Treatment of streptococcus during pregnancy. Infection caused by Streptococcus agalactiae (group B streptococci). How does streptococcus affect pregnancy?

Streptococcus during pregnancy indicates the presence of pathogenic microorganisms in the normal microflora of the genitourinary system. Their penetration is often provoked by unprotected sexual intercourse.

Streptococcus is a special type of bacteria that can lead to the development of acute inflammatory and infectious processes in the body. It lives in both animals and humans.

Most representatives of microorganisms are not dangerous and form the basis of normal microflora. However under the influence of provoking factors, they can cause a heavy blow to the body.

It is worth noting that streptococci play an important etiological role in the development of diseases such as rheumatism and endocarditis.

Streptococcus

Streptococcus in a smear during pregnancy indicates the development of streptococcal infection. It causes a lot of diseases that are accompanied by acute inflammatory processes. In most cases, the organs of the digestive and genitourinary systems are affected.. Often the infection affects the respiratory system.

The bacterium is transmitted through sexual, airborne, household or contact contact. Cases of infection are often recorded during the birth process. In this case, the microbe is transmitted to the child when passing through the birth canal.

There are four in total ;

• gamma-;
• non-hemolytic.

Alpha and gamma streptococci are part of the normal microflora of the oral cavity, digestive and respiratory systems. They do not harm the body. Dangerous and pathogenic types of streptococci are beta-hemolytic.

They are divided into several main groups: A, B, C, D and G. The main provocateurs of serious diseases are representatives of groups A and B. They cause pneumonia, sore throat, laryngitis, pharyngitis, inflammation of the genitourinary system and rheumatism.

Diagnostic measures

Group B streptococcus during pregnancy is determined through laboratory tests.

The standard procedure involves taking a vaginal smear. Then the laboratory assistant examines the obtained material. The duration of the procedure is on average 5 days. During this period, both the type of bacterium and its sensitivity to antibiotics are determined.

Material collection– this is not a long process that requires special preparation. It is not recommended to carry out hygiene procedures. This action is appropriate only in the evening, on the eve of visiting a medical facility. 2-3 hours before the test, you should not urinate.

To diagnose streptococcus, a vaginal smear is taken

A laboratory technician collects material using a cotton swab.. The mucus is then sent to the blood hangar and kept there for about 24 hours. At the same time, a certain temperature of 37 degrees is maintained.

Express testing

Streptococci in a smear in women during pregnancy are also detected through rapid testing. This is the fastest way to determine the presence/absence of bacteria. Testing is carried out using special reagents. So, the test package includes a special flask, 2 bottles, a cotton swab and an express strip.

First, you need to pour 4 drops from the red bottle into the flask, then from the yellow one. Their sequence can be changed, this will not affect the effectiveness of testing in any way. Then a swab is taken using a cotton swab.

The resulting material is swirled in flasks with reagents 10 times and left for 60 seconds. Then the express strip is lowered into the liquid for literally 5 minutes. One strip means the test is negative, two strips means the test is positive.

The danger of streptococcal infection during pregnancy

Group B streptococci are the most common type of bacteria. They can cause an acute inflammatory process in the body. For adults, microbes are not dangerous, but for pregnant women and newborns, they are major provocateurs of serious diseases.

Many people are considered carriers of the infection, but do not themselves suffer from its presence in the body. In most cases, representatives of group B lead to an inflammatory process in the genitourinary system.

How does streptococcus affect pregnancy?

Streptococcus during pregnancy increases the risk of premature birth, rupture of membranes and intrauterine fetal death. The presence of group B bacteria leads to infectious lesions of the genitourinary system. This process is accompanied by pain, itching, burning and fever.

Timely diagnostic measures will allow you to determine the presence of a pathogenic microorganism.

Infection of a newborn

Streptatest rapid test for determining streptococcus

Infection of the newborn occurs during the birth process. When entering a child’s body, they do not appear immediately. This process depends entirely on the type of infection that the newborn has contracted.

There are two main types infectious lesions: early and late. The first is characterized by the appearance of signs immediately after birth. The child suffers from prolonged fever, has breathing problems, and excessive sweating. This symptomatology is recorded in the first week of life.

Late onset of infection manifests as cough, runny nose and fever. Some children have problems eating and experience seizures. The first symptoms appear 30-90 days after birth.

This type of infection is the most dangerous; it can provoke the development of meningitis and sepsis.

Why is bacteria dangerous for newborns?

Group B streptococcus is not dangerous for a woman during pregnancy; it can cause severe complications only in a newborn. In most cases, severe complications are recorded, in particular meningitis, pneumonia and sepsis.

Meningitis can be fatal. It leads to infection of the fluid that is located around the brain. Sepsis, represented by blood poisoning, is also particularly dangerous.

These diseases are life-threatening for the newborn. In most cases, timely therapy leads to complete recovery. However, in 5%, death still occurs, even after correctly prescribed treatment tactics.

The presence of streptococcus in the body can lead to problems in the future. Often children who have had infectious diseases are retarded in mental development and have poor vision or hearing.

Postpartum complications

Streptococcus B during pregnancy leads to the development of complications in the future. Women are often diagnosed with intrauterine infection. It can manifest itself both during pregnancy and after the birth process.

The presence of a serious illness is indicated by elevated body temperature, severe abdominal pain and a high heart rate.

Timely antibiotic therapy avoids complications.

Streptococcus is a dangerous microorganism that can lead to damage to both the mother and the child. In this case, it is important to provide timely medical assistance. The future health and well-being of the child depends on the correct diagnosis and treatment tactics.

