Streptococci cause various diseases and are detected by modern diagnostic methods. A study of urine analysis during pregnancy allows you to confirm or deny the presence of group B streptococci in a woman's body. With a positive laboratory result, antibiotic treatment is performed.

Group B streptococcus

Group B Streptococcus (GBS) is a widespread bacterium that causes health problems. For an adult, this microorganism, as a rule, is not dangerous. Detected during pregnancy, GBS poses a serious threat to the fetus.

About 10-30% of expectant mothers are carriers of group B streptococcus. Since this bacterium is present in the body of every fourth woman in an "interesting" position, it cannot be called rare. However, treating GBS with indifference is also unacceptable. The fact is that a woman can transmit this microorganism to her child during childbirth.

To determine that streptococcus is present in the body, in most cases it is possible only by the results of laboratory tests. For this, it is necessary to conduct a detailed study of urine or smear. In only a small proportion of the GBS-infected population, bacterial activity leads to urinary tract and bladder infections.

Types of streptococci and diagnosis of infection during pregnancy

Hemolytic streptococci are the most common pathogenic bacteria. They are divided into several groups based on various criteria.

Group A streptococci are transmitted by airborne droplets, less often through contaminated dishes and food. These microorganisms are found on a throat swab. To prevent infection, doctors recommend basic hygiene requirements.

Group B streptococci are detected in 10-30% of expectant mothers. Most carriers of the bacteria are sexually active women, younger than 20 years old. GBS is transmitted during intercourse from an infected partner to a healthy partner.

Streptococci can be found in various organs. To identify pathogenic microorganisms in the urinary tract, a urine test is performed on a culture tank. If the rules for collecting material are not followed, this diagnostic method gives false positive results.

The study requires a medium portion of urine and a sterile container. It is best to use disposable containers, which are available in every pharmacy. Before collecting material, you must thoroughly wash yourself. When urinating, it is advisable to cover the entrance to the vagina with a sterile swab.

Another diagnostic method is taking a vaginal swab. Analysis is optional. Pregnant women take it to the direction of a gynecologist.

If the expectant mother has suffered a urinary tract infection caused by streptococci during the gestational period, or has given birth to a child infected with these microorganisms in the past, then at 35-37 weeks of the term she needs to take a smear. If the result is positive, the doctor will prescribe a course of antibiotics and will closely monitor the woman's health.

Why is streptococcal infection dangerous?

Unfortunately, GBS is a dangerous bacterium that can lead to various pathologies. That is why if group B streptococci are found in urine or smear, urgent treatment is necessary. Lack of timely therapy increases the risk of:

• premature birth;
• intrauterine fetal death;
• premature rupture of the membranes.

In addition, GBS is a common cause of urinary tract infections. This microorganism can lead to an increase in body temperature, burning sensation and pain when urinating. Almost always, streptococcal infection is asymptomatic, but it is detected by examination of urine and smear.

Passing the infection to a child - pneumonia may occur

In 1-2% of cases, infected mothers transmit group B streptococci to their babies during childbirth. If this happens, then the child develops the following diseases:

• meningitis;
• sepsis;
• pneumonia.

However, you should not despair. Modern medicine successfully combats GBS in newborns with antibiotics (penicillin, ampicillin) and intensive symptomatic therapy. Most of the infected children will recover. In only a small number of young patients, streptococcal infection causes future pathologies, such as hearing or learning problems.

To prevent transmission of the infection, the newborn should be closely monitored during pregnancy. It is advisable to be tested for the presence or absence of GBS shortly before delivery. For preventive purposes, it is necessary to strengthen the immune system, lead a healthy lifestyle.

Signs of a child being infected with streptococcal infection

Signs of early and late infection are possible. In the first case, fever, increased drowsiness in the first week of life, and problems with the respiratory system appear. Early onset of the disease occurs in 50% of newborns and sometimes leads to sepsis, pneumonia, and meningitis.

If the infection starts late, there is a cough, eating problems, high body temperature, cramps or drowsiness, and nasal congestion. These symptoms occur between 7 days and 3 months after delivery and often provoke meningitis and sepsis.

In 99% of cases, infected newborns are asymptomatic. For this reason, doctors recommend establishing GBS colonization through laboratory diagnostics. The test material is obtained by taking samples from the throat, external auditory canal, navel, and rectum of the baby. The presence of pathogenic microorganisms can be detected by examining the amniotic fluid.

Consequences and treatment of streptococcal infection after childbirth

Sometimes GBS leads to infection of the uterus. In this case, the following symptoms arise:

• high body temperature;
• increased heart rate of the mother and fetus;
• painful sensations in the abdomen.

