often it begins in the evening or at night. May worsen after sexual intercourse or taking a bath in hot water.
Often women complain of pain during urination.
The uterus may be hypertonic.
Pain in the pelvic area may sometimes bother you.

If at least one of these symptoms appears during pregnancy, you must inform your doctor and undergo additional examination. One can hope that treatment will not be required and bacterial vaginosis will go away on its own in the pregnant woman. However, this happens extremely rarely, and the risk of complications of the disease for both the child and his mother after childbirth is high.

Causes

The causes of fetal death are varied and often intertwined. The main ones are the following:

Infection. But here there are 2 options:
The presence of chronic inflammation leads to disruption of the process of implantation of the fertilized egg into the wall of the uterus and disruption of its blood supply. All this leads to primary placental insufficiency and, ultimately, to fetal death.

Hormonal disorders. It is believed that severe disturbances in a woman’s hormonal status lead to infertility, and pregnancy is possible only with erased forms of the pathology, but it most often ends in termination at one time or another. The main forms of hormonal disorders leading to missed abortion include:
increased production of androgens (male sex hormones);
diseases of the thyroid gland (especially increased levels of its hormones);
neuroendocrine syndromes.

Congenital malformations of the genital organs that interfere with the normal growth and development of the embryo.
Chromosomal abnormalities. Occur as a result of disruption of the process of fusion of maternal and paternal material.
Disorders of the blood coagulation system. This includes antiphospholipid syndrome, when the mother’s body produces antibodies to platelets and thrombosis occurs in the vessels feeding the fertilized egg.
Socio-biological factors : in recent decades there has been a significant deterioration of the ecological environment (various types of pollution, for example, radiation and chemical); poor living conditions (unbalanced diet, vitamin deficiency); various occupational hazards that can affect both before pregnancy and in its initial stages; mother's age.

Diagnosis of anaerobic vaginosis in pregnant women

Before a pregnant woman is prescribed treatment, it is necessary to accurately diagnose bacterial vaginosis. To do this, use diagnostic methods such as:

Inspection using mirrors. In this case, foamy discharge will be visible, most often abundant. The difference between them specifically in anaerobic vaginosis is that they stick to the walls of the vagina.
Establishment of vaginal acidity. When sick, it will be higher than 4.5.
Amine test. To carry it out, potassium hydroxide is used, which is mixed with vaginal discharge. If the smell of rotting fish occurs, it is considered positive.
Examination of a smear under a microscope. Using this method, bacterial vaginosis in pregnant women can be determined with almost 100% accuracy.

Sometimes, before starting treatment for a pregnant woman with bacterial vaginosis, more complex diagnostic methods are required, such as colposcopy, culture to identify the pathogen, etc. However, they are rarely used and standard studies are sufficient. It is important to undergo a complete examination while planning pregnancy. Bacterial vaginosis itself cannot become an obstacle to conception, and it is possible to become pregnant if you have inflammation. However, it is fraught with a number of complications for both the expectant mother and the child.

Pregnancy after illness

Planning the next pregnancy is allowed six months after failure.

This break is aimed at the complete restoration of hormonal status and reproductive functions of the body and includes the following mandatory examinations :

Ultrasound of the pelvic organs;
PCR diagnostics (detection of urogenital infections);
blood test for the level of autoantibodies, homocysteine;
blood test to detect the titer of antibodies to rubella;
determination of the level of thyroid hormones in the blood.

This list can have many more items. Each woman is treated with an individual examination plan, which is prescribed by a gynecologist.

But how is a non-developing pregnancy treated, what do doctors do in this case?

Therapy of vaginal bacteriosis in pregnant women: modern methods

Treatment in both ordinary women and pregnant women is carried out in most cases with metronidazole.
However, if for the former it is preferable to use tablets, then for the latter the drug is more often prescribed in the form of a gel. It is used topically - inserted into the vagina, where bacterial vaginosis is localized. Doctors recommend carrying out the procedure before a night's rest, so that the medicine remains inside as long as possible and the treatment gives maximum effect. The duration of the course is one week. If a woman is uncomfortable using the gel, then bacterial vaginosis can be treated during pregnancy using special pills. The active ingredient in them remains the same metronidazole. They are administered locally, before bedtime. The course is most often 10 days.

More often, pregnant women do not require additional treatment and bacterial vaginosis can be overcome with local therapy only. However, in complex forms of the disease, oral medications based on metronidazole are required. In this case, the disease always recedes. However, you should start using the tablets after the 20th week of pregnancy. Until this time, it is better to limit yourself to the use of local medications.

