IS THE DETERMINATION OF CHLAMYDIA TRACHOMATIS IN THE FALLOPIAN TUBES INDICATED FOR TUBAL PREGNANCY SURGERY?


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Abstract

Objective. To provide a rationale for intraoperative therapy aimed at reducing the rate and magnitude of small pelvic adhesions in patients with tubal pregnancy. Subject and methods. Laparoscopy was carried out in 121 women with tubal pregnancy (a study group) and 24 patients with infertility (a comparison group). PCR diagnosis of biopsy specimens of the cervix uteri and fallopian tubes from the patients with tubal pregnancy was made to identify Chlamydia trachomatis, Neisseria spp. and gonorrhoeae, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, and Trichomonas vaginalis. In Subgroup 1 (n=28) of the study group, sumamed (azithromycin) was given intraoperatively and postoperatively to create conditions for intraoperative hydroflotation. Subgroup 2 (n=26) received Interacoat gel intraabdominally in addition to sumamed. In Subgroup 3 (n=37), ceftriaxone was used intraoperatively to produce the effect of hydroflotation. In Subgroup 4 (n=30), the gel was injected into the abdomen in addition to cefrriaxone. Following 6-12 weeks, endoscopic resurgery was performed in 17, 13, 33, and 15 patients from Subgroups 1, 2, 3, and 4, respectively. The study group patients had immunoglobulins (IgG), IgA, and IgM to Chlamydia trachomatis, IgG to major outer membrane protein (MOMP), and IgG to heat shock protein 60. Statistical processing was carried out using AtteStat 7.3, MedCalc, Microsoft Excel 2003, Statistica 6.0packages. Results. Ureaplasma urealyticum was most common (up to 27.27%). Mycoplasma hominis was the second most frequently diagnosed pathogen (up to 4.96% in the abdominal cavity). The other isolated pathogens were 0 to 5.79%. In the patients with tubal pregnancy, MOMP and Pgp3 antibodies were the most commonly diagnosed anti-Chlamydia trachomatis ones (73.55%) and IgA and IgG were less significant (63.64% and 51.24%). Tubal pregnancy was characterized by a combination of IgA antibodies to both MOMP and Pgp3 (63.64%). After second-look laparoscopy, the degree of an adhesive process was 7 (5-10), 4 (4-5), 18 (15-21), and 14 (12-18.5) in Subgroups 1, 2, 3, and 4, respectively. The differences between the subgroups other than Subgroups 3 and 4 were statistically significant (p < 0.01). Conclusion. It is inexpedient to take material to be tested using PCR assay for different infectious organisms in the upper portions of the genital tract during surgery for tubal pregnancy. Intraoperative intravenous sumamed administration with abdominal Interacoat gel injection is effective in preventing adhesive disease after surgery for tubal pregnancy, which gives rise to a reduced adhesive process from 18 to 4 scores (P < 0.01) after cephalosporin hydroflotation, as shown by the adnexal adhesion scale developed by the American Fertility Society, and may contribute to the maintenance of reproductive function in patients.

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S. O DUBROVINA

Rostov Research Institute of Obstetrics and Pediatrics, Ministry of Health of the Russian Federation

Email: s.dubrovina@gmail.com
Rostov-on-Don

V. YU LESOVAYA

Rostov Research Institute of Obstetrics and Pediatrics, Ministry of Health of the Russian Federation

Email: s.dubrovina@gmail.com
Rostov-on-Don

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