Impact of amniotic fluid “sludge” on the risk of preterm delivery

Objective: To evaluate the impact of amniotic fluid “sludge” (AFS) on the risk of preterm delivery and to describe the effect of antibiotic treatment in that situation.

Methods: Case–control study including singleton pregnancies with or without AFS, between 15–32 weeks of gestation. Factors associated with preterm delivery before 32 weeks, 34 weeks and 37 weeks were evaluated with univariate and multivariate logistic regression. Since all women with AFS in this study were treated with antibiotics, a historical comparison was performed with similar patients with AFS found before 2007 and not treated with antibiotics.

Results: AFS was observed in 90/1220 patients (7.4%). AFS was associated with shorter cervical length, greater body mass index, cervical cerclage and preterm birth before 28 weeks. However, after adjustment, AFS did not remain associated with preterm delivery before 32 or 34 weeks. The historical comparison suggested that azithromycin could significantly reduce the risk of preterm delivery before 34 weeks (odds ratio: 0.2; 95% CI: 0.04–0.92).

Conclusions: AFS, treated with azithromycin, was associated with a higher risk of prematurity, but not independently after adjustment for cervical length and second trimester vaginal bleeding. Further studies need to evaluate the effect of antibiotics in pregnancies with AFS.     

产后逐瘀胶囊对人工流产术后康复的影响

目的 探讨产后逐瘀胶囊对人工流产术后孕妇康复的影响.方法 选取行人工流产术结束分娩的孕妇120例,随机分为治疗组及对照组,各60例,2组术后常规给予头孢拉定胶囊、奥硝唑片口服,治疗组在常规用药的基础上口服产后逐瘀胶囊,3粒/次,3次/d,2组均1周为1疗程,观察2组孕妇术后阴道出血量及时间,并采用彩色超声检测仪测量子宫三径、内膜厚度及子宫动脉血流动力学指标.结果 治疗组孕妇人工流产术后阴道血量及时间、术后子宫三径线显著低于对照组(P＜0.05);2组术后子宫内膜厚度比较无统计学意义(P＞0.05),治疗组术后2周子宫动脉收缩期峰值流速(PSV)显著高于对照组(P＜0.05),2组子宫动脉搏动指数(PI)、阻力指数(RI)比较无统计学意义(P＞0.05);治疗组随访月经复潮情况显著优于对照组(P＜0.05).结论 产后逐瘀胶囊可显著减少人工流产术后孕妇阴道出血量,缩短出血时间,并可有效改善子宫血流动力学指标,利于人工流产术后子宫康复及月经周期的恢复.     

Bioadhesive vaginal drug delivery of nystatin using a derivatized polymer: Development and characterization

Increasing incidence of resistance to azole antifungals has highlighted the importance of the use of alternative therapeutic agents such as nystatin for the treatment of vulvovaginal candidiasis. The aim of the present study was to develop and characterize locally acting, film formulation for the treatment of candidiasis using a derivatized natural polymer. Derivatization of natural polymer was carried out in order to introduce anionic character to an otherwise neutral polymer, so as to enhance its interaction with vaginal mucous membrane along with inheriting the biocompatibility and nonirritant characteristics of its parent polymer. A carboxymethyl derivative of fenugreek gum (CMFG) was prepared, and characterized by DSC, FTIR and X-ray diffraction studies. The derivatized gum was found to possess bioadhesive and film forming properties. A 3² factorial design was employed to formulate vaginal films and a response surface methodological approach was used to study the effect of formulation variables on film properties. Films containing 5% w/v polymer and 2% v/v glycerol exhibited optimum properties in vitro. The optimized drug loaded formulation was able to release 100% drug over a period of 5 h and followed Korsmeyer–Peppas kinetics. It was found to be non-irritant and nontoxic to vaginal mucosa and showed appropriate antifungal properties in vivo.     

阴道炎五联检验对阴道炎病原体诊断与白带清洁度检测的应用效果分析

目的观察和分析阴道炎五联检验对阴道炎病原体诊断与白带清洁度检测的应用效果。方法选择门诊接受阴道分泌物检查的患者260例作为研究对象,提取患者阴道分泌物标本分别进行阴道炎五联检测和常规镜检,对两种方法检测真菌性阴道炎、滴虫性阴道炎、细菌性阴道炎和白带清洁度的结果进行比较和分析。结果常规镜检法和阴道五联检法检测真菌性阴道炎、滴虫性阴道炎、白带清洁度结果的总符合率分别为95.8%、97.7%和83.8%,两种方法的检出率差异无统计学意义,而两种方法检测细菌性阴道炎结果的总符合率为85.0%,阴道五联检法检出率显著高于常规镜检法(χ2=16.058,P<0.05)。结论阴道炎五联检测法可提高细菌性阴道炎的检出率,具有较高的灵敏度和特异度,可为临床医师制定合理的治疗方案提供有价值的依据。     

Mimics of malignancy caused by concurrent imperforate hymen and transverse vaginal septum: an instructive case and review of the literature

The coexistence of imperforate hymen and vaginal septum is rare and their ability to mimic malignant manifestations have not been frequently reported. This current case report describes a 13-year-old girl that presented with cyclic abdominal pain for 6 months. She was found to have a huge mass via abdominal plain film X-ray and sonography, with inexplicably high levels of serum carcinoembryonic antigen, cancer antigen (CA)-19-9 and CA-125. Pelvic computed tomography imaging disclosed two huge cystic lesions in the uterine and upper vaginal cavities. Surgical intervention conformed the diagnosis of a concurrent imperforate hymen and transverse vaginal septum, echoing the imaging findings of haematocolpometra. Her tumour marker levels gradually returned to normal after surgery. This rare case of concomitant imperforate hymen and transverse vaginal septum highlights that haematocolpometra, a benign disease that might mimic malignancy, should be taken into consideration in any adolescent females with an abdominal mass and amenorrhoea to ensure an early diagnosis and timely appropriate management.     