Antibiotics are used to combat GBS. These drugs are given intramuscularly or intravenously before delivery. It is optimal to use antibiotics 4 hours before the baby is born. This will help prevent infection of the newborn.

Penicillin (sometimes ampicillin) is usually given to treat streptococcal infections. In some cases, these drugs cause an allergic reaction (1 in 25 women). This therapy is used only if natural childbirth is planned. As a rule, a cesarean section relieves the expectant mother from the need to take antibiotics.

Despite all the negative consequences that a streptococcal infection can cause during pregnancy, you should not be afraid. First, during gestation, various abnormalities are diagnosed, including the presence of GBS in the body (by examining urine and smear). Secondly, timely treatment helps to cope with a dangerous disease, preventing negative consequences for the mother and her baby.

Streptococcus detected by smear analysis , is a problem faced by every third woman during pregnancy.

The main reason for the development of streptococcal infection is an increase in the number of streptococci in the cavity of the gastrointestinal tract, nasopharynx and on the mucous membranes of the genital organs. These microorganisms have the peculiarity of being transmitted through kisses and hugs. Moreover, they may not have a negative effect on the body in the active phase.

Streptococcus lives in the rectum and vaginal mucosa of every third girl. He is not the causative agent of sexually transmitted diseases. Often, the beta-hemolytic streptococcus does not cause disease. In a number of women, it can provoke the course of severe infections.

In order to exclude the occurrence of a disease in a pregnant woman's body, it is necessary:

• Monitor the hygiene of the genitals daily.
• Subject to hygiene, exclude the use of agents that violate the microflora.
• It is necessary to use special soap substances to maintain the acidity of the vagina at a normal level.

The presence of this bacterium in the organisms of approximately 20% of pregnant women has been clinically proven. Some girls do not experience the harmful effects of streptococcus. It is possible to reveal its presence by the abundant short yellow discharge from the girl's genital organ.

Symptoms of streptococcal infection

In the absence of signs of infection, a woman may be a carrier of the bacteria. In this case, the microflora of the vagina will not be changed. When itching and burning appears in the vagina and labia, as well as profuse discharge, this is a sure sign of a streptococcal infection.

Due to a decrease in immunity in a woman during the period of bearing a child, a moderate growth of bacteria is associated with the development of other diseases. For example, it can affect the course of colds (become complicated).

When a pregnant girl has itching and burning in the genital area, the obstetrician-gynecologist gives a referral to take a smear on the flora. Staphylococcus should be absent in the microflora of the vagina and cervical canal, or be in a small amount. Streptococcus in a smear in women during pregnancy is found in large quantities.

After receiving the results of the analysis, the doctor gives a referral for the delivery of a bacterial culture, to determine the type of coccus in order to build the right treatment.

If you suspect a streptococcal infection in a pregnant woman, a smear is taken for analysis for bacterial culture and determination of the type of coccus.

In practice, signs of bacterial infection in various areas of the body are distinguished.

Respiratory Infection Symptoms:

• an increase in body temperature up to 39 degrees;
• feeling unpleasant when swallowing saliva;
• lymph nodes begin to enlarge in the neck area;
• lethargy;
• the appearance of white bloom on the tonsils.

Due to the fact that the disease tends to progress rapidly, complications appear - otitis media, sinusitis, pneumonia.

Skin infection symptoms:

• the damaged area begins to turn red;
• there is a line between damaged and healthy skin;
• when touched - acute pain;
• swelling, inflammation appears.

Leads to impetigo, streptoderma.

Impetigo in pregnant women and newborns: symptoms and treatment:

Classification of streptococci: the danger of different types of infection for the fetus

Several groups of bacteria have been studied - streptococci, which are harmful to both the mother's body and the fetus:

Group name	Characteristics, features
Group A	The group includes - Streptococcus pyogenes. Activates purulent infectious diseases. In more advanced cases, necrotizing fasciitis and streptococcal toxic shock.
Group C and G	Microorganisms of this group are beta-hemolytic. They can cause diseases, as bacteria of group A. Difficult to diagnose and eliminate.
Group B	Causative agents of meningitis in newborns. In a pregnant woman - after childbirth is the cause of postpartum sepsis. The main species is Streptococcus agalactiae.

Group B streptococci are the sources of the development of 2 types of infection in an infant.

Early signs

The early signs appear in the first week of life. If a pregnant woman was a carrier of this streptococcus, then it is transmitted to the newborn. The congenital presence of this type of bacteria is observed only in 2% of cases. The disease was confirmed in premature babies, as well as babies after complicated delivery.

