Risk for miscarriage and premature birth in women with HPV infection and recurrent vaginal dysbiosis


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Objective. To determine the rate and risk of miscarriage and preterm birth (PB) and to evalute the effect of progesterone in reducing the risk of PB in women with human papillomavirus (HPV) and recurrent dysbiosis. Subjects and methods. The investigation enrolled 170 pregnant women (145 of them had HPV and recurrent vaginal dysbiosis). Group 1 (n = 36) took an antiseptic; Group 2 (n = 41) received an antiseptic and a probiotic. A control group (n = 25) had neither HPV nor dysbiosis. Sixty-eight patients used micronized progesterone. The strength of an association between variables (Cramer’s V coefficient) was analyzed. Results. The rate of PB and late miscarriages was 24.7% and was strongly associated with the absence of effect of treatment for dysbiosis (VC = 0.7) and with the presence of recurrences (VC = 0.5). Micronized progesterone could reduce the rate of PB by 70% (OR = 0.3; 95% CI, 0.07-0.8; p = 0.02). Conclusion. Pregnancy in the presence of HPV and recurrent dysbiosis is associated with a high risk of miscarriage and PB. The use of micronized progesterone reduces the rate of PB.

Full Text

Restricted Access

About the authors

Tamara N. Bebneva

Peoples’ Friendship University of Russia; National Medical Research Center of Endocrinology of the Ministry of Health of Russia

Email: bebn@mail.ru
PhD, associate professor, Department of Obstetrics, Gynecology and Reproductive Medicine, Faculty of Advanced Training for Medical Professionals of the Medical Institute; doctor

Galina B. Dikke

Private Educational Institution «Academy of Medical Education named F.I. Inozemtsev»

Email: galadikke@yandex.ru
MD, associate professor, professor of the Department of Obstetrics and Gynecology with a course of reproductive medicine

