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Aim to study the microbiome of the placenta in full-term pregnancy with premature rupture of the membranes (PROM) in comparison with the intact membranes. Material and methods. The study was conducted on the basis of Samara City Clinical Hospital N 1 named after N.I. Pirogov and involved 43 pregnant women at 37-41 weeks of gestation subject to elective cesarean section. The patients were divided in two groups: the main group included 24 women with PROM, the control group was formed with 19 women with intact fetal membranes. The placental tissues were taken for the real-time PCR-test for the following microorganisms: Lactobacillus spp., Enterobacteriaceae, Streptococcus spp., Staphylococcus spp., Gardnerella vaginalis / Prevotella bivia / Porphyromonas spp., Eubacterium spp., Sneathia spp. / Leptotrihia spp. / Fusobacterium spp., Megasphaera spp. / Veillonella spp. / Dialister spp., Lachnobacterium spp. / Clostridium spp., Mobiluncus spp. / Corynebacterium spp., Peptostreptococcus spp., Atopobium vaginae, Mycoplasma hominis, Ureaplasma (urealyticum + parvum), Candida spp., Mycoplasma genitalium. Results. At the end of physiological full-term pregnancy, the bacterial population was detected in 66.7% of placentas in the main group, total bacterial count Ме 103,2 Q1:Q3 0,0 103,4 GE/sample; and in 78.9% of the placentas in the control group, total bacterial count Ме 103,3 Q1:Q3 103,1 103,5 GE/sample. The main representatives of the identified microorganisms were Enterobacteriaceae spp. (Me 103,2 GE/sample for PROM and Me 103,2 GE/sample for intact amniotic sac (p0.05)). Lactobacillus spp. were determined in the placenta only in the PROM group in 8.3% of patients. The presence of Lactobacillus spp. in the tissues of the placenta is typical only for patients with PROM. Microorganisms not identified by the Femoflor-16 test were found in 50% of patients with PROM, Me 102,1 GE/sample, and in 63.2% of patients with an intact fetal bladder, Me 103,2 GE/sample, (p = 0.09). No correlation was found between PROM incidents and the characteristics of the placental microbiota. Conclusion. In case of physiologically proceeding full-term pregnancy, it is possible to detect using the real-time PCM test a bacterial population represented by the Enterobacteriaceae spp., while in cases of PROM, Lactobacillus spp. and anaerobic vaginal flora were also detected in placental samples.

Premature rupture of membranes (PROM) is diagnosed in 6–26.5% of full-term pregnancies. An analysis of the characteristics of labor and the frequency of complications in tPROM could allow us to identify «weak» points and optimize the managing this category of patients.The aim of the study was to assess the characteristics of labor during full-term pregnancy (at 37.0–41.0 weeks), complicated by premature rupture of the membranes.Materials and methods. A prospective analysis of the course of labor and the postpartum period was carried out in 425 patients with singleton pregnancy in cephalic presentation, 37,0–41,0 weeks of gestation, women of low and moderate risk groups, without contraindications to vaginal delivery.. As a complication of the pregnancy, 310 of them had PPROM (main group) and 115 women in labor went into labor with intact fetal membrane (comparison group). The features of the delivery and postpartum complications were analyzed.Results: The features of delivery patients with PROM was the longer duration of rupture – 4.7 times higher than in the comparison group (p<0.001), the second stage of labor – in the main group more an average of 7 minutes (p=0.008). The frequency of abnomally labor activity in the main group, such as abnormally slow or protracted labor (primary and secondary), was 2 times higher than it was in the comparison group. The diagnosis of «cervical dystocia» was observed in 27 cases (8.7%) only in the group with PROM. In the main group, oxytocin was used in 165 patients (53.2%), which is more than 2 times higher than in the comparison group – 25 (21.7%, p<0.001), respectively, the total dose of oxytocin used was higher at vaginal delivery: 8 .06 (0.44) U and 1.06 (0.46) U (p<0.001). The differences in this parameter at patents of both group with C-section were not signifcant. Medical analgesia in the main group was required 2 times more often than in the comparison group (83.5 and 43.5%; <0.001).The problem of tPROM is a higher percentage of operative delivery and obstetric trauma. Thus, in our study, the incidence of C-section was 54 cases (17.4%) compared with the another group – 2 cases (1.7%), vaginal operative delivery – 20 cases (6.5%) and 3 (2.6%)%) respectively (Xi=21.88; Df=2; p<0.001), cervical ruptures: 11.3% (p=0.002), episiotomies: 8.3% (p=0.099). The frequency of postpartum septic complications was comparable in groups, but high level of leukocyts and antibiotic therapy were more often in patients with PROM.Conclusion: the management of labor in patients with PROM is associated with a high percentage of the use of oxytocin, antibacterial therapy, various methods of medical analgesia, and operative delivery.

Objective. To study the microbial landscape of amniotic fluid in physiological process of full-term pregnancy. Recently, after publication of a number of studies regarding human microbiota (The Human Microbiome Project HMP), there occurred a change in paradigm on absolute sterility of fetal membranes and amniotic fluid in physiologically developing pregnancy. Materials and methods. At the City Clinical Hospital № 1 named after N.I. Pirogov, during elective cesarean section of 19 pregnant women (at the terms of 3741 weeks) with intact fetal membranes, an amniotic fluid of the following microorganisms was taken by means of PCR-PB: Lactobacillus spp., Enterobacteriaceae, Streptococcus spp., Staphylococcus spp., Gardnerella vaginalis / Prevotella bivia / Porphyromonas spp., Eubacterium spp., Sneathia spp. / Leptotrihia spp. / Fusobacterium spp., Megasphaera spp. / Veillonella spp. / Dialister spp., Lachnobacterium spp. / Clostridium spp., Mobiluncus spp. / Corynebacterium spp., Peptostreptococcus spp., Atopobium vaginae, Mycoplasma hominis, Ureaplasma (urealyticum + parvum), Candida spp., Mycoplasma henitalium. Results. The general bacterial mass (GBM) of amniotic fluid in intact fetal membranes is 103,02 Ge/copies, in 47.4 % of cases the amniotic fluid is sterile. Microbiota is most often presented by Enterobacteriaceae spp. 37 %, the share of the rest, identified bacteria is 28 %, the share of unknown is 35 %. Conclusions. In case of physiologically developing pregnancy and intact fetal membranes, the general bacterial mass is low (GBM = 103,02 345 Ge/ml). In the intact amniotic sac the most typical microorganisms living in amniotic fluid are Enterobacteriaceae spp. (37 %), the rest are presented in single instances. The presence of the representatives of anaerobic vaginal dysbiosis as well as lactobacilli is not typical for the intact fetal membranes.