Streptococcus of this group causes:

Late signs

Late signs develop between 1 week and 3 months. Infection occurs in 2 ways: during childbirth or as a result of infection from medical personnel. The acute form of the infection is neonatal meningitis.

In 50% of cases, pediatricians diagnose children with neurological pathologies (mild speech delay, blindness, epilepsy). It can also occur in the form of purulent arthritis, osteomyelitis.

To eliminate streptococcal infection of this group, benzylpenicillin is prescribed. With the development of streptococcal sepsis, the pediatrician prescribes ampicillin and gentamicin. Such treatment is carried out until a sowing result is obtained.

Streptococcal sepsis is treated for 10 days; meningitis - 2 weeks. A shorter course will lead to relapses.

Suffer from forms of diseases caused by cocci of group B, newborns at risk (premature babies born before the PDD). The route of infection is the birth canal. If streptococcus is found in a pregnant girl in a smear, urgent treatment is carried out in order to avoid complications in the fetus.

During the period of delivery, gynecologists recommend antibiotic prophylaxis women who are passive carriers of the bacteria. Also, similar recommendations apply to pregnant women whose children in previous births have complications from streptococcal infection during the neonatal period.

There is a rational way to prevent the disease through immunization with a vaccine against bacteria of group B. Today, a vaccine is under development. Its essence is to provide passive immunity to the fetus during the penetration of antibodies through the placental barrier.

Consequences for a pregnant woman

After detection of streptococcus in a smear, a pregnant woman is sent for a bacterial culture to determine the strain of infection and prescribe an appropriate course of treatment.

After passing the bacterial culture, the doctor prescribes a specific course of antibiotic treatment. In the absence of such treatment, about 15% of births end in death for the newborn.

It is possible to avoid the death of a child only if all the necessary tests are passed and medications are used. Infection of a child with epidemic pemphigus occurs from a mother who is a carrier of Staphylococcus aureus and who refused the proposed course of therapy.

Doctors associate premature delivery with the presence of bacteria of group B in the smear of a pregnant woman in excess of the norm.

When examination is necessary

Streptococcus in a smear in women during pregnancy is first detected at an initial routine appointment with an obstetrician-gynecologist. Its essence is a smear is taken from the cervical canal. During the study, the level of cleanliness of the vagina is assessed, the first symptoms of streptococcal infection are revealed.

Diagnosis of infection

In case of an excess of bacteria of group B in a smear in a pregnant girl, the doctor prescribes a culture study. This method is the main one in the diagnosis of infection. During it, cocci are grown in a different environment. Further, special substances are attached to them in order to exclude other microorganisms.

Group B is detected in practice in newborns. Laboratories have created special screening tests that allow you to find antigens of bacteria. Among the advantages of methods such as latex agglutination, coagglutination and enzyme immunoassay are quick results.

As disadvantages, it is carried out after childbirth. The object of the study is the fluid released during childbirth and amniotic fluid. With the PCR method - diagnostics, streptococcus is determined in the urine, the vagina of the pregnant woman and on the skin of the baby.

This method is performed in the 3rd trimester (35-37 weeks). With its help, the qualitative and quantitative composition of the bacteria is determined. An excess of the indicator over the normal level entails a probable infection of the child in severe form. The disadvantage is the inability to identify live pathogens, as well as their resistance to drugs.

Norms of indicators in a smear in a woman

The normal indicator of the amount of streptococcus in a smear in a pregnant woman is the level of 10 ^ 3 and 10 ^ 4 degrees CFU / ml. An infectious disease doctor should evaluate the results of the study together with an obstetrician-gynecologist.

Features of the treatment of streptococcus during pregnancy

Given the course of the disease, there are various ways of treating infection in pregnant women:

1. Treatment with antibiotics of the penicillin group. It is carried out under the strict guidance of a doctor. It is recommended to include vitamin C in the diet. In case of allergic reactions to the drug, macrolides are used.
2. To eliminate the coccus, an immunomodulating course is carried out.
3. The use of folk recipes to eliminate the causative agent of the infection.

The therapy regimen is determined by the state and course of pregnancy. With a latent form of infection, when the girl is not planning a pregnancy, local therapy is used. In the planning stage of conception, procedures to eliminate bacteria begin after the first symptoms appear.

Pregnant women who do not have symptoms - are under the close supervision of a gynecologist and infectious disease specialist... Upon reaching 35 weeks from the moment of conception, a re-examination of the smear is carried out.

Antibiotics are not given during lactation. They have the ability to penetrate into breast milk for a fairly fast period. Use topical treatment.

Types of drugs for pregnant women: tablets, ointments, suppositories

There are several types and methods of treating streptococcus during pregnancy.

