Modifying the risk of ascending uterine cavity infection during gynecological procedures

Objective: To modify the risk of ascending uterine cavity infection during gynecological procedures by preventive medical vaginal sanitation. Materials and methods: A prospective cohort study was conducted in 80 patients who required outpatient gynecological procedures (hysterosalpingography, office hysteroscopy). There were 2 randomized groups: a study group who before the manipulation received a 6-day cycle of sanitizing therapy with a multicomponent local agent; a comparison group had no therapy. The formed groups were matched by age, parity, anamnestic data, and gynecological history. The Femoflor-16 PCR-RT assay was used to assess the microbiocenosis of the vagina and uterine cavity. Results: The total vaginal bacterial mass in the patients of both groups was lg 6.3 and 6.2 GE/sample (p=0.94). After the sanitizing therapy, the study group showed a decrease in the total vaginal bacterial contamination to lg 4.8 (Q1-Q3: 4.4-5.05) (p=0.03). The total uterine bacterial mass was lg 2.3 GE/sample (Me, IQR 2.05- 2.95) and lg 4.8 GE/sample (Me, IQR 4.25-5.2) in the study and comparison groups, respectively (p<0.001). Comparing the indicators of uterine bacterial contamination with those of vaginal biocenosis after sanitation revealed a decline in the number of Peptostreptococcus spp., Veilonella spp. and Mobiluncus spp. in 17.5% of patients (p=0.018), Staphylococcus spp. (p=0.043) and Atopobium vaginae in 12.5% (p=0.042), Streptococcus spp. in 20% (p=0.012), Gardnerella vaginalis in 27.5% (p=0.003), and members of the Enterobacteriaceae family in 35.5% (p=0.01). Uterine cavity biocenosis could be characterized as lactobacillus-dominant in 98% of patients in the study group; the dominant lactobacillus type of biocenosis was detected in 42.5% of those in the comparison group. Before and after the therapy, the correlation between the total vaginal bacterial mass was statistically significant (p=0.03; r =0.63) (Spearman's rank correlation coefficient) and had a noticeable tightness in accordance with the Chaddock scale. There were statistically significant direct correlations between the total vaginal bacterial mass after the therapy and the amount of Lactobacillus spp. (ry=0.514; p=0.02) and Gardnerella vaginalis (ry=0.55;p=0.01) in the uterine cavity. Conclusion: Preoperative sanitizing therapy can reduce the overall bacterial contamination of the vagina and uterine cavity by 2 times.

intrauterine biocenosis, endometrial microbiota, chronic endometritis, endometrial microflora, contamination, hysterosalpingography, hysteroscopy, endometrial biopsy