Most representatives of the group of streptococci do not pose a mortal danger to humans, but can significantly harm the health of a pregnant woman and prevent the normal development of her child. Streptococci are classified as opportunistic spherical bacteria, which can almost always be found in the body. Some of them, under the influence of certain circumstances, provoke the development of serious diseases: food poisoning, purulent-inflammatory reactions, rheumatism, glomerulonephritis. However, streptococcus is most dangerous because it can infect the fetus, as well as cause sepsis and meningitis in the infant.

The indicators of a woman’s immune system decrease significantly when she learns about her lucky situation. During the gestation period, expectant mothers easily succumb to colds, relapses of chronic diseases, and infectious diseases, which most often appear due to the active activity of streptococci.

Statistics report that streptococcal bacteria infect 10 to 30% of pregnant women. The development and course of the infectious process is almost always asymptomatic. A sure sign of the presence of problematic bacteria in the body is abundant yellowish discharge from the genital tract, which is not constant.

Some children become infected from a sick mother even at the intrauterine stage of their existence, while others remain healthy, despite their “neighborhood” with a dangerous microorganism. Based on the results of numerous studies, scientists have concluded that the ability to resist infection depends on the strength of the baby’s innate immunity.

In Russia, the following statistics have been officially announced: the probability of intrauterine infection of the fetus by streptococcus is approximately 1 - 2%. At the same time, there are factors that increase the likelihood of infection of the baby.

What is important to know about streptococcus during pregnancy

The Streptococcaceae family includes gram-positive microorganisms that are spherical in shape and do not form spores. Bacteria do not have flagella, so they cannot move independently. But they have one important advantage over other active microorganisms - they survive in an environment deprived of oxygen.

Using a microscope, you can see what streptococci look like - these are “balls” arranged in pairs or chains. The prevalence of the microorganism in the external environment is high: it lives not only in the body of animals and humans, but also in the soil and on plants. Easily tolerating various temperature changes, it retains the ability to reproduce, even if it remains in the soil for several years. Moreover, all representatives of the streptococcal family are extremely sensitive to penicillin antibiotics, macrolides and sulfonamides. They multiply at lightning speed in nutrient media such as serum, blood, and sweet solution.

Ways of infection with streptococcus during pregnancy

Streptococcus in expectant mothers is found mainly in the urine. There are three options for infection:

• with unprotected intimacy;
• as a result of ignorance of the basic rules of intimate hygiene;
• due to wearing synthetic underwear.

Types of streptococci during pregnancy

The vaginal microflora of the expectant mother contains streptococci belonging to 3 different species;

• serological group D (enterococci);
• serological group B;
• viridans streptococci.

Doctors also know the 2 most dangerous types of pathogens that can harm the body of the expectant mother:

• hemolytic streptococcus group A, which occurs during pregnancy due to repeated cases of bacterial sepsis;
• group B hemolytic streptococcus, which currently infects newborns.

Group A streptococci during pregnancy

The bacterial strain poses the greatest health hazard and is often localized on the skin and mucous membranes. When such bacteria enter wounds and injuries, an acute inflammatory reaction begins with the formation of pus. In the internal environment of the body, streptococci of this group behave very aggressively and can cause tissue atrophy or provoke infectious-toxic shock. The infection is concentrated in the nasopharynx, vagina and perianal area.

The consequences of group A streptococcus during pregnancy are as follows:

• tonsillitis;
• pharyngitis;
• genitourinary system infections;
• endometritis;
• postpartum sepsis.

How dangerous is streptococcus during pregnancy for the fetus? Children infected with this pathogen before birth often subsequently develop diseases affecting the respiratory system.

Group B streptococci during pregnancy

Opportunistic microorganisms of this group are better known during pregnancy as Streptococcus agalactiae (S. agalactiae). Bacteria accumulate mainly in the nasopharynx, gastrointestinal tract and vagina. I diagnose the infection in more than 20% of expectant mothers. In the absence of a timely response to the pathogen, a pregnant woman may encounter a wide range of diseases caused by streptococcus agalactia:

• inflammatory reaction in the genitourinary system;
• miscarriage;
• endometritis after childbirth;
• sepsis;
• meningitis;
• endocarditis;
• inflammation of the membranes;
• pneumonia in a newborn;
• mental disorders in the child.

Streptococcus in a smear in women during pregnancy: previous symptoms of infection

Opportunistic bacteria that cause the development of skin diseases such as erysipelas and impetigo manifest themselves with the following symptoms:

• redness of the affected skin;
• manifestation of a clear line dividing diseased and healthy skin;
• severe pain when palpating the inflamed area;
• swelling and specific “gloss” of the affected area;
• in some cases, an increase in temperature.

If, as a result of the active activity of the pathogen, erysipelas develops, the face, arms and legs turn red. With streptoderma, the skin is strewn with blisters containing purulent contents, which after a while burst and dry out to form a crust. At the same time, the patient is plagued by painful itching. If you scratch the itchy areas, the infection will spread further.

Symptoms of streptococcus in the throat during pregnancy:

• high body temperature (up to 40°C);
• painful swallowing;
• protrusion of lymph nodes on the sides of the neck;
• severe weakness;
• spread of light plaque over swollen tonsils;
• sudden changes in sensations - changes from fever to chills;
• difficulty moving the neck muscles.

The development of the disease is acute, and complications such as pneumonia, otitis, and sinusitis are often associated.

