Assessing the feasibility of preoperative preventive vaginal cleansing to prevent contamination of the uterine cavity with vaginal microflora
Objective: To demonstrate the feasibility of preoperative preventive use of vaginal Elgin tablets with an applicator (VERTEX, Russia) to prevent contamination of the uterine cavity with vaginal microflora during hysteroscopy and separate diagnostic curettage.Dobrokhotova Yu.E., Borovkova E.I., Zaidieva Z.S., Romanovskaya V.V., Nugumanova O.R.
Materials and methods: A prospective observational clinical study was conducted in parallel groups involving 50 patients. The investigators formed a study group (n=30) and a control group (n=20), which included patients with vaginal normocenosis and indications for hysteroscopy. The vagina was preoperatively cleansed with Elgin for 6 days in the study group. No preventive treatment was performed in the control group. The study methods included general clinical examinations and real-time polymerase chain reaction (Femoflor-16, DNA-Technology, Moscow).
Resuls: The indications for hysteroscopy and separate diagnostic curettage in the study and control groups were infertility of unknown origin (16.7% and 20%), endometrial polyp (46.7% and 50%), and suspected endometrial disease (36.7% and 30%). After a cycle of preventive therapy with Elgin, the vaginal concentration of lactobacilli vagina did not change, but there was a substantial decrease in opportunistic pathogens (Enterobacteriaceae by 5.7 times, Gardnerella vaginalis by 1.5 times, and Mobiluncus by 1.86 times) (p≤0.001). Staphylococci, streptococci, mycoplasmas, Candida fungi, veillonella, and fusobacteria were completely absent. The intrauterine microbiota in the study group patients was represented only by lactobacilli. The total bacterial mass in the uterine cavity was 1.48 times lower than that in the vagina, while the concentration of lactobacilli was almost 1.5 times lower. A variety of bacteria was identified in the uterine cavity of the control group patients. All the bacteria were characterized by a quantitative decrease as compared to vaginal biocenosis. The titer of streptococci and staphylococci in the uterine cavity was 1.2 times lower than that in the vagina, there were reductions in the titers of gardnerella by 1.7 times, eubacteria by 1.9 times, veillonella by 1.5 times, mobiluncus by 1.4 times, and Candida fungi and ureaplasma by 1.3 times. In the control group, the uterine cavity displayed the representatives of the intestinal microflora and eubacteria in significantly higher titers (the titer was 1.8 times higher), streptococci and staphylococci (that was 2.1 times higher), veillonella and ureaplasma (1.3 times higher), and mobiluncus (1.9 times higher).
Conclusion: A preventive vaginal cleansing cycle before intrauterine manipulations can reduce overall vaginal bacterial contamination and the risk of intrauterine ascending infection from indigenous microflora.
Keywords
vaginal microbiocenosis
intrauterine microflora
chronic endometritis
vaginal cleansing
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Received 27.07.2022
Accepted 17.08.2022
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.
Valentina V. Romanovskaya, PhD, Teaching Assistant at the Department of Obstetrics and Gynecology, N.I. Pirogov RNRMU, Ministry of Health of Russia,
+7(495)722-63-99, valentinaromano2005@yandex.ru, https://orcid.org/0000-0003-0413-5431, 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.
Authors’ contributions: Dobrokhotova Yu.E. – development of the design of the investigation, writing the article; Borovkova E.I., Zaidieva Z.S., Romanovskaya V.V. – material collection, writing the article; Nugumanova O.R. – material collection, statistical analysis.
Conflicts of interest: The authors declare that there are no possible conflicts of interest.
Funding: The investigation has been sponsored by Vertex Co.
Ethical Approval: The study was reviewed and approved by the Ethics Committee of the 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., Zaidieva Z.S., Romanovskaya V.V., Nugumanova O.R. Assessing the feasibility of preoperative preventive vaginal cleansing to prevent contamination of the uterine cavity with vaginal microflora.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 8: 132-142 (in Russian)
https://dx.doi.org/10.18565/aig.2022.8.132-142
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