Local treatment

The use of vaginal suppositories and tablets is implied. Immediately before delivery, the vagina is sanitized in order to minimize the risk of possible infection of the child. This method can reduce infection by up to several percent.

In a situation of significant deviation in the amount of streptococcus, as well as not using measures to cleanse the vagina, antibiotics are prescribed immediately at the time of childbirth.

Approved medicines:

• Hexicon. Suppositories have antimicrobial and antiseptic properties. Used for vaginosis and colpitis during pregnancy and during lactation. Method of application - insert candles into the vagina 1-2 times a day for 5-10 days.

Medicines for systemic use: names, instructions

Streptococcus in a smear in women during pregnancy is actively treated with antibiotics. They are prescribed only by an infectious disease doctor in the presence of a medical history and pregnancy management and test results. Inappropriate drug use can create drug resistance and imbalances in the gut microflora.

Until 12 weeks of pregnancy, antibiotics are not used in the treatment of streptococcal infection due to the formation of the placental barrier. Penicillin drugs are prescribed from the 2nd trimester.

Antibiotics must be prescribed when bacteria are found in the urine.

Types of medicines:

Antibiotics affect not only the site of infection, but also the functioning of the liver and gastrointestinal tract. On the 5th day after starting the medication, you must start taking probiotics.

Alternative methods of treating streptococcus

Alternative methods are also used to treat streptococcal infection. They are an addition to the main drug therapy.

The folk methods are based on the use of certain types of decoctions:

1. The decoctions include raspberries and rose hips, which contain a large amount of vitamin C. With their help, immunity is increased and toxins are eliminated.
2. Decoctions from oak and willow bark, as well as from chamomile - have antibacterial and anti-inflammatory effects. They are used both internally and externally.
3. Apricot is rich in healthy vitamins. It has a beneficial effect on the elimination of streptococcus together with the intake of medications. Daily use of apricot puree will reduce inflammation and accelerate recovery.
4. The use of black currant will eliminate the action of bacteria inside the body and replenish the deficiency of vitamin C. It is necessary to consume fresh berries at least 700 grams per day. The course of treatment is about 10-12 days.

Prevention of infection of a pregnant woman and a fetus

Streptococcus in a smear in women during pregnancy does not imply preventive measures to eliminate this infection. Strengthening the immune system is considered one of the effective preventive measures.

It is necessary:

If streptococcal infection has frequent relapses, it is necessary to resume drug treatment with a specialist. The most effective drugs are antibiotics of the penicillin and ampicillin series.

If the pregnant woman is at risk and previous deliveries occurred during the active growth phase of streptococcus, doctors recommend passing an analysis to identify streptococcus in the 3rd trimester. Based on the results of the results obtained, the doctor will prescribe a treatment regimen during the period of childbirth and organize babysitting for the first three months after birth.

In the absence of the necessary treatment, there is a possibility of premature rupture of the fetal bladder, outpouring of amniotic fluid and the death of an unborn child.

Complications in newborns

After childbirth, it is necessary to exercise enhanced supervision and control over the condition of the baby.During the first week of life, the main complication from streptococcal infection can be sepsis. It occurs against the background of the presence in the body of a newborn streptococcus of group B.

Streptococcal meningitis and pneumonia may occur later. Hearing system disorders, deviations in intellectual and physical development are possible - as complications after suffering meningitis.

According to statistics, about 5% of children die from complications after contracting streptococcal infection. Streptococcus should be treated with a complex method. When a bacterium is detected in a smear, a woman is assigned an individual treatment regimen, depending on the course of the pregnancy.

Article design: Svetlana Ovsyanikova

Video on the topic: streptococcus in a smear in women during pregnancy

Streptococcus in a smear:

Group B streptococcus and pregnancy:

Among the inflammatory diseases of bacterial origin that occur during pregnancy, a significant place is occupied by conditions caused by disorders of the normal microflora of the urinary 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 adverse external influences, in stressful situations, with a decrease in the body's immunological defense, 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 the excessive reproduction of opportunistic microorganisms. 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 the predominance of lactic acid sticks (lactobacilli).

There are a number of factors that control and influence the composition of the 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, the vaginal microflora includes various types of microorganisms. The vaginal discharge normally contains 108-1010 microorganisms in 1 ml, while aerobic bacteria are 105-108, anaerobic 108-109 CFU / ml. Lactobacilli dominate in the microbial flora of the vagina and cervix. It should be noted that bifidobacteria are more common in pregnant women 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 organisms. Among aerobic bacteria, diphtheroids, staphylococci, streptococci are most often detected, and among anaerobic bacteria - lactobacilli, bifidobacteria, peptostreptococci, prevotella and bacteroids.