If a harmful bacterium has infected the genitourinary system during pregnancy, the signs will be as follows:

• acute inflammation of the membranes;
• infection of the fetus in the womb, which subsequently results in a miscarriage or stillbirth;
• with the development of endometritis after cesarean section, the symptoms are not obvious: fever, general weakness, unpleasant discomfort in the lower abdomen, pain when examining the uterus.

If a newborn is infected, the baby may be diagnosed with sepsis on the same day, and 10 days after birth - meningitis.

Methods for diagnosing streptococcus during pregnancy

In most cases, it is very difficult to detect a streptococcal infection without laboratory testing. Most often, streptococcus is diagnosed in women during pregnancy in a smear. Biological material is collected from the following foci:

• sputum - to find out on what basis inflammation of the bronchi began and pneumonia developed;
• mucus from the throat and tonsils - if there is reason to believe that the cause of tonsillitis or pharyngitis during pregnancy is streptococcus in the woman’s throat;
• mucus from the vagina - to confirm or deny the presence of streptococcus in the cervical canal during pregnancy;
• urine - this is where the streptococcal nephritis pathogen is found;
• mucus from the urethra - to diagnose urethritis;
• purulent fluid - blot with a cotton swab and examine if the development of streptococcal pyoderma or erysipelas is suspected.

To clarify the nature of the infectious process, the ill expectant mother is prescribed a blood test for streptococcus using the polymerase chain reaction (PCR) method. If we are talking about a pyogenic pathogen, they can additionally test for the susceptibility of pathogenic microorganisms to various antibiotics. However, you will have to wait for a response for several days, and all this time the infection will quietly multiply without drug intervention. In order not to aggravate an already dangerous situation, doctors often choose an antibacterial drug at their discretion. Naturally, the specialist is primarily guided by his own experience, as well as information about the streptococcus that predominates in a given region.

We remind you once again that every person has a streptococcal infection. It will “sleep” as long as the body is guarded by a strong immune system. The norm of streptococcus in a smear during pregnancy is no more than 104 CFU/ml.

However, for a correct diagnosis, the most reliable way for the expectant mother is to submit urine for bacteriological culture. Since opportunistic bacteria of this family are almost always present in the vaginal microflora, after the onset of the disease, streptococcus appears in the urine during pregnancy almost immediately. Such a study is currently prescribed for preventive purposes: in the early stages, as well as at the end of gestation. Early detection of infection allows you to protect the child from intrauterine or birth infection.

To ensure the most accurate test result, a woman needs to follow these recommendations:

• do not take choleretic and diuretic medications 3 days before collecting biological material;
• 6 - 8 hours before urine collection, avoid salty foods and smoked foods;
• before collecting urine, thoroughly wash the external genitalia and insert a hygienic tampon into the vagina;
• A sterile container is used to collect biological material. The container is filled with the second portion of morning urine;
• urine must be delivered to the laboratory no later than 2 hours after its collection.

The presence of streptococcal bacteria in urine looks like colonies of “balls”. Normally, there should be no streptococcus in the urine during pregnancy.

How to treat streptococcus during pregnancy

If streptococcal bacteria are found in a woman’s smear during pregnancy, treatment is urgent. The fight against pathogenic microorganisms is multi-stage:

1. Treatment with antibiotics (Penicillin, Ampicillin - no side effects).
2. Increasing the body's defenses.
3. Restoration and support of intestinal microflora simultaneously with antibacterial therapy (Linex, Bifiform, Acipol).
4. Cleansing the body of toxins.
5. Symptomatic treatment (Zodak, Cetrin).

When drawing up a complex therapy regimen for the treatment of streptococcus in a pregnant patient, doctors select the safest medications for both mother and child. Before starting treatment, all expectant mothers are given a test to determine the likelihood of an allergic reaction. During treatment, a pregnant woman should not overexert herself, and if the disease is severe, if possible, adhere to bed rest.

The active form of streptococcus cannot be ignored, since the microscopic bacterium can cause damage to the membranes, premature birth or stillbirth. According to doctors, streptococcus during pregnancy is easier to prevent than to cure. Prevention of infection consists of careful intimate hygiene, timely treatment of colds, and maintaining the body's defenses. Only in this case can one hope for a calm pregnancy and successful development of the fetus. Be healthy!

SYNONYMS

Streptococcal B infection.
ICD-10 CODE
A40 Streptococcal septicemia.
A40.1 Septicemia caused by group B streptococcus (GBS).
B95.1 GBS as causative agents of diseases classified in other headings.

EPIDEMIOLOGY

The first description of a streptococcal infection with an early onset of the disease appeared in 1939. By this time, a classification of streptococci based on the structure of their polysaccharide Ags had already been developed (Lancefield R., 1935), and Streptococcus agalactiae was classified in group B.

In the 60s of the last century, the first reports appeared that these microorganisms could cause severe diseases in newborns. Infection caused by GBS in newborns is acute, sometimes lightning fast, and mortality reaches 60%. Up to 50% of surviving children suffer from central nervous system diseases. Infection occurs during childbirth from a mother whose birth canal is colonized with GBS.

GBS is characterized by asymptomatic presence on mucous membranes (colonization). It is assumed that in adults the main way of spreading GBS is through sexual contact, although not all researchers recognize this. Due to the increasing prevalence of STIs and the widespread use of oral contraceptives, which disrupt the natural balance of sex hormones and maintain the increased sensitivity of the vaginal epithelium to the adhesion of GBS, there is a significant increase in colonization of the vagina by these microorganisms.

The main reservoir of streptococcal infection in humans is the gastrointestinal tract, and in women it is also the vagina and urethra. In the USA, the percentage of GBS colonization of the vagina and rectum in women is 20–40%, in Brazil - 26%, in India - 6%, in Italy - 7%, in Austria - 12%, in Israel - 2-3%.

