Introduction. Abnormal vaginal microflora in the first trimester of pregnancy is a risk factor for miscarriage. Opportunistic microorganisms predominate among microorganisms causing microflora disturbance. Aim. The aim of the study was to evaluate the vaginal microflora in the first trimesterфIntroduction. Abnormal vaginal microflora in the first trimester of pregnancy is a risk factor for miscarriage. Opportunistic microorganisms predominate among microorganisms causing microflora disturbance. Aim. The aim of the study was to evaluate the vaginal microflora in the first trimester of pregnancy in women having history of pregnancy loss. Matherials and Methods. Real-time polymerase chain reaction, microscopic and cultural methods were used to examine 60 pregnant women having history of pregnancy loss and 10 pregnant women with uncomplicated obstetric history. Results. Disorders of the vaginal microflora were observed only in women having history of pregnancy loss. The lactoflora in both groups was shown to consist most frequently of 3 Lactobacillus species: Lactobacillus crispatus, L. jensenii, and L. iners. However, the species L. iners were detected only in the group of women with history of pregnancy loss. Non-Lactobacillus microbiota was significantly more often observed in pregnant women having history of pregnancy loss. Facultative and obligate anaerobes were detected in both groups. The concentration of Ureaplasma spp. and Mycoplasma hominis in women in both groups had no significant differences. Conclusions. The results of this study indicate that abnormal microbiota is more often observed in women having history of pregnancy loss.of pregnancy in women having history of pregnancy loss. Matherials and Methods. Real-time polymerase chain reaction, microscopic and cultural methods were used to examine 60 pregnant women having history of pregnancy loss and 10 pregnant women with uncomplicated obstetric history. Results. Disorders of the vaginal microflora were observed only in women having history of pregnancy loss. The lactoflora in both groups was shown to consist most frequently of 3 Lactobacillus species: Lactobacillus crispatus, L. jensenii, and L. iners. However, the species L. iners were detected only in the group of women with history of pregnancy loss. Non-Lactobacillus microbiota was significantly more often observed in pregnant women having history of pregnancy loss. Facultative and obligate anaerobes were detected in both groups. The concentration of Ureaplasma spp. and Mycoplasma hominis in women in both groups had no significant differences. Conclusions. The results of this study indicate that abnormal microbiota is more often observed in women having history of pregnancy loss.

ВведениеНевынашивание беременности -основ-ная причина перинатальной заболеваемости и смертности во всем мире и одна из важ-нейших проблем практического акушерства.Согласно данным ВОЗ частота встречаемости данной патологии в разных странах остается стабильно высокой и составляет 10-25 % от всех выявленных беременностей (20-25 % -самопроизвольные выкидыши, 5-10 % -пре- ■ Дисбиоз влагалища -одна из ведущих причин неблагоприятных исходов беременности. Основная роль в под-держании постоянства микробиоценоза влагалища принадлежит лактобациллам. Инфекционный процесс мо-гут вызвать как патогенные, так и условно-патогенные микроорганизмы, однако в подавляющем большинстве случаев возбудителями генитальной инфекции являются представители нормальной микрофлоры. Нарушение микробиоценоза влагалища в сочетании с несостоятельностью цервикального барьера ведет к миграции бак-терий в амниотическую полость и запуску патологических механизмов, приводящих к прерыванию беремен-ности. В статье представлены современные данные о роли инфекционного фактора в генезе невынашивания беременности. Рассмотрен вопрос о способности Lactobacillus iners предрасполагать к развитию патологической влагалищной микрофлоры. Уделено внимание основным подходам к профилактике и лечению дисбиотических нарушений. Затронут вопрос о применении бактериофагов в акушерстве и гинекологии.■ Ключевые слова: микробиоценоз влагалища; преждевременные роды; самопроизвольный выкидыш; бактери-альный вагиноз; аэробный вагинит. CURRENT VIEWS ON VAGINAL MICROBIOTA AND ITS IMPACT ON PREGNANCY OUTCOMES © A.A. SiniakovaThe ■ Vaginal dysbiosis is one of the leading causes of adverse pregnancy outcomes. The main role in maintaining the constancy of vaginal microbiocenosis belongs to lactobacilli. The infection process can be caused by both pathogenic and opportunistic microorganism, however, in the vast majority of cases vaginal infections is associated with the normal microflora. Violation of microbiocenosis of the vagina in combination with a cervical barrier failure leads to migration of bacteria in the amniotic cavity and the launch of the pathological mechanisms leading to pregnancy loss. The paper presents current data on the influence of vaginal infection on pregnancy loss. Consider the ability of Lactobacillus iners predispose to the development of pathological vaginal microflora. Attention was paid to the basic approaches to prevention and treatment of dysbiotic disorders. Discussion on the use of bacteriophages in obstetrics and gynecology.

Hypothesis/aims of study. The problem of vaginal infections during pregnancy is of high importance in obstetric practice. To predict the risks and reduce the frequency of pregnancy and childbirth complications, it is necessary to dynamically assess the vaginal microflora and treat its disorders. The aim of the study was to investigate the vaginal microflora and evaluate the effectiveness of treating vaginal infections in pregnant women with a history of miscarriage. Study design, materials and methods. The study included 153 pregnant women in the first trimester. The main group (group I) consisted of 99 women with a history of miscarriage, 35 of whom had signs of threatened abortion (subgroup IA) and 64 did not (subgroup IB). The control group (group II) comprised 54 women without a history of miscarriage and signs of threatened abortion. The vaginal microflora was examined using microscopic, bacteriological and quantitative real-time PCR methods. All patients with an established vaginal infection (bacterial vaginosis, aerobic vaginitis, and vulvovaginal candidiasis) received etiotropic therapy, depending on the microorganisms identified and their sensitivity to antimicrobial drugs. After treatment, in order to assess the effectiveness of the therapy, the vaginal microflora was examined in the second trimester and the outcomes and complications of present pregnancy were evaluated. Results. In women of subgroup IA, vulvovaginitis and bacterial vaginosis were detected 3.5 times more often compared to the control group, and 1.6 times more often compared to subgroup IB (66% and 19%, respectively, p 0.001; 66% and 42%, respectively, p 0.05). Aerobic vaginitis was the most frequent vaginal infection in the first trimester of pregnancy in women of the main group (p 0.05). After treatment, the frequency of the vaginal infections in the second trimester in women of the main group significantly decreased: by 1.9 times in subgroup IA and by 1.5 times in subgroup IB (p 0.05). There were no significant differences in the frequency of adverse pregnancy outcomes in women with bacterial vaginosis or vulvovaginitis as compared to women with normal vaginal microflora. Nevertheless, pregnancy and childbirth complications were diagnosed 4 times more frequently in the main group (23% and 6%, respectively, p 0.05), with the complications occurring significantly more often in the cases of vulvovaginitis or bacterial vaginosis and signs of threatened abortion in the first trimester (p 0.05). Conclusion. Etiotropic therapy of vaginal infections diagnosed in the first trimester of pregnancy in women with a history of miscarriage was highly effective. In 40% of women, vaginal microbiocenosis normalized, and the clinical symptoms of vaginosis/vaginitis disappeared. Differences in the frequency of adverse pregnancy outcomes in women with vulvovaginitis or bacterial vaginosis in the first trimester and in women with normal vaginal microbiocenosis were not significant. However, the treatment of vaginal infections in the group of pregnant women with a history of miscarriage did not significantly affect the frequency of pregnancy and childbirth complications.