Analysis of puerperal hematoma: a retrospective study

Objective: To evaluate the characteristics and risk factors of puerperal hematoma.Materials and Methods: Data from the medical records of 2,776 women, who delivered vaginally between January 2008 and December 2017 in the authors’ hospital, were analyzed retrospectively.Results: Primigravida status was considered to be a significant risk factor. Among women with multigravida status, maternal age, instrumental delivery, and episiotomy were considered to be statistically significant risk factors. Regarding characteristics, hematoma occurred on the right side in 61.5% of cases, 53.8% were ≥50 mm in size, 61.5% were detected within 2 h of delivery, 46.2% were associated with severe pain, and 61.5% required surgical treatment.Conclusion: Primigravida status a risk factor for puerperal hematoma, and maternal age, instrumental delivery, and episiotomy were risk factors for puerperal hematoma in women with multigravida status. Puerperal hematomas occurred more frequently on the right side than the left reflected by the number of episiotomies performed on the right side. Approximately one-half of the hematomas were associated with severe pain, and many were detected within 2 h after delivery. Many hematomas, especially those associated with severe pain, required surgical removal.     

THE PROTECTIVE IMMUNE RESPONSE AGAINST VAGINAL CANDIDIASIS: LESSONS LEARNED FROM CLINICAL STUDIES AND ANIMAL MODELS

Recurrent vulvovaginal candidiasis (RVVC) is a significant problem in women of childbearing ages and is caused by Candida albicans, a commensal organism of the intestinal and reproductive tracts. As a result of this commensalism, most healthy individuals have demonstrable Candida -specific adaptive immunity that is considered protective. In women with RVVC, a deficiency/dysfunction of this protective immunity is postulated to affect susceptibility to infection. Although cell-mediated immunity (CMI) is considered important for protection against mucosal candidal infections, little is understood about specific host defenses that are important at the vaginal mucosa. Studies to date suggest that a compartmentalized local, rather than systemic, immunity is important for defense against vaginitis. This review will summarize the current state of knowledge regarding protective host defense mechanisms against vaginal C. albicans infections both from clinical studies and animal models. From these data, hypotheses are presented for what host defense mechanisms appear important for resistance/susceptibility to vaginal infection.     

Vulvovaginal candidiasis: Epidemiology,microbiology and risk factors

Abstract

Vulvovaginal candidiasis (VVC) is an infection caused by Candida species that affects millions of women every year. Although Candida albicans is the main cause of VVC, the identification of non-Candida albicans Candida (NCAC) species, especially Candida glabrata, as the cause of this infection, appears to be increasing. The development of VVC is usually attributed to the disturbance of the balance between Candida vaginal colonization and host environment by physiological or nonphysiological changes. Several host-related and behavioral risk factors have been proposed as predisposing factors for VVC. Host-related factors include pregnancy, hormone replacement, uncontrolled diabetes, immunosuppression, antibiotics, glucocorticoids use and genetic predispositions. Behavioral risk factors include use of oral contraceptives, intrauterine device, spermicides and condoms and some habits of hygiene, clothing and sexual practices. Despite a growing list of recognized risk factors, much remains to be elucidated as the role of host versus microorganisms, in inducing VVC and its recurrence. Thus, this review provides information about the current state of knowledge on the risk factors that predispose to VVC, also including a revision of the epidemiology and microbiology of VVC, as well as of Candida virulence factors associated with vaginal pathogenicity.     

孕期血清25-羟维生素D水平与孕妇细菌性阴道病的相关分析

目的分析孕期血清25-羟维生素D水平与孕妇细菌性阴道病(BV)之间的关系。方法选取2018年1-12月在该院进行孕检的孕妇共1477例为研究对象,其中BV孕妇382例(BV组),非BV的其他阴道炎孕妇137例(非BV组),健康孕妇958例(正常对照组),分别检测3组孕妇血清25-羟维生素D水平,并通过Spearman相关和单因素Logistic回归分析血清25-羟维生素D水平与BV之间的关系。结果43.72%的BV组孕妇阴道优势菌群由革兰阳性杆菌变为革兰阳性球菌,菌群密集度和多样性级别明显增高,与正常对照组及非BV组相比,差异有统计学意义(P<0.05)。非BV组与正常对照组阴道微生态变化不明显,差异无统计学意义(P>0.05)。BV组孕妇血清25-羟维生素D水平明显低于正常对照组和非BV组,差异有统计学意义(P<0.05)。72.25%的BV组孕妇体内25-羟维生素D水平处于缺乏和不足状态,而60%以上的非BV组和正常对照组孕妇体内25-羟维生素D水平处于充足状态,BV组与非BV组、正常对照组间25-羟维生素D缺乏孕妇所占构成比比较,差异有统计学意义(P<0.05)。Spearman相关分析显示,25-羟维生素D水平与BV发生之间呈负相关(r=-0.339,P<0.05),单因素Logistic回归分析发现25-羟维生素D不足或缺乏(OR=1.831,P<0.05)为BV发生的危险因素。结论孕妇阴道微生态失衡则BV发病率较高,体内25-羟维生素D不足或缺乏可以促进BV的发生。