Sometimes, if a pregnant woman is intolerant to metronidazole-based drugs, the disease can be treated with clindamycin or dalacin. These drugs are somewhat less effective than metronidazole. However, if bacterial vaginosis is detected at an early stage, they will be effective.

Additional methods of treating vaginal bacteriosis

After the pathogenic bacteria that caused the development of vaginosis in a pregnant woman are eliminated, treatment can be continued with additional agents. To normalize microflora, biological products are used. It could be:

Bifidumbacterin, which is administered 1 suppository twice a day. The course is 10 days.
Dried bacteria - the drug Bifikol, it is also treated for up to 10 days.
Vagilact or Laktozhinal. These are products with lactobacilli that are used topically. They are administered once a day before a night's rest. The duration of the therapeutic course is 10 days.

In addition to products aimed at restoring microflora, mineral and vitamin complexes are used. They are necessary to maintain the immunity of a pregnant woman who has undergone treatment for vaginosis.

About pregnancy planning and vaginal dysbiosis

Before you try to conceive a child, you need to undergo a complete examination. Bacterial vaginosis - the reason for the plan to get pregnant in the next few months, has been somewhat pushed back in time. Doctors say that this disease cannot become an obstacle to conception. Nevertheless, the risk of developing complications against its background is quite real.

Therefore, if a diagnosis of bacterial vaginosis has been made, it is necessary to undergo a full course of treatment. After its completion and restoration of the bacterial microflora of the vagina, you can fearlessly begin to conceive. The rules of prevention are simple:

Change sexual partners as little as possible and not have sex.
Do not use antibiotics without a subsequent course of taking drugs with bifidobacteria.
Don't get carried away with douching.
To refuse from bad habits.
Regularly visit a gynecologist and undergo all necessary examinations.

Symptoms

In the early stages (up to 12 weeks), the main clinical manifestation will be the disappearance of subjective signs of pregnancy (morning nausea and vomiting, drooling). At a later date, these symptoms lose their relevance, since normally they should have passed and the absence or cessation of the sensation of fetal movement comes to the fore. On days 3-6 after the development of the embryo stops, the mammary glands soften and milk is released from them.

dangerous When a dead fetus remains in the uterus for more than 4 weeks, some women develop signs of general intoxication (weakness, malaise, fever) associated with infection of the ovum.

Signs such as lack of uterine growth and the appearance of bloody discharge from the genital tract (as a sign of spontaneous miscarriage) most often appear only 6 weeks after the embryo has stopped developing.

Consequences

All consequences of a frozen pregnancy can be divided into two groups:

arising against the background of a non-developing pregnancy and in the near future after removal of the fertilized egg;
appearing later.

If we talk about the first ones, then most often they are infectious in nature and depend on where the infectious agents ended up:

When the process is localized only in the uterus, acute endometritis can develop . And after treatment of a non-developing pregnancy, due to the fact that the inflamed uterus is not able to adequately contract, blood clots are retained in the cavity, and repeated curettage will be required.
If a dead embryo or fetus remains in the uterine cavity for a long time, peritonitis may develop if infectious agents enter the abdominal cavity, or sepsis if they enter the blood.
Early consequences also include severe disorders in the coagulation system in women, which is associated with the entry of toxic products into the blood.

As for the second group, they primarily depend on the cause of freezing and the correct approach to its treatment and rehabilitation. The possibility of subsequent pregnancy and its outcome will depend on this. According to research, during rehabilitation in the postoperative period, pregnancy occurs in 85% of cases and ends in childbirth in 70%, without restorative treatment - in 83 and 18%, respectively.

Treatment

The clear outcome of a pregnancy that does not develop is termination. Depending on the period at which the death of the fetus occurred, it can be carried out spontaneously, surgically or medicinally.

It should be remembered that the presence of a dead fetus in the uterine cavity is almost always accompanied by changes in hemostasis in the pregnant woman’s body. Delays in terminating a non-developing pregnancy can lead to the formation of severe coagulopathic bleeding. Possible infectious complications also play a significant role. Consequently, termination of an undeveloped pregnancy should be carried out by an experienced doctor exclusively in a hospital setting.

With timely diagnosis of this pathology and carried out rehabilitation measures, the chances of carrying and giving birth to a full-term and healthy child in the future are quite high.