ASPECTS CONCERNING FREQUENCY AND ETHIOLOGY OF VAGINITIS IN PREGNANT WOMEN IN THE TWO LAST TERMS OF PREGNANCY
Authors: D. Anastasiu
Received for publication: 15th of February, 2006
Revised: 16th of April, 2006
SUMMARY: (Hide the summary)
The study was made on 315 unselected pregnant women in the second and third of pregnancy. In this group we systematically prelevated samples from vaginal discharge. 147 (46,66%) had no clinical signs and 186 (53,34%) presented specific vaginitis clinical symptoms. The percentage 35,3% of pregnant woman with vaginal infections without clinical symptoms confirms the health carrier existence. Vaginal infections were caused in 24,12% of cases by Candida albicans, Trichomonas vaginalis (11,11%), Chlamydia trachomatis (12,38%), Neisseria gonorrhaeae (0,63%), Gardenerella vaginalis (3,17%). The pregnancy was not affected by treatment, no preterm deliveries and abortions occur.
pregnancy, vaginitis, treatment
Generally, vaginal infections in the most cause of a gynaecological exam, one third of women accusing vaginal symptoms.
In two last terms of pregnancy, many women are requesting a gynaecological exam because of the vaginitis.
Added to increased physiological vaginal discharge in pregnancy, leucorrhoea can be caused by infections with Candida albicans, Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhaeae and Gardenerella vaginalis. Frequently, a mixed ethiology of vaginitis can occur.
The frequency of Trichomoniasis is very controversial; the percentage vary between 5,1% - 20% (2-4). Vaginal Candidiasis seems to be the most frequent ethiology; in pregnancy a incidence between 15-42% is reported (7).
The incidence of Gardenerella vaginalis is about 23,6% (9). The symbiosis concept that Gardenerella vaginalis and anaerobic bacteria might be responsible of non-specific vaginitis is admitted by a great number of authors.
Infections with Chlamydia trachomatis in pregnant women are very important.
In many cases the disease is asymptomatic but with some implications in pregnancy pathology and without doubt is correlated with the newborn infections intrapartum. Newborns present conjunctivitis with inclusions or neonatal pneumonia.
Generally, the incidence of infections with Chlamydia trachomatis reported in the literature is 2-3 %. Dieterle (5) shown that the regional incidence is 8% (1994).
Shachter (10,11) revelled that the infections with Chlamydia trachomatis have an endemic aspect and Pearlemen and Nectey (8) reported 2-34% incidence in SUA.
In Romanian literature the incidence of Chlamydia trachomatis in vaginitis vary between 6-21%. (Anastasiu) (2,6).
Concerning gonococical vaginitis there is related a higher incidence worldwide, Solola presented a percentage about 2,5-7,5 infections with Neisseria gonorrhaeae in pregnant women (12).
Material and method
We studied the ethiology of the vaginitis upon an unselected of 315 pregnant women, 80 in the second and 235 in the third term of pregnancy.
To all examinated patients, we prelevated a native smear and three supplementary smears stained with Gram, Giemsa and Pich-Iacobson stain for the study of normal and pathological flora and antigenic determinations by direct immunofluorescence of Chlamidia tr.
In 100 third team pregnant women we performed bacteriological cultures from cervix. In the group we surveyed also the newborns development and the postpartum state of the mother related to the pathology of vaginal infections from pregnancy.
We mention that in 147 cases (46,66%) there were no clinical signs and the rest 186 cases (53,34%) has vaginitis sign.
In 95 cases (30,15%) we had normal smears. The most frequent vaginal infections are with Candida albicans (24,15%), the incidence begin constant in the two last terms of pregnancy. An interesting aspect seems to be an almost equal incidence of Chlamidia tr.
(12,38%) and Trichomonas vaginalis (11,11%) infections. In 10,79% cases there might be possible mixed infection with Candida albicans and Trichomonas vaginalis (Table 3).
Observing gram stained smears, we found 35,55% gram positive and 24,75% gram negative bacilli, in most cases we identified association of gram positive or negative bacilli and cocci.
Analysing the bacteriological cultures of cervix in 74% of cases we had normal vaginal flora, in 1% of cases E. coli and in 2% of cases Peptostreptococci.
The results of bacteriological exams of the cervix in pregnant women in the third term of pregnancy (Table 4)
Applying vaginitis treatment principles and using specific medications we obtained good results in 70% of cases without obstetrical accidents, but 30% of cases needs two or even three cures.
From 110 pregnant women newborn’s were surveyed delivery, 86,18% had normal evolution and the rest presented: 12 cases (10,40%) gram positive cocci conjunctivitis, 2 cases (1,81%) gram negative bacilli otitis, 1 case (0,90%) gram positive germs omphalytis and 9 cases (8,18%) oral Candidiasis.
The results seems to be jarring concerning the pathology found in studies from which more than half presented various ethiology vaginitis but were treated in the third team of pregnancy and even in the lat month of gestation.
In the two last terms of pregnancy, vaginal infections were detected in 70% of cases, mostly with Candida albicans.
Chlamydia trachomatis vaginitis is frequent in pregnancy (12,38%), predominantly in the last term.
The specific treatment had no harmful effects on pregnancy, no preterm birth or abortions were observed.
The increased last term vaginitis incidence require a correct diagnosis and treatment for the new born benefit.
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