Microbiological safety of the Dr. Arabin cervical pessary in pregnant women with short cervix

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Abstract

BACKGROUND: The insertion of a cervical pessary is a method for treating short cervix and preventing preterm birth. The study of the vaginal microbiota composition and the need for its routine correction after the pessary insertion remain to be investigated. To date, there are no works devoted to the assessment of changes in vaginal microbiocenosis after the cervical pessary insertion.

AIM: The aim of this study was to assess the microbiological safety of the Dr. Arabin cervical pessary in pregnant women with short cervix.

MATERIALS AND METHODS: This prospective study included 22 pregnant women with singleton or multiple pregnancies with short cervix (<25‰ L.J. Salomon scale) and threatened miscarriage in the second and third trimesters who received the Dr. Arabin cervical pessary. The obtained clinical materials included the secretion of the posterolateral vaginal fornix. We used the Femoflor 16 test (NPO DNA-Technology Ltd., Moscow, Russia) as a method of molecular biological analysis. In addition, the patients independently controlled the pH of the vaginal contents using the pH-balance express test. Vaginal microbiocenosis was assessed in a dynamic manner: before the cervical pessary insertion, then every two to four weeks after it, and on the day the pessary was removed. In all 22 pregnant women, clinical material was obtained twice: before the cervical pessary was inserted and when it was removed; in 15 women (68.18%) three times, and in nine pregnant women (40.91%) four times.

RESULTS: The analysis of vaginal microbiocenosis showed no significant changes in vaginal microbiocenosis in the examined pregnant women before and after the insertion of the cervical pessary (p > 0.05). The concentration of lactobacilli remained high (in the range of 107 lg DNA copies/ml) during the entire observation period. The numbers of facultative and obligate anaerobic bacteria, as well as yeast-like fungi of the Candida genus, Ureaplasma spp., and Mycoplasma hominis were within the physiological levels. No pathogenic microorganisms such as Mycoplasma genitalium were detected in any patient. After the cervical pessary insertion against the background of normocenosis, 72.73% of pregnant women noted an increase in the amount of light and odorless discharge from their genital tract. However, we found no changes in the vaginal microbiota composition.

CONCLUSIONS: The insertion of the Dr. Arabin cervical pessary under conditions of vaginal normocenosis is a microbiologically safe way to correct short cervix and prevent preterm birth, and does not disrupt the vaginal microflora in pregnant women before delivery.

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About the authors

Gabriel S. Sargsyan

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Saint Petersburg

Author for correspondence.
Email: gabsarg89@yahoo.com
Russian Federation, 3 Mendeleyevskaya liniya, Saint Petersburg, 199034, Russian Federation

Olesya N. Bespalova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: shiggerra@mail.ru
ORCID iD: 0000-0002-6542-5953
SPIN-code: 4732-8089
ResearcherId: D-3880-2018

MD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Alevtina M. Savicheva

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; St. Petersburg State Pediatric Medical University

Email: savitcheva@mail.ru
ORCID iD: 0000-0003-3870-5930
SPIN-code: 8007-2630
Scopus Author ID: 6602838765
ResearcherId: P-6788-2015

MD, Dr. Sci. (Med.), Professor, Honored Scientist of the Russian Federation

Russian Federation, Saint Petersburg; Saint Petersburg

Tatyana A. Khusnutdinova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; St. Petersburg State Pediatric Medical University

Email: husnutdinovat@yandex.ru
ORCID iD: 0000-0002-2742-2655
SPIN-code: 9533-9754
Scopus Author ID: 57015542400
Russian Federation, Saint Petersburg; Saint Petersburg

Olga V. Budilovskaya

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; St. Petersburg State Pediatric Medical University

Email: o.budilovskaya@gmail.com
ORCID iD: 0000-0001-7673-6274
SPIN-code: 7603-6982
Scopus Author ID: 12545757500
ResearcherId: K-1854-2018
Russian Federation, Saint Petersburg; Saint Petersburg

Anna A. Krysanova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; St. Petersburg State Pediatric Medical University Saint Petersburg

Email: krusanova.anna@mail.ru
ORCID iD: 0000-0003-4798-1881
SPIN-code: 2438-0230
Russian Federation, Saint Petersburg; Saint Petersburg

Kira V. Shalepo

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; St. Petersburg State Pediatric Medical University Saint Petersburg

Email: 2474151@mail.ru
ORCID iD: 0000-0002-3002-3874
ResearcherId: K-1364-2018

Cand. Sci. (Biol.)

Russian Federation, Saint Petersburg; Saint Petersburg

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Supplementary files

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1. Fig. 1. Total bacterial mass of the vaginal contents of the examined pregnant women (four time points)

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2. Fig. 2. The concentration of Lactobacillus spp. in the examined pregnant women (four time points)

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3. Fig. 3. Facultative anaerobic microorganisms in the examined pregnant women (four time points)

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4. Fig. 4. The concentration of obligate anaerobes and Ureaplasma spp. in the examined pregnant women (four time points)

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5. Fig. 5. Detection of Eubacterium spp. and yeast-like fungi of the genus Candida among patients with term birth and spontaneous preterm birth (time point 4; * p < 0.05). SPB — spontaneous preterm birth

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