Modifying the risk of ascending uterine cavity infection during gynecological procedures

Dobrokhotova Yu.E., Borovkova E.I., Burdenko M.V., Zaidieva Z.S., Amiryan D.S., Marakhovskaya E.

1) Department of Obstetrics and Gynecology, Faculty of General Medicine, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia; 2) Maternity Hospital, Separate Subdivision, A.K. Yeramishantsev City Clinical Hospital, Moscow City Healthcare Department, Moscow, Russia

Objective: To modify the risk of ascending uterine cavity infection during gynecological procedures by preventive medical vaginal sanitation. Materials and methods: A prospective cohort study was conducted in 80 patients who required outpatient gynecological procedures (hysterosalpingography, office hysteroscopy). There were 2 randomized groups: a study group who before the manipulation received a 6-day cycle of sanitizing therapy with a multicomponent local agent; a comparison group had no therapy. The formed groups were matched by age, parity, anamnestic data, and gynecological history. The Femoflor-16 PCR-RT assay was used to assess the microbiocenosis of the vagina and uterine cavity. Results: The total vaginal bacterial mass in the patients of both groups was lg 6.3 and 6.2 GE/sample (p=0.94). After the sanitizing therapy, the study group showed a decrease in the total vaginal bacterial contamination to lg 4.8 (Q1–Q3: 4.4–5.05) (p=0.03). The total uterine bacterial mass was lg 2.3 GE/sample (Me, IQR 2.05–2.95) and lg 4.8 GE/sample (Me, IQR 4.25–5.2) in the study and comparison groups, respectively (p<0.001). Comparing the indicators of uterine bacterial contamination with those of vaginal biocenosis after sanitation revealed a decline in the number of Peptostreptococcus spp., Veilonella spp. and Mobiluncus spp. in 17.5% of patients (p=0.018), Staphylococcus spp. (p=0.043) and Atopobium vaginae in 12.5% (p=0.042), Streptococcus spp. in 20% (p=0.012), Gardnerella vaginalis in 27.5% (p=0.003), and members of the Enterobacteriaceae family in 35.5% (p=0.01). Uterine cavity biocenosis could be characterized as lactobacillus-dominant in 98% of patients in the study group; the dominant lactobacillus type of biocenosis was detected in 42.5% of those in the comparison group. Before and after the therapy, the correlation between the total vaginal bacterial mass was statistically significant (p=0.03; rxy=0.63) (Spearman's rank correlation coefficient) and had a noticeable tightness in accordance with the Chaddock scale. There were statistically significant direct correlations between the total vaginal bacterial mass after the therapy and the amount of Lactobacillus spp. (rxy=0.514; p=0.02) and Gardnerella vaginalis (rxy=0.55; p=0.01) in the uterine cavity. Conclusion: Preoperative sanitizing therapy can reduce the overall bacterial contamination of the vagina and uterine cavity by 2 times.

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About the Authors

Yulia E. Dobrokhotova, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology of the Faculty of Medicine, N.I. Pirogov RNRMU,
Ministry of Health of Russia, +7(495)722-63-99, pr.dobrohotova@mail.ru, https://orcid.org/0000-0002-7830-2290, 117997, Russia, Moscow, Ostrovityanova str., 1.
Ekaterina I. Borovkova, Dr. Med. Sci., Associate Professor, Professor at the Department of Obstetrics and Gynecology, N.I. Pirogov RNRMU, Ministry of Health of Russia, +7(495)722-63-99, Katyanikitina@mail.ru, https://orcid.org/0000-0001-7140-262X, 117997, Russia, Moscow, Ostrovityanova str., 1.
Marina V. Burdenko, PhD, Associate Professor at the Department of Obstetrics and Gynecology, N.I. Pirogov RNRMU, Ministry of Health of Russia, +7(495)722-63-99,
bmv-0306@rambler.ru, https://orcid.org/0000-0002-0304-4901, 117997, Russia, Moscow, Ostrovityanova str., 1.
Zulya S. Zaidieva, PhD, Head of the Consultative and Diagnostic Department, Maternity Hospital at Moscow City Clinical Hospital No. 40, +7(903)788-39-95,
dr.zaydieva@mail.ru, 129301, Russia, Moscow, Taimyrskaya str., 6.
Diana S. Amiryan, 4th year student, Medical Faculty, N.I. Pirogov RNRMU, Ministry of Health of Russia, +7(495)722-63-99, diasha.am1234@gmail.com,
https://orcid.org/0000-0001-5005-1462, 117997, Russia, Moscow, Ostrovityanova str., 1.
Elyzaveta Marakhovskaya, 4th year student, Medical Faculty, N.I. Pirogov RNRMU, Ministry of Health of Russia, +7(495)722-63-99, lizamarahovskay35@gmail.com,
https://orcid.org/0000-0001-7413-646X, 117997, Russia, Moscow, Ostrovityanova str., 1.

Authors’ contributions: Dobrokhotova Yu.E. – development of the design of the investigation; Borovkova E.I., Zaidieva Z.S., Burdenko M.V., Amiryan D.S., Marakhovskaya E. – material collection, writing the article, statistical analysis.
Conflicts of interest: The authors declare that there are no possible conflicts of interest.
Funding: The investigation has not been sponsored.
Ethical Approval: The investigation has been approved by the local Ethics Committee, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Dobrokhotova Yu.E., Borovkova E.I.,
Burdenko M.V., Zaidieva Z.S., Amiryan D.S., Marakhovskaya E.
Modifying the risk of ascending uterine cavity infection during gynecological procedures.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 10: 150-158 (in Russian)
https://dx.doi.org/10.18565/aig.2022.10.150-158

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