The maximum contamination of the vagina with GBS in pregnant women is observed at 35–37 weeks. Risk factors for transmission of the microorganism to the fetus and child are: the presence of GBS in the urine, childbirth before the 37th week of pregnancy, an anhydrous interval of more than 18 hours, maternal fever above 38 °C. Therefore, the CDC (Center for Diseases Control) recommends that pregnant women be screened for GBS colonization at 35–37 weeks of pregnancy, as well as in the presence of the above risk factors at any other stage of pregnancy.

The main source of infection of a newborn is the mother's genital tract. When passing through the birth canal, as well as during ascending infection, GBS infects the skin of the fetus. During aspiration of OM, microorganisms enter the respiratory tract and lungs. The lack of protective mechanisms against infection in the fetus can cause generalized illness and death of the newborn.

ETIOLOGY (CAUSES) OF STREPTOCOCCAL INFECTION

The causative agent of infection caused by GBS is the gram-positive diplococcus Streptococcus agalactiae. It is the only species in this group of streptococci and more often forms chains than other strains.

Most strains of this species are b-hemolytic. GBS contains two polysaccharide Ags: group-specific C-Ag and type-specific S-Ag; on the basis of the latter, GBS strains are divided into types 1a, 1b, 1c, 1a/c, 2, 3, 4, 5 and 6. Type-specific Ags are contained in the capsule and are important virulence factors.

Serotype 1c contains protein Ag. Serotypes 3, 2 and 1c most often cause early-onset disease, while serotype 3 is also dominant among late-onset diseases.

PATHOGENESIS

GBS is an opportunistic microorganism. Currently, the possibility of manifestation of the pathogenic effect of the microorganism under certain conditions is being studied. The presence of virulence genes has been proven in some strains that more often cause the development of intrauterine GBS infection.

Pathogenesis of gestational complications

Infection of the fetus occurs as it passes through the mother's birth canal. GBS can penetrate the uterine cavity both during PROM and intracanalicularly through intact membranes and thereby affect the fetus in utero. In such cases, they can cause early and late miscarriages, premature births, and stillbirths.

When the endometrium is damaged, the process of placentation and development of the placenta is disrupted, which contributes to secondary placental insufficiency. GBS can affect the placenta (placentitis) and fetal membranes (chorioamnionitis), which in turn leads to FGR, as well as premature initiation of labor. Untimely passage of the OB and labor anomalies (quick labor) are often observed. In the postpartum period, the development of parametritis is possible due to the spread of infection through the lymphogenous route from a postpartum wound or infected uterus, as well as when the cervix and upper third of the vagina are ruptured.

In the pathogenesis of the development of GBS infection in the fetus and newborn, the massiveness of colonization by Streptococcus agalactiae is important. When more than five areas of the skin and mucous membranes are colonized in a newborn in the first days of life, the development of GBS sepsis is possible.

When studying the protein factors of the pathogenicity of GBS, such as b-, a-Ag and C5a peptidase, it was found that these factors, despite their importance in the formation of the virulent phenotype of the microbe, are not decisive.

CLINICAL PICTURE (SYMPTOMS) OF STREPTOCOCCAL INFECTION IN PREGNANT WOMEN

In adults, GBS most often causes inflammatory diseases of the urinary organs, especially with anomalies of their development and diabetes. Currently, GBS is considered one of the main causative agents of genitourinary tract infections. Pneumonia, endocarditis, and osteomyelitis in adults have also been described.

A pregnant woman may experience chorioamnionitis, urinary tract infection, and after childbirth, endometritis. The frequency of these complications in the United States is estimated at 12 per 1000 births for endometritis, and 8 per 1000 births for bacteriuria. The risk of developing endometritis and bacteremia is higher during delivery through CS surgery. Symptoms of GBS infection are nonspecific: fever, feeling unwell, chills, pain in the lower abdomen, tenderness of the uterus on palpation. If the fetus is infected, stillbirth is possible. There are few symptoms indicating fetal disease, and they are nonspecific (palpitations, metabolic acidosis, low pH of umbilical cord arterial blood).

During the neonatal period, one of two forms of streptococcal infection can develop - sepsis with an early onset of the disease in the first hours and days of the child’s life and the second form, which is characterized by a late onset, most often after the tenth day of life. A disease with a late onset clinically most often occurs as meningitis.

Early-onset neonatal disease is characterized by the onset of signs of disease within the first 7 days, with 90% of cases showing signs of disease within the first 24 hours of life. Respiratory organ lesions are detected in 54%, sepsis without a specific focus - in 27%, meningitis - in 12%.

COMPLICATIONS OF GESTATION

Colonization of the genitourinary tract by GBS in pregnant women does not significantly affect the course of pregnancy.

The exception is asymptomatic bacteriuria or pyelonephritis in pregnant women caused by GBS. In newborns, it is possible to detect an intrauterine infection, especially when more than 5 areas of the skin and mucous membranes are colonized.

DIAGNOSIS OF STREPTOCOCCAL INFECTION IN PREGNANCY

Based solely on laboratory results.

ANAMNESIS

It is important to have a history of long-term colonization of the genitourinary tract with GBS, as well as pyelonephritis or bacteriuria.

PHYSICAL INVESTIGATION

Identify signs of inflammatory diseases of the genitourinary system.

LABORATORY RESEARCH

To diagnose GBS colonization in women, material taken from the vagina and anorectal area is inoculated onto a liquid or solid nutrient selective medium.

