Restoration of vaginal microbiocenosis is an obligatory component of a complex of medical and preventive measures in women carrying a pregnancy under martial law

Restoration of the vaginal microbiocenosis is a mandatory component of the complex of therapeutic and preventive measures in women carrying a pregnancy under martial law.The objective: to study the role of synbiotics in the treatment of vaginal microbiocenosis disorders during pregnancy in military personnel and temporarily displaced women under martial law.Materials and methods. In total, 96 pregnant women aged 19 to 44 years with diagnosis vaginitis and vaginosis were examined and treated in the II and III trimesters: I group – 31 pregnant military women; II group – 33 pregnant women who were displaced from the combat zones (Zaporizhzhya, Kherson, Kharkov, Donetsk and Lugansk regions); III group – 32 pregnant women living in Kyiv and Kyiv region and who do not serve in Armed Forces of Ukraine (AFU). For the treatment of vaginitis and vaginosis in pregnant women of these three groups, according to the identified pathogens, a drug containing ornidazole – 500 mg, neomycin sulfate – 100 mg, nystatin – 100,000 IU, prednisolone – 3 mg was used intravaginally for 10 days. In addition, for pregnant women in the I and II groups a drug containing a combination of probiotics and prebiotics, a synbiotic, was included in the treatment regimen to correct vaginal microflora disorders.Results. During the examination, normal vaginal pH was detected only in 3 (9.7%) women in the I group and 4 (12.1%) pregnant women in the II group, which necessitated the mandatory use of synbiotics in the treatment schemes.Microscopy data revealed high fungal-bacterial contamination of the vaginal microflora in women of the I and II groups, namely:– gram-positive flora (bacilli – in 14 (45.2%) cases of the I group and 16 (48.5%) of the II group; cocci – in 12 (38.7%) and 14 (42.4%), respectively);– gram-negative flora (bacilli – in 10 (32.2%) and 12 (36.4%); cocci – in 14 (45.2%) and 13 (39.4%);– extracellular diplococci – in 9 (29.0%) and 12 (36.4%);– “key” cells – in 9 (29.0%) and 10 (30.3%);– fungi of the genus Candida – in 23 (74.2%) and 20 (60.6%) women, respectively.The obtained results of molecular diagnostics confirmed the microscopy data: Gardnerella vaginalis was found in 9 (29.0%) and 11 (30.3%) women of the I and II groups, Atopobium vaginae – in 5 (16.1%) and 6 (18.2%), Mobiluncus spp. – in 7 (22.6%) and 6 (18.2%) women, respectively.Conclusions. The study of the vaginal microbiocenosis and subsequent treatment of vaginitis and vaginosis in pregnant women demonstrated that the normalization of vaginal pH after treatment was significantly better in pregnant servicewomen and displaced women, who received symbiotic in addition to vaginal tablets with ornidazole, neomycin sulfate, nystatin, prednisolone – in 90.3% and 90.9% of patients, respectively. In the III group (residents of Kyiv and Kyiv region who do not serve in the AFU), normalization of vaginal pH was observed only in 65.6% of patients.Molecular diagnostic data by groups before and after treatment of vaginitis and vaginosis indicate that in pregnant servicewomen and displaced women, the beneficial microflora Lactobacillus spp. recovered significantly better – from 9.7 to 93.6% in women of the I group, from 12.1 to 93.9% in the II group, than in pregnant women of the III group – from 46.9 to 68.8%. Pathogenic microflora (Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp., Bacteroides fragilis, Megasphaera type 1) was not detected after treatment in all three groups.The use of a new generation drug – a synbiotic that combines a probiotic and a prebiotic, opens up new opportunities for the effective treatment of vaginitis and vaginal vaginosis in pregnant servicewomen and internally displaced women.