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. By the appearance of the colonies and the nature of hemolysis on blood agar, these pathogens are divided into hemolytic, greening and non-hemolytic species. Streptococci belonging to three groups may be present in the vagina of healthy women: viridans streptococci (green streptococci), serological group B streptococci and serological group D streptococci (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, pathogens such as Streptococcus pyogenes (beta-hemolytic group A streptococcus) and Streptococcus agalactiae (group B streptococcus, which has recently become the most common cause of infections in newborns, especially premature babies, are of importance. and their mothers).

Diseases caused by Streptococcus pyogenes

About 20% of pregnant women are bacteria carriers (nasopharynx, vagina and perianal area). A pregnant woman may experience: tonsillitis, pharyngitis, pyoderma, urinary infection, chorionamnionitis, endometritis, postpartum sepsis. The infection can be passed on to the baby during childbirth, with the subsequent risk of neonatal sepsis increasing, especially with prolonged anhydrous periods.

Is the culture method (on blood agar aerobically and anaerobically).

When treating, appoint antibiotics from the group of penicillins and cephalosporins for at least 10 days. For postpartum sepsis, high doses of benzylpenicillin or parenteral ampicillin are prescribed. Newborns with streptococcal infections are also given high doses of benzylpenicillin, ampicillin, or cephalosporins.

Due to the fact that Streptococcus pyogenes is transmitted by contact, prevention consists in observing the rules of asepsis in childbirth.

Diseases caused by Streptococcus agalactiae

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

The main diagnostic method is the cultural method. The more intense the infection of the pregnant woman, the more likely the child will become infected. With vaginal delivery, the frequency of transmission of the infection to the child is 50-60%. The risk of illness in a full-term baby is 1-2%, and for a premature baby - 15-20%, with a period of less than 28 weeks of pregnancy - 100%. In case of infection of a child during childbirth, it is possible to develop sepsis, pneumonia, meningitis, and severe neurological complications. In severe cases, the disease begins immediately after birth and progresses rapidly. The risk for the child increases with premature rupture of the fetal bladder, premature birth, symptoms of chorionamnionitis in the mother.

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

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 disorders of the normal microflora of the genital tract. Bacterial vaginosis is a clinical syndrome caused by pathological changes in the structure of the microbial environment of the vagina. In patients with bacterial vaginosis, concentrations of facultative and anaerobic bacteria predominate, which displace lactic acid bacteria, which leads to significant changes in the vaginal microflora. The main feature of a violation of the composition of the normal vaginal microflora in bacterial vaginosis is a significant decrease in the number of lactic acid rods and a pronounced colonization of the vagina by anaerobic bacteria (Prevotella / Porphyromonas spp., Peptostreptococcus spp., Fusobacteium spp., Mobilunardcus spp.) And Gavinalis vaginalis.

During pregnancy, the reasons for the violation of the normal composition of the vaginal microflora may be the corresponding hormonal changes, the use of antibiotics, etc. More than half of all women with bacterial vaginosis have no subjective complaints and pathological discharge from the genital tract (leucorrhoea), along with the available positive laboratory signs. An inflammatory reaction of the vaginal epithelium is not a characteristic feature of bacterial vaginosis. In the clinical variant of the course of bacterial vaginosis with severe symptoms, prolonged, abundant, liquid, milky or grayish-white homogeneous discharge (leucorrhoea), mainly with an unpleasant fishy odor, are 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 of bacterial vaginosis with premature termination of pregnancy and untimely rupture of the amniotic membranes was noted. The risk of developing these complications in comparison with healthy pregnant women in patients with bacterial vaginosis increases 2.6 times. Approximately 10% of women who have given birth prematurely excrete gardnerella and other microorganisms from the amniotic fluid, while the amniotic fluid is normally sterile. It is noted that in women who gave birth before 37 weeks. there is a high likelihood of 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 found in the endometrium in patients with endometritis is often similar to that in 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 of developing pelvic inflammatory disease, premature termination of pregnancy, untimely discharge of amniotic fluid, the occurrence of chorionamnionitis, postpartum and postoperative endometritis. A high concentration of virulent microorganisms in the vagina of patients suffering from bacterial vaginosis is a risk factor for bacteria to enter the higher parts of the genitourinary system.