Because entry of the microorganism from the lower gastrointestinal tract occurs intermittently, simultaneous anorectal and vaginal culture specimens provide 5–15% higher GBS growth compared to vaginal culture alone. It should also be noted that selective nutrient media (for example, with the addition of antibiotics that suppress the growth of accompanying microflora) increase the release of GBS by 50%.

For the etiological diagnosis of GBS infection in newborns, sterilely collected blood, cerebrospinal fluid, urine, and endobronchial aspirate are used. It is important to know that in a large percentage of cases, GBS in newborns is isolated from urine. It must be remembered that early-onset sepsis is associated with relatively rapidly increasing neutropenia, determined by frequent blood testing. It is advisable to conduct a complete blood count, including determination of indicators such as C-reactive protein, fibronectin, complement fraction C3d.

SCREENING

Since colonization of the genitourinary tract of pregnant women by GBS is associated with a high risk of preterm birth, premature rupture of OB, GBS colonization of the fetus and the risk of developing systemic infection in the newborn, the question arises of choosing a test for screening GBS infection in pregnant women.

The chemoprophylaxis strategy requires the establishment of GBS colonization in women using tests that have high sensitivity and specificity for the isolation and identification of streptococcal cultures.

The disadvantage is that the result is not obtained earlier than 18–24 hours, which is not always convenient. However, to date, sowing and isolating a culture of GBS followed by species and type identification of the microorganism remains the gold standard for diagnosing streptococcal colonization and infection.

Screening tests are based on determining GBS Ag using latex agglutination, coagglutination, and ELISA. Latex agglutination is based on the sorption of antibodies to Ag SGV on small latex particles standardized in size. The reaction is performed on glass by mixing a drop of the test sample and a drop of the test system. A positive result is taken into account by the formation of flakes.

In the coagglutination reaction, Abs are sorbed on the surface of staphylococcal cells that have protein A. Abs to SGV are attached to protein A due to the Fc fragment, and the Fab fragment is free to combine with SGV Ag if Ag is contained in the material under study. It should be noted here that polysaccharide Ag is involved in the reaction, therefore it is extracted from the material under study by acid extraction with boiling.

ELISA is more specific and sensitive for determining the GBS antigen, but reagents for it are not always available. Quick tests - coagglutination and latex agglutination are not very sensitive for premature rupture of fluid and premature birth due to dilution of the material with water and blood. Therefore, the cultural method for detecting GBS remains the most reliable.

Molecular biological diagnostic methods (PCR) are also used to detect GBS. At the same time, an opportunity arose to study virulence genes in GBS. Streptococci with the presence of virulence genes can cause the most severe lesions in newborns.

DIFFERENTIAL DIAGNOSTICS

Carry out with similar inflammatory diseases of a different etiology (vulvovaginitis, pyelonephritis, bacteriuria).

INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS

If pyelonephritis is present, consult a nephrologist. It is possible to consult other specialists if complications of infection develop.

TREATMENT OF STREPTOCOCCAL B INFECTION DURING PREGNANCY

To prevent infection of the fetus, drug treatment is carried out starting from the 35th week of pregnancy and during childbirth. If necessary (there is a threat of miscarriage, development of pyelonephritis in pregnant women or bacteriuria), it is possible to prescribe therapy at earlier stages of pregnancy (after 12 weeks).

TREATMENT GOALS

Treatment should be aimed at eliminating GBS, maintaining pregnancy and preventing transmission of infection to the fetus.

DRUG TREATMENT

Carry out according to the sensitivity of SGV to antibacterial drugs. The most commonly prescribed drugs are ampicillin, benzylpenicillin, and in some cases macrolides.

ASSESSMENT OF TREATMENT EFFECTIVENESS

The effectiveness of treatment is assessed by the absence of GBS colonization of the newborn.

INDICATIONS FOR HOSPITALIZATION

An independent disease does not require hospitalization.

PREVENTION OF STREPTOCOCCAL INFECTION IN PREGNANCY

Antibiotic prophylaxis for transmission of GBS to newborns is carried out. For this, pregnant women colonized with GBS at 35–37 weeks of pregnancy are prescribed benzylpenicillin at a dose of 5 million units intravenously, then 2.5 million units every 4 hours also intravenously or ampicillin at a dose of 2 g intravenously, then 1 g every 4 hours for 5 days. In this case, the reproduction of GBS is temporarily suppressed, and after the antibiotics are discontinued, colonization can be restored.

INFORMATION FOR THE PATIENT

· GBS may be present in the vagina as part of a normal microbiocenosis.
· Transmission to the fetus occurs in only 37% of cases when GBS colonizes the mother's genital tract.
· Treatment is carried out starting from 35-37 weeks of pregnancy. If necessary, the attending physician may prescribe treatment at an earlier date, but not earlier than 12 weeks.
· Newborns are not always born infected.

Among inflammatory diseases of bacterial origin that occur during pregnancy, a significant place is occupied by conditions caused by disturbances in the normal microflora of the genitourinary tract. The vaginal microflora is characterized by a wide variety of bacterial species and is divided into flora characteristic of healthy women (obligate) and pathological. Under unfavorable external influences, in stressful situations, when the body's immunological defense is reduced, with hormonal disorders, gynecological diseases in the genital tract, qualitative and quantitative changes in the microflora can occur. A decrease in the number of bacteria belonging to the normal microflora in the vagina leads to a decrease in the protective barriers in the vagina, and to excessive reproduction of opportunistic microorganisms. Disturbances of the normal microflora of the birth canal pose a great danger to pregnant women, as they can lead to miscarriage, premature birth, intrauterine infection of the fetus and postpartum inflammatory complications in postpartum women.

Physiological and biological changes that occur in the genital tract during pregnancy lead to the fact that the vaginal microflora becomes more homogeneous with a predominance of lactic acid bacilli (lactobacillus).

There are a number of factors that control and influence the composition of normal vaginal microflora. The vaginal environment affects the microflora, providing conditions for the possible presence of various types of microorganisms in certain quantities. In general, vaginal microflora includes various types of microorganisms. Vaginal discharge normally contains 108-1010 microorganisms per 1 ml, with aerobic bacteria accounting for 105-108, anaerobic bacteria 108-109 CFU/ml. Lactobacilli dominate in the microbial flora of the vagina and cervix. It should be noted that in pregnant women, bifidobacteria are more common than lactobacilli, and this fact is regarded as a reaction to the absence or inhibition of lactobacilli. In general, anaerobic organisms prevail over aerobic and facultative anaerobic ones. Among aerobic bacteria, diphtheroids, staphylococci, and streptococci are most often detected, and among anaerobic bacteria, lactobacilli, bifidobacteria, peptostreptococci, prevotella and bacteroides.

Streptococcal infection

The family of these microorganisms includes several genera of morphologically similar gram-positive cocci, which are facultative anaerobes. There are serological groups of streptococci A, B, C, D, E, F, G and H. Based on the appearance of the colonies and the nature of hemolysis on blood agar, these pathogens are divided into hemolytic, greening and non-hemolytic types. Streptococci belonging to three groups may be present in the vagina of healthy women: streptococci of the viridans group (viridans streptococci), streptococci of serological group B and streptococci of serological group D (enterococci). The frequency of detection and the number of streptococci belonging to these groups varies significantly and is normally no more than 104 CFU/ml. During pregnancy, from the point of view of possible infection, the most important pathogens are Streptococcus pyogenes (beta-hemolytic streptococcus of group A), and Streptococcus agalactiae (streptococcus of group B, which has recently become the most common cause of infections in both newborns, especially premature infants, so do their mothers).

Diseases caused by Streptococcus pyogenes

About 20% of pregnant women are carriers of the bacteria (nasopharynx, vagina and perianal area). A pregnant woman may experience: tonsillitis, pharyngitis, pyoderma, urinary infection, chorioamnionitis, endometritis, postpartum sepsis. The infection can be transmitted to the child during childbirth, with the subsequent risk of neonatal sepsis increasing, especially with a long anhydrous interval.

There is a culture method (on blood agar aerobically and anaerobically).

During treatment it is prescribed antibiotics from the group of penicillins and cephalosporins for at least 10 days. For postpartum sepsis, high doses of benzylpenicillin or ampicillin are prescribed parenterally. Newborns with streptococcal infection are also prescribed high doses of benzylpenicillin, ampicillin or cephalosporins.

Due to the fact that Streptococcus pyogenes is transmitted by contact, prevention is to observe the rules of asepsis during childbirth.

Diseases caused by Streptococcus agalactiae

This type of streptococcus is part of the vaginal microflora in 20% of pregnant women. When the disease occurs, a pregnant woman may experience asymptomatic bacterial colonization of the vagina and perianal area, urinary tract infection, chorioamnionitis, and endometritis.

The main diagnostic method is the cultural method. The more intense the infection of a pregnant woman, the more likely it is that the child will become infected. During vaginal delivery, the incidence of infection transmission to the child is 50-60%. The risk of disease in a full-term baby is 1-2%, and in a premature baby - 15-20%, and at less than 28 weeks of pregnancy - 100%. If a child becomes infected during childbirth, sepsis, pneumonia, meningitis, and severe neurological complications may develop. In severe cases, the disease begins immediately after birth and progresses rapidly. The risk for the child increases with premature rupture of the membranes, premature birth, and symptoms of chorioamnionitis in the mother.

When prescribing treatment It should be taken into account that group B streptococci are sensitive to all beta-lactam antibiotics and cephalosporins. If streptococci are detected in a pregnant woman, even without clinical symptoms, penicillin therapy is required for 10 days; cephalosporins and macrolides may be used.

Prevention. According to some studies, the administration of ampicillin to a woman in labor prevents infection with Streptococcus agalactiae. The disadvantages of prophylactic administration of ampicillin include the need for preliminary bacteriological examination. It is advisable to screen all pregnant women in the third trimester for the presence of group B streptococci using gynecological culture.

Bacterial vaginosis

Among bacterial diseases in pregnant women, a large proportion are pathological conditions associated with disturbances of the normal microflora of the genital tract. Bacterial vaginosis is a clinical syndrome caused by a pathological change in the structure of the microbial environment of the vagina. In patients with bacterial vaginosis, the concentrations of facultative and anaerobic bacteria largely predominate, displacing lactic acid bacilli, which leads to significant changes in the vaginal microflora. The main feature of the disruption of the composition of normal vaginal microflora in bacterial vaginosis is a significant decrease in the number of lactic acid bacilli and pronounced colonization of the vagina by anaerobic bacteria (Prevotella/Porphyromonas spp., Peptostreptococcus spp., Fusobacterium spp., Mobiluncus spp.) and Gardnerella vaginalis.

During pregnancy, the reasons for disruption of the normal composition of the vaginal microflora may be corresponding hormonal changes, the use of antibiotics, etc. More than half of all women with bacterial vaginosis do not have any subjective complaints and pathological discharge from the genital tract (leucorrhoea), along with the existing positive laboratory signs. An inflammatory reaction of the vaginal epithelium is not a characteristic sign of bacterial vaginosis. In the clinical course of bacterial vaginosis with severe symptoms, long-lasting, abundant, liquid, milky or grayish-white homogeneous discharge (leucorrhoea), predominantly with an unpleasant fishy odor, is noted.