References

  1. Domza G., Gudleviciené Z., Didziapetriené J., Valuckas K.P., Kazbariené B., Drqsutiené G. Human papillomavirus infection in pregnant women. Arch. Gynecol. Obstet. 2011; 284(5): 1105-12. doi: 10.1007/S00404-010-1787-4.
  2. Xiong Y.Q., Mo Y., Luo Xiong Q.M., Huo S.T., He W.Q., Chen Q. The risk of human papillomavirus infection for spontaneous abortion, spontaneous preterm birth, and pregnancy rate of assisted reproductive technologies: a systematic review and meta-analysis. Gynecol. Obstet. Invest. 2018; 83(5): 417-27. doi: 10.1159/000482008.
  3. Дикке Г.Б. Полимикробные ассоциации в этиологии воспалительных заболеваний половых органов у женщин. Акушерство и гинекология. 2017; 6: 151-8.
  4. Хрянин А.А., Решетников О.В. Бактериальный вагиноз. Новые представления о микробном биосоциуме и возможности лечения. Медицинский совет. 2014; 17: 128-32. doi: 10.21518/2079-701X-2014-17-128-133.
  5. Jain R. Role of bacterial vaginosis in preterm labor - a prospective study. Int. J. Med. Res. Rev. 2016; 4(4): 543-9. doi: 10.17511/ ijmrr.2016.i04.12.
  6. Donders G., Van Calsteren C., Bellen G., Reybrouck R., Van den Bosch T., Riphagen I., Van Lierde S. Association between abnormal vaginal flora and cervical length as risk factors for preterm birth. Ultrasound Obstet. Gynecol. 2010; Jan 26. doi: 10.1002/uog.7568.
  7. Nygren P., Fu R., Freeman M., Bougatsos C., Klebanoff M., Guise J.M. Evidence on the benefits and harms of screening and treating pregnant women who are asymptomatic for bacterial vaginosis: an update review for the U.S. Preventive Services Task Force. Ann. Intern. Med. 2008; 148(3): 220-33.
  8. Серов В.Н., Сухорукова О.И. Профилактика преждевременных родов. РМЖ. 2014; 22(1): 3-6.
  9. Государственный реестр лекарственных средств. Инструкции по медицинскому применению препаратов. [State Register of Medicines. Instructions for the medical use of the drugss (in Russian)]. Available at: https:// grls.rosminzdrav.ru/grls.aspx
  10. Nayar R., Wilbur D-С., eds. The Bethesda system for reporting cervical cytology, definitions, criteria, and explanatory notes. 3rd ed. Springer; 2015. 321р. doi: 10.1007/978-3-319-11074-5.
  11. Gupta A., Garg P., Nigam S. Bacterial vaginosis in pregnancy (<28weeks) and its effect on pregnancy outcome: a study from a western up city. Ind. J. Clin. Pract. 2013; 23(11): 740-4. doi: 10.5958/2394-2754.2016.00021.7.
  12. Кузьмин В.Н., Мурриева Г.А. Роль неспецифических урогенитальных инфекций в патогенезе самопроизвольных преждевременных родов. Лечащий врач. 2013; 6: 60-2.
  13. Савельева Г.М., Шалина Р.И. Преждевременные роды (диагностика, тактика ведения). Акушерство и гинекология. Новости, мнения, обучения. 2015; 1: 31-9.
  14. Савельева Г.М., Шалина Р.И., Курцер М.А., Клименко П.А., Сичинава Л.Г., Панина О.Б., Плеханова Е.Р., Выхристюк Ю.В., Лебедев Е.В. Преждевременные роды как важнейшая проблема современного акушерства. Акушерство и гинекология. 2012; 8-2: 4-10.
  15. Badshaw C.S., Brotman R.M. Making inroads into improving treatment of bacterial vaginosis - striving for long-term cure. BMC Infectious Diseases. 2015; 15: 292. doi: 10.1186/s12879-015-1027-4.
  16. Tielsch J.M. Global incidence of preterm birth. Nestle Nutr. Inst. Workshop Ser. 2015; 81: 9-15. doi: 10.1159/000365798.
  17. McNamee K.M., Dawood F., Farquharson R.G. Mid-trimester pregnancy loss. Obstet. Gynecol. Clin. North Am. 2014; 41(1): 87-102. doi: 10.1016/j. ogc.2013.10.007.
  18. Romero R., Nicolaides K., Conde-Agudelo A., Tabor A., O’Brien J.M., Cetingoz E. et al. Vaginal progesterone in women with an asymptomatic sonographic shot cervix in the midtrimester deceases preterm delivery and neonatal morbidity: a systematic review and meta-analysis of individual patient data. Am. J. Obstet. Gynecol. 2012; 206(2): 124. e1-19. doi: 10.1016/ j.ajog.2011.12.003.
  19. Brocklehurst P., Gordon A., Heatley E., Milan S.J. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst. Rev. 2013; (1): CD000262. doi: 10.1002/14651858.CD000262.pub4.