Diagnostics - the complex includes four diagnostic tests

• during an external gynecological examination of the patient in the area of \u200b\u200bthe vestibule of the vagina, leucorrhoea typical for bacterial vaginosis is noted. If the discharge is too heavy, it can also drain onto the perineum. In this case, usually the external genital organs are not hyperemic and not edematous. However, in the presence of concomitant infection, edema 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;
• positive amine test, which is accompanied by the appearance of an unpleasant fishy odor when exposed to a 10% potassium hydroxide solution on a sample of contents from the middle third of the vagina;
• detection by microscopy in the vaginal discharge of "key cells", which are mature cells of the vaginal epithelium with adhered to them in a large number of microorganisms, which are located mainly chaotically.

Microscopic analysis of vaginal secretions is the final diagnostic method, including Gram stained smears.

Bacterial vaginosis treatment

In the first trimester of pregnancy, for the treatment of bacterial vaginosis, it is possible to prescribe clindamycin 2% in the form of a 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, and also with the appointment of Clindamycin by mouth, 300 mg, 2 times - 7 days.

In the III 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 sexually transmitted infection. 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, while lesions of the cervix are observed in more than 50% of cases, the rectum - in more than 85%, the pharynx - in more than 90%. The presence of gonorrhea in a pregnant woman is a significant risk factor for adverse outcomes for both the mother and the fetus. Women who become infected with gonorrhea after 20 weeks of pregnancy or after childbirth have an increased risk of developing gonococcal arthritis. In acute gonorrhea, the risk of premature rupture of amniotic fluid, spontaneous abortion, and premature birth is increased. Chronic gonorrhea may worsen immediately after childbirth, with an increased risk of gonococcal sepsis.

Fetal infection occurs in utero or during childbirth. Intrauterine infection is manifested by gonococcal sepsis in the newborn and chorionamnionitis. Infection during childbirth can lead to gonococcal conjunctivitis, otitis externa, and vulvovaginitis.

If gonorrhea is suspected, discharge from the vagina and cervix is \u200b\u200bexamined. An approximate diagnosis is established when gonorrhea pathogens are found in a smear. To confirm the diagnosis, sowing of the discharge on a special medium is used. A PCR method is also used.

Treatment of gonorrhea in pregnant women

Treatment of pregnant women at any gestational age 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 1 time per day for 7-10 days. In 7 days after the end of treatment, repeated crops are carried out. For ophthalmorrhea of \u200b\u200bnewborns, ceftriaxone is used at a dose of 25-50 mg / kg intravenously or intramuscularly once and frequent washing of the conjunctiva with isotonic sodium chloride solution.

As a control over the treatment, sowing is carried out after the end of treatment after 7 days and after 4 weeks.

As a prevention during the initial examination of a pregnant woman, sowing of discharge from the cervix for gonorrhea is mandatory. For women at risk at the end of the third trimester of pregnancy, repeat cultures are prescribed. Treating sexual partners.

They belong to the group of pathogens widespread in the external environment; they can inhabit the skin, mucous membranes, including pregnant women. But due to changes in the immune system, against the background of an unfavorable course of pregnancy, these opportunistic microbes can lead to certain problems both in the mother herself and in the fetus, and then also in the newborn baby. The greatest importance is attached to group B streptococci, which can form various types of infections, ranging from the skin to systemic lesions.

Overview of Streptococcus and Infection

Streptococci belong to the group of coccal flora (globular microbes). They actively inhabit the human body and live freely in the external environment, and most of these microbes are not dangerous for people. Some of the representatives are classified as conditionally pathogenic or pathogenic, which is why, under the confluence of special circumstances, they are able to provoke infections of varying severity - from food poisoning and purulent-septic processes, to provocation of autoimmune and allergic pathologies in the body -,. During pregnancy, they can cause intrauterine infection of the fetus, and during the neonatal period they provoke or, especially in the weakened,.

Of greatest interest is group B streptococcus, it is widespread among other coccal microbes, and can form a number of infectious diseases. For adults, it usually does not pose a danger if they do not have problems with immunity.

During gestation, it can stimulate some complications in pregnant women, and also threatens the fetus and then the baby during birth. Carriage of group B streptococcus is noted in about a quarter of expectant mothers. In some representatives, it can lead to damage to the urinary system or some other types of infections.

How is group B streptococcus transmitted

Bacteria can live in the mouth, intestines, mucous membranes of the urinary system and genitals. They enter the body in various ways - through contact with carriers, using common objects, dishes, with food, which is seeded with streptococcus and with air current. Sexually streptococci are not transmitted, they usually fall on the mucous membranes of the genitals and the urinary tract ascending from the skin or hematogenous, from the foci of infection.

Causes of infections: features of microbes

Streptococci are represented by an extensive family of nodular microbes that do not form spores. They belong to gram-positive microbes, genus Streptococcus, family Streptococcaceae. These microbes do not have flagella, do not move independently, and are able to survive in environments without oxygen. Under a microscope, they can appear in pairs, groups or chains.