Bacterial vaginosis occurs in 15-20% of pregnant women and is a serious risk factor for the development of infectious complications. A pronounced relationship between bacterial vaginosis and premature termination of pregnancy and untimely rupture of membranes has been noted. The risk of developing these complications in patients with bacterial vaginosis increases by 2.6 times compared to healthy pregnant women. In approximately 10% of women who give birth prematurely, gardnerella and other microorganisms are released from the amniotic fluid, whereas normally the amniotic fluid is sterile. It was noted that in women who gave birth before 37 weeks. there is a high probability of having bacterial vaginosis.

There is also a relationship between the presence of bacterial vaginosis and the development of postpartum endometritis, including after cesarean section. The risk of developing postpartum endometritis in pregnant women with bacterial vaginosis is 10 times higher than in healthy women. The microbial flora detected in the endometrium of patients with endometritis is often similar to that of bacterial vaginosis. This is especially true for anaerobic microorganisms. Mixed microflora in bacterial vaginosis can lead to the development of other inflammatory complications, such as breast abscess, inflammation of the umbilical wound, etc.

Thus, patients with bacterial vaginosis are at increased risk for the development of inflammatory diseases of the pelvic organs, premature termination of pregnancy, untimely rupture of amniotic fluid, the occurrence of chorioamnionitis, postpartum and postoperative endometritis. A high concentration of virulent microorganisms in the vagina of patients suffering from bacterial vaginosis is a risk factor for the penetration of bacteria into higher parts of the genitourinary system.

Diagnostics - the complex includes four diagnostic tests

• During an external gynecological examination of the patient, leucorrhoea typical of bacterial vaginosis is noted in the area of ​​the vaginal vestibule. If the discharge is too abundant, it may also flow onto the perineal area. In this case, usually the external genitalia are not hyperemic or swollen. However, in the presence of concomitant infection, swelling and hyperemia of the vaginal mucosa are observed;
• The pH value of vaginal discharge in patients with bacterial vaginosis is usually 5.0 - 6.0;
• a positive amine test, which is accompanied by the appearance of an unpleasant fishy odor when exposed to a 10% solution of potassium hydroxide on a sample of contents from the middle third of the vagina;
• detection by microscopy of “key cells” in vaginal discharge, which are mature cells of the vaginal epithelium with large numbers of microorganisms adhered to them, which are located mainly chaotically.

Microscopic analysis of vaginal secretions is a definitive diagnostic method, including Gram-stained smears.

Treatment of bacterial vaginosis

In the first trimester of pregnancy, for the treatment of bacterial vaginosis, it is possible to prescribe clindamycin 2% in the form of vaginal cream 5.0 g for 3 - 7 days or povidone-iodine 1 vaginal suppository per day for 14 days or from the 10th week Terzhinan 1 vaginal tablet 10 days.

In the second trimester of pregnancy, the arsenal of drugs for the treatment of bacterial vaginosis can be supplemented with Clotrimazole, 1 vaginal tablet for 10 days, as well as oral administration of Clindamycin 300 mg 2 times - 7 days.

In the third trimester, in addition to the listed drugs, Ornidazole 500 mg 2 times - 5 days, or Metronidazole 500 mg 2 times - 7 days, as well as Viferon-2 suppositories or KIP-feron 1 suppository 2 times 10 days rectally can be used.

Gonorrhea

The causative agent of the disease is Neisseria gonorrhoeae- gram-negative bacteria, sensitive to light, cold and dryness. Outside the human body, these pathogens are not able to live long. The infection is transmitted through sexually transmitted infections. When infected, gonococci are detected in the urethra, large gland of the vestibule, cervix, tubes and peritoneum. The infection can spread through the mucous membranes of the endometrium and pelvic organs.

In 80% of women, gonorrhea is asymptomatic, with the cervix affected in more than 50% of cases, the rectum in more than 85%, and the pharynx in more than 90%. The presence of gonorrhea in a pregnant woman is a significant risk factor for adverse outcomes for both mother and fetus. Women who become infected with gonorrhea after 20 weeks of pregnancy or after childbirth are at increased risk of developing gonococcal arthritis. With acute gonorrhea, the risk of premature rupture of amniotic fluid, spontaneous abortion and premature birth is increased. Chronic gonorrhea can worsen immediately after childbirth, and the risk of gonococcal sepsis increases.

Infection of the fetus occurs in utero or during childbirth. Intrauterine infection manifests itself as gonococcal sepsis in the newborn and chorioamnionitis. Infection during childbirth can lead to gonococcal conjunctivitis, otitis externa and vulvovaginitis.

If gonorrhea is suspected, discharge from the vagina and cervix is ​​examined. A tentative diagnosis is made when gonorrhea pathogens are detected in a smear. To confirm the diagnosis, culture of the discharge on a special medium is used. The PCR method is also used.

Treatment of gonorrhea in pregnant women

Treatment of pregnant women at any stage of gestation should be carried out in a hospital. Treatment of disseminated gonorrhea should be carried out with the involvement of specialists of the appropriate profile. When treating the disease, pregnant women with gonococcal urethritis, endocervicitis, proctitis or pharyngitis are prescribed ceftriaxone 250 mg intramuscularly or spectinomycin (trobicin) 2.0 g intramuscularly once. For gonococcal sepsis, ceftriaxone is prescribed 1 g intravenously or intramuscularly once a day for 7-10 days. Repeated cultures are carried out 7 days after the end of treatment. For ophthalmoblennorrhea of ​​newborns, ceftriaxone is used at a dose of 25-50 mg/kg intravenously or intramuscularly once and frequent rinsing of the conjunctiva with isotonic sodium chloride solution.

