Infection and its role in the causes of preterm birth

In recent years, the results of a number of studies on the problem of preterm birth have been published. It supposed that the rate of preterm birth should have reduced. Despite this, infection factors still contribute significantly to the structure of the causes of preterm birth. The aim of our study was to determine the role of infection in the structure of premature birth causes. A retrospective analysis of the course of pregnancy, delivery, complications in children at a level 1 unit was carried out in 276 patients with a gestational age of 22.0 to 34.6 weeks. Special attention was paid to various methods of infection diagnosis and its influence on the mother and fetus. Upon admission to the hospital, all patients underwent an assessment of the flora of the vagina and cervical canal by the bacterioscopic and cultural method, also by the method of polymerase chain reaction (qualitative PCR). To identify the role of infection in the genesis of extremely preterm birth in 196 (71.0%) children from 22.0 to 27.8 weeks, the bacterial spectrum of the flora was studied (sampling of material from the pharynx, anus; blood culture), a morphological study of the placentas was carried out. In preterm labor complicated by preterm premature rupture of membranes, a high rate (88.7%) of intrauterine infection and the presence of signs of inflammation (92.3%) in fetuses was revealed during post mortem examination. Analyzing the infection factor in newborns, in 81.6% opportunistic (58.8%) and pathogenic (41.2%) flora was detected. At the same time, only 36.0% showed a correspondence between the identified flora in mothers and children. In the absence of pathological flora and clinical symptoms of infection in the mothers 22.6% of children were born with intrauterine infection. It was noted that among the patients with the onset of preterm labor, in most of the results (91.2%), there was no lactobacilli domination that heads antimicrobial protection, while normally in the vaginal microbiota their number should reach up to 80.0%. It was shown that in order to objectify the infection factor in the genesis of preterm labor, it is necessary to introduce a new method for identifying the specific representatives of normo- and opportunistic vaginal biota - polymerase chain reaction (with real-time detection). Along with antibiotics, probiotics should be included in the treatment of preterm labor.

obstetrics and gynecology, preterm birth, preterm premature rupture of membranes, PPROM, intrauterine infection, chorioamnionitis, bacterial biofilms, probiotics