  20. Niyibizi J., Zanré N., Mayrand M.H., Trottier H. The association between adverse pregnancy outcomes and maternal human papillomavirus infection: a systematic review protocol. Syst. Rev. 2017; 6(1): 53. doi: 10.1186/s13643-017-0443-5.
  21. Kwon J.Y., Romero R., Mor G. New insights into the relationship between viral infection and pregnancy complications. Am. J. Reprod. Immunol. 2014; 71(5): 387-90. doi: 10.1111/aji.12243.
  22. Zuo Z., Goel S., Carter J.E. Association of cervical cytology and HPV DNA status during pregnancy with placental abnormalities and preterm birth. Am. J. Clin. Pathol. 2011; 136(2): 260-5. doi: 10.1309/AJCP93JMIUEKRPIW.
  23. Gomez-Lopez N., StLouis D., Lehr M.A., Sanchez-Rodriguez E.N., Arenas-Hernandez M. Immune cells in term and preterm labor. Cell. Mol. Immunol. 2014; 11(6): 571-81. doi: 10.1038/cmi.2014.46.
  24. Ходжаева З.С., Федотовская О.И., Донников А.Е. Клинико-анамнестические особенности женщин с идиопатическими преждевременными родами на примере славянской популяции. Акушерство и гинекология. 2014; 3: 28-32.
  25. Assefa N.E., Berhe H., Girma F., Berhe K., Berhe Y.Z., Gebreheat G. et al. Risk factors of premature rupture of membranes in public hospitals at Mekele city, Tigray, a case control study. BMC Pregnancy Childbirth. 2018; 18(1): 386. doi: 10.1186/s12884-018-2016-6.
  26. Choudhary M., Rathore S.B., Chowdhary J., Garg S. Pre and post conception risk factors in PROM. Int. J. Res. Med. Sci. 2017; 3(10): 2594-8. doi: 10.18203/2320-6012.ijrms20150797.
  27. Сухих Г.Т., Серов В.Н., Адамян Л.В., Филиппов О.С., Баев О.Р., Клименченко Н.И., Тетруашвили Н.К., Тютюнник В.Л., Ходжаева З.С., Холин А.М. Преждевременные роды. Клинические рекомендации (протокол). М.; 2014. 35с.
  28. Workowski K.A., Berman S.; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm. Rep. 2010; 59(RR-12): 1-110. Available at: http://www.cdc.gov
  29. Dodd J.M., Flenady V., Cincotta R., Crowther C.A. Prenatal administration of progesterone for preventing PTB. Cochrane Database Syst. Rev. 2006; (1): CD004947. doi: 10.1002/14651858.CD004947.pub2.
  30. Vaginal Micronized Progesterone Capsules for the Prevention of Miscarriage and Preterm Birth: A Review of the Clinical Evidence. Rapid Response Report: Summary with Critical Appraisal Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014; Apr 28.
  31. Ходжаева З.С., Дембовская С.В., Доброхотова Ю.Э., Сичинава Л.Г., Юзько А.М., Мальцева Л.И., Серова О.Ф., Макаров И.О., Ахмадеева Э.Н., Башмакова Н.В., Шмаков Р.Г., Клименченко Н.И., Муминова К.Т., Талибов О.Б., Сухих Г.Т. Медикаментозная профилактика преждевременных родов (результаты международного многоцентрового открытого исследования МИСТЕРИ). Акушерство и гинекология. 2016; 8: 37-43. doi: 10.18565/aig.2016.8.37-43
  32. Савельева Г.М., Аксененко В.А., Андреева М.Д., Базина М.И., Башмакова Н.В., Боровкова Л.В., Брюхина Е.В., Буштырева И.О., Волков В.Г., Гурьев Д.Л., Данькова И.В., Доброхотова Ю.Э., Егорова А.Т., Иванова Т.В., Константинова О.Д., Коротких И.Н., Кравченко Е.Н., Крамарский В.А., Кулешов В.М., Лебеденко Е.Ю. и др. Исходы второй половины беременности у пациенток с привычным выкидышем в анамнезе (результаты многоцентрового исследования ТИРСТАН-2). Акушерство и гинекология. 2018; 8: 111-20. DOI: 10.18565/ aig.2018.8.111-121.
  33. Hassan S.S., Romero R., Vidyadhari D., Fusey S., Baxter J.K., Khandelwal M. et al. Vaginal progesterone reduces the rate of preterm birth in omen with a sonographic short cervix: a multicenter, randomized, double-blind, placebocontrolled trial. Ultrasound Obstet. Gynecol. 2011; 38(1): 18-31. doi: 10.1002/ uog.9017.
  34. Choi S.J. Use of progesterone supplement therapy for prevention of preterm birth: review of literatures. Obstet. Gynecol. Sci. 2017; 60(5): 405-20. doi: 10.5468/ogs.2017.60.5.405.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies