Bacteriologic and virologic examination for habitual non-pregnancy

Analysis of literature data and the department's experience allow us to conclude that bacteriological and virological examination of patients with habitual miscarriage is of great importance. According to research data, persistent bacterial and viral infection is one of the main factors of miscarriage. Even in the absence of direct specific impact of infectious agents on the fetus, reproductive system disorders caused by their persistence in the endometrium, with the development of chronic endometritis, as well as concomitant endocrinopathies and autoimmune disorders, lead to disruption of embryonic and fetal development and to termination of pregnancy.

A characteristic feature of endometrial microcinoses in patients with miscarriage is the presence of associations of obligate anaerobic microorganisms, and in case of miscarriage of the type of non-developing pregnancy - the persistence of associations of viruses: herpes simplex virus type II, cytomegalovirus, Coxsackie A and B, etc.

For microbiological examination, the contents of the vagina and cervical canal are taken with a sterile cotton swab, which is then placed in a sterile test tube. The collected material is sent to a bacteriological laboratory within the next 2-3 hours. Species identification of opportunistic microorganisms is carried out using generally accepted methods. At the same time, the sensitivity of all isolated cultures to antibiotics is determined.

If it is necessary to collect the endometrium for bacteriological and morphological examination, it is taken with a special curette or catheter with vacuum aspiration on the 5th-6th day of the menstrual cycle, taking precautions to avoid mixing samples obtained from the uterine cavity and cervical canal, and only after determining that there is no pathogenic flora in the cervical canal.

Simultaneously with bacteriological examination, it is advisable to perform bacterioscopic examination of the discharge from the genital tract. For bacterioscopy, smears are taken from the cervical canal, posterior vaginal fornix and urethra on two slides. The first smear is stained according to Gram to exclude vaginosis, first of all, gonococcal infection; the second is stained according to Romanovsky-Giemsa to identify trichomonads. The data from bacterioscopy of the discharge from the genital tract help to determine the qualitative composition of the microbial flora, the number of leukocytes, the composition of epithelial cells, which can to some extent characterize the severity of the inflammatory process.

If a urinary tract infection is suspected, a bacteriological urine test is indicated. To do this, after cleaning the external genitalia, a midstream portion of urine is collected in a sterile test tube (without a catheter).

The test tube is tightly closed with a stopper. 1-2 ml of urine is sufficient for the study. Bacteriuria is considered true if there are 10 ⁵ or more colony-forming units (CFU/ml).

To detect chronic inflammatory process of kidneys simultaneously with bacteriological examination of urine it is advisable to conduct urine examination according to Nechiporenko. For this purpose after toilet of external genitals collect in a test tube the middle portion of morning urine in the amount of not less than 10 ml. The presence of an inflammatory process is indicated by detection of more than 2500 leukocytes and more than 1000 erythrocytes in urine.

The diagnosis of persistent viral infection should include an assessment of the antigen or antigens themselves and the body's objective response to these antigens. If only viruses (antigens) are determined by any method, this will not be sufficient for diagnosis, since a case of transient passage of viruses without affecting the body is possible. In addition, there may be a period of remission when there are no viruses in the cervical canal, but the fact of virus carriage may exist. If only antibodies to viruses are determined, this is also not sufficient. The presence of antibodies to IgG viruses means that the body has already encountered this type of virus in the past and there is a response in the form of antibody formation. This is very important in obstetric practice, since it means that the pregnant woman will not have a primary viral infection, and this infection is the most dangerous for the fetus. A secondary infection, i.e. reactivation of a viral infection, is less dangerous for the fetus and even in case of illness, it will proceed in a milder form than with a primary infection.

The most informative methods for the clinician:

• Degree of viruria - determination of viruses in urine sediment cells using indirect immunofluorescence reaction (IIFR).

Based on the results obtained in the RNIF, a morphometric indicator of viral infection activity is determined. The intensity of specific luminescence and the relative number of cells containing the viral antigen are taken into account. The assessment is carried out in a point system from "0" to "4+", in which almost the entire field of vision is covered with cells with bright granular and diffuse specific luminescence.

• DNA probe method, DOT hybridization - detection of viruses in cervical mucus. This method is accurate for pathogens. For opportunistic microorganisms and persistent viruses, its significance is less and the cost is higher than when assessing viruria.
• Polymerase chain reaction (PCR diagnostics) is a highly sensitive method for determining antigens in acute and chronic forms of infection. Scraping of epithelial cells of the cervical canal is used as clinical material. The PCR diagnostics method determines the presence of herpes simplex viruses, cytomegalovirus, chlamydia, mycoplasma, and ureaplasma in the cells of the cervical canal.
• Determination of antibodies to viruses, especially the presence of IgG. The presence of IgM antibodies is less informative, they disappear quickly, or, on the contrary, persist for a long time. If reactivation is suspected, IgM antibodies are also examined.

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