The habitat for these microbes is diverse - it is soil, plants, animals and the human body. They survive sharp changes in temperature well, can actively reproduce in the soil, on food. They cannot stand boiling, direct ultraviolet radiation, antimicrobial drugs from the groups of penicillins, sulfonamides or macrolides. On nutrient media, they are capable of active reproduction and sowing of colonies, on which the methods of their diagnosis are based. They are examined in a laboratory, determining the properties and sensitivity to antibiotics, which is important in subsequent treatment.

Basis of classification: why are different types of streptococci dangerous?

According to their properties, two groups are distinguished: beta-hemolytic streptococci and alpha-hemolytic streptococci.

Among the group of beta-hemolytic microbes, a number of types have been identified, which are assigned Latin capital letters.

• group a belongs to the most pathogenic strains of streptococcus. They affect the skin and mucous membranes, penetrating wounds and cracks in the skin, form purulent foci of inflammation. The penetration of these bacteria into the body leads to tissue necrosis and infectious-toxic shock, and may also have the properties of damaging myocardial cells.
• Group B refers to conditionally pathogenic, showing activity only in conditions of decreased immunity and diseases. They live in the nasopharynx, digestive tract and vagina in women. Against the background of reduced immunity, pregnant women can multiply, forming certain diseases, are able to penetrate the placenta during pregnancy, affecting the embryo or fetus, are dangerous for a newborn child, they threaten him with serious brain damage and sepsis. Can lead to a woman, sore throat or.
• Group C and Group G during pregnancy are not relevant.

TO alpha-gemtolytic streptococci include pneumococcal microbes that threaten the development and Streptococcus viridans, which is capable of provoking bacterial.

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The most dangerous for pregnant women are streptococci from group B, which can live in the microbial flora of the vagina, they are detected according to smear data during examination, the field of which requires a doctor's consultation and a decision on treatment, usually.

Manifestations of streptococcal infections during pregnancy

The manifestations of streptococcal infection depend on where the pathogen begins its active reproduction and which organs and tissues it actively affects:

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During pregnancy, the genitourinary system can become vulnerable, with an infection of the bladder and kidneys, damage to the uterus and fetal bladder, placenta, which threatens fetal damage in the early stages or stillbirth in the late. During childbirth against the background of streptococcal infection, including during a cesarean section, pelvioperitonitis may develop.

Symptoms of the lesion do not differ in specificity - high fever and weakness are typical, and a sharp increase in pain when it is felt, bleeding. If such infections are suspected, a full diagnosis is necessary with the determination of the pathogen and its sensitivity to antibiotics.

Consequences of streptococcus during pregnancy for the mother

During pregnancy, a woman's immune defense is reduced in order to easily bear a fetus, half of the father's antigens. This leads to the fact that a woman may become more vulnerable to various infections, including group B streptococcus. For pregnancy, such consequences are typical as premature birth with premature birth, placental rupture and its early with bleeding, intrauterine fetal death, in the early stages and ... Infection of the membranes leads to tears and rupture, discharge of amniotic fluid or infection with the transfer of pathogens to the fetus. No less dangerous during pregnancy is the formation of kidney and urinary tract infections, which also complicate the course of pregnancy.

The effect of streptococcus on the fetus, child

Streptococcus during pregnancy is dangerous for the embryo and fetus, and then for the newborn. It will burn to become infected even in utero, or during childbirth, which happens much more often. Often, signs of infection do not appear immediately, and this largely depends on the type of pathogen that the baby was infected with at birth. There are two different types of group B streptococcus infection.

• with early onset of infection , for which the most leading signs will be severe fever, respiratory distress and constant depression of the infant during the first week of life. Usually, all signs begin to appear on the first day. This early onset of streptococcal infection often leads to lung lesions with formation, as well as septic complications.

In half of newborns, the infection has an early onset and poor prognosis.

• late onset of the disease , in which the signs may be specific. These include the presence and violation of breast sucking, constant high fever and severe drowsiness, the development of seizures. Signs can occur between 1 week and 3 months after delivery. Often, this type of infection leads to septic complications and meningitis in children.

About 5% of children have fatal complications of this infection, among premature babies this percentage is higher... If the child recovers, then the transferred infection caused by type B hemolytic streptococci can form residual (residual) phenomena in the form, leading to problems with the development of the brain, which leads to impaired posture, motor functions and muscle tone. Problems with the development of the organ of hearing and external defects, learning disabilities are also possible.