To monitor treatment, culture is carried out after the end of treatment after 7 days and after 4 weeks.

As a preventive measure During the initial examination of a pregnant woman, it is necessary to culture the discharge from the cervix for gonorrhea. Women at risk are prescribed repeat cultures at the end of the third trimester of pregnancy. Treatment of sexual partners is carried out.

Streptococci are gram-positive bacteria that are very widespread in nature, but are found only on the mucous membrane of animals and humans. Although group B streptococci are usually harmless, their presence during pregnancy can cause complications and more serious illness in newborns.

Clinical relevance - group B streptococci

Bacterial genus Streptococcus includes about 20 species, and Streptococcus agalactiae is also known as group B beta-hemolytic streptococcus (BHS-B). BHS-B can colonize the female reproductive system in 5-40% of healthy women and is rarely found in the intestines and pharynx.

Although this bacterium is generally considered harmless, things change during pregnancy, when GHS-B can cause urinary tract infections, inflammation of the cervix (cervicitis), infections of the placenta and amniotic fluid (chorioamnionitis), bacteremia (bacteria in the blood) and sepsis .

In addition, a newborn can become infected when passing through the birth canal during or after birth, which in turn can lead to neonatal sepsis.

After childbirth, this type of streptococcus can cause inflammation of the vaginal lining (vaginitis), puerperal sepsis, as well as urinary tract infections, skin infections and endocarditis.

However, the main concern is the possibility of transferring bacteria to the baby. In cases where the test result is group B streptococci are negative, then women do not need further treatment, but if the results are positive during pregnancy, treatment and prevention of diseases caused by group B streptococcus are necessary.

Streptococcus agalactiae often part of the microflora of the gastrointestinal tract and vagina. In 10-30% of pregnant women, BHS-B can be found in the vagina. There are numerous studies and clinical studies on the relationship between GBS and pathological conditions during pregnancy.

The presence of BHS-B correlates with an increased risk of developing disorders during pregnancy (compared with healthy flora), and is the most important bacterial pathogen in neonatal infections.

Pregnancy and BGS group B

Urogenital Streptococcus group B during pregnancy can lead to urinary tract infections, inflammation of the cervix, inflammation of the upper part of the gynecological system (endometritis, chorioamnionitis), and can also cause premature rupture of the membrane.

In most cases, testing of all pregnant women for asymptomatic bacteriuria and significant presence of bacteria in urine culture without symptoms of acute urinary tract infections or clinical signs of disease is recommended.

Asymptomatic bacteriuria occurs in 2-10% of pregnant women, while bacteriuria with group B beta-hemolytic streptococcus occurs in 2-4% of pregnant women. E. coli is the most common cause of urinary tract infections and can be found in urine, followed by gram-negative bacteria and group B streptococci.

However, a urine culture is required to diagnose group B streptococcal bacteriuria. If the concentration of group B streptococci is greater than or equal to 10% or 5 CFU/ml, pregnant women without clinical symptoms of a urinary tract infection (i.e., with asymptomatic bacteriuria), as well as pregnant women with symptoms of a urinary tract infection, are given appropriate treatment with antibiotics .

Moreover, every woman with culture of group B streptococcus in urine (regardless of the number of colonies) should undergo prophylaxis to prevent early neonatal infection of newborns with this bacterium.

Pregnant women who have no symptoms and a urine culture of less than 10% or 5 CFU/ml should not be treated with antibiotics to prevent possible adverse complications such as pyelonephritis (inflammation of the kidneys), chorioamnionitis (inflammation of the membranes), or.

Also, women who already have a positive culture for HCV-B during pregnancy should be tested again.

Untreated asymptomatic bacteriuria before birth is associated with a higher incidence of pyelonephritis, preterm birth, and low birth weight in newborns, and their incidence is significantly reduced with antibiotic treatment.

Cervicitis during pregnancy is a common infection of the reproductive organs, which affects the health of the cervix, and is caused by various microorganisms, including group B streptococci.

One of the first symptoms is vaginal irritation, vaginal bleeding, or pain during intercourse. During the examination, if inflammation of the vagina and cervix is ​​suspected, the doctor takes a cervical smear. If aerobic BHS-B bacteria are detected in the cervical smear test, the gynecologist will prescribe antibiotic treatment.

Group B streptococcus infection may manifest as chorioamnionitis, endometritis, cystitis, pyelonephritis. Cesarean section can be complicated by post-operative wound infections, pelvic inflammation and thrombophlebitis (inflammation of the veins).

Colonization of the pregnant woman's vagina group B streptococci during the passage of a child through the birth canal it can be transmitted to the baby, which is one of the main causes of early neonatal illness. Bacteria reach the amniotic fluid, usually after rupture of the membranes. BHS-B reaches the lower respiratory tract and lungs and can attack epithelial cells, which can lead to pneumonia and respiratory distress syndrome in the first few hours after birth.

Prevention and treatment leads to a reduction in neonatal sepsis, pneumonia and other complications by 60-80%. Widespread use of antibiotics significantly reduces the incidence of diseases in newborns.

Antibiotic prophylaxis during labor is given to women with positive cultures who have previously given birth to children with group B streptococcal infection or who had it during pregnancy. The first choice drug is penicillin or clindamycin.