Analysis for streptococcus in pregnant women: norm and decoding

Based only on complaints and general symptoms of infection, it is difficult to accurately determine the streptococcal nature of the infection, but in some cases the infection manifests itself quite clearly - with erysipelas or streptoderma. The basis of diagnosis is bacteriological research. - taking smears with their crops on nutrient media and identification of the pathogen. Swabs are taken from the affected areas or the vagina, cervix, urethra to determine the carriage of streptococcus. Blood is also indicated for suspected spread of infection and sepsis. For pulmonary sites and bronchial lesions, sputum culture is performed. Determine not only the pathogen itself, but also immediately its sensitivity to antibiotics.

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Normally, streptococcus in pregnant women can be no more than 10 * 4 CFU / ml, its detection in large volumes requires sanitation of all areas during pregnancy where they are found.

To clarify the nature of the infection and the severity of the pathology, the doctor can conduct blood tests to identify streptococcus, as well as screening tests to determine the titer of antibodies and agglutinins, according to the level of which conclusions are drawn.

Treatment of streptococcus during pregnancy

With positive test results and detection of dangerous concentrations of streptococcus in the skin, mucous membranes or other localizations, it is necessary to carry out active treatment during pregnancy. Most often, expectant mothers suffer from group B streptococcus of two types - pyogenic and agalactic.According to the results of the cultures, a spectrum is issued to which the identified microbes are sensitive, and from them those that are as safe as possible during pregnancy are selected.

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Usually, in the acute stage and in severe conditions, drugs are administered intravenously or drip, or intramuscularly, as the condition improves, you can switch to oral forms of drugs.

Therapy for poor smears is prescribed after 35 weeks of pregnancy and continues into labor. In the presence of streptococcal infections in pregnant women, antibiotics can be used after the 12th week of pregnancy.

Most often, antibiotics are selected from the group of penicillins; if they are intolerant, macrolides are used. These drugs do not harm the fetus and may have minimal side effects in expectant mothers. Can also be used preparations of streptococcal bacteriophages - these are biological agents, more active in relation to specific types of pathogen.

Antibiotics for prophylactic purposes may also be used before childbirth 4 hours before birth.

Complications of infection after childbirth

Against the background of streptococcal infection, postpartum infection of the uterine cavity is possible, especially in complicated labor. It can manifest itself a few days after the birth of a child with abdominal pain and bleeding, purulent discharge and fever, a sharp deterioration in the general condition, tachycardia, and increased breathing. In these cases, hospitalization is required. And if the woman is still in the hospital - active antibiotic treatment and control over uterine contractility and secretions.

Alena Paretskaya, pediatrician, medical columnist

Streptococci are gram-positive bacteria that are very widespread in nature, but are found only on the mucous membranes 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 significance - group B streptococci

Bacterial genus Streptococcus includes about 20 species, and Streptococcus agalactiae is also known as group B beta-hemolytic streptococcus (BGS-B). BGS-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 BGS-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, the newborn can become infected when passing through the birth canal during or after childbirth, which in turn can lead to, or sepsis of the newborn.

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

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

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

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

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 is recommended, as well as a significant presence of bacteria in the urine culture without symptoms of acute urinary tract infections and clinical signs of disease.

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 the urinary tract 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 urinary tract infection (i.e. with asymptomatic bacteriuria), as well as pregnant women with symptoms of urinary tract infection, are prescribed appropriate antibiotic treatment ...

In addition, every woman with culture of group B streptococcus in urine (regardless of the number of colonies) should be prevented to prevent early neonatal infection in newborns with this bacterium.

Pregnant women who do not have any symptoms and urine cultures have 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 retested c.

Lack of treatment for asymptomatic bacteriuria before childbirth is associated with a higher incidence of pyelonephritis, premature 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 that 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 you suspect inflammation of the vagina and cervix, the doctor takes a cervical smear. If aerobic bacteria BGS-B are found in the analysis of the cervical smear, antibiotic treatment will be prescribed by the gynecologist.

Group B streptococcus infection can manifest as chorioamnionitis, endometritis, cystitis, pyelonephritis. Caesarean section can complicate postoperative wound infections, pelvic inflammation, and thrombophlebitis (inflammation of the veins).

Colonization of the vagina of a pregnant woman group B streptococci during the passage of the child through the birth canal, it can be transmitted to the infant, which is one of the main causes of early neonatal illness. Bacteria reach the amniotic fluid, usually after rupture of the membranes. BGS-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 60-80% reduction in neonatal sepsis, pneumonia and other complications. The widespread use of antibiotics significantly reduces the incidence of disease 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 have had it during pregnancy. The first choice is penicillin or clindamycin.