Recurrent vaginitis as a major predictor of obstetric perineal injury: searching for evidence

• Liliya R. Toktar
• Lyudmila M. Mikhaleva
• Kseniya I. Lee
• Verаnika E. Pak
• Konstantin Yu. Midiber
• Irina A. Samsonova
• Rustam F. Gaifulin

Abstract

Background. Obstetric perineal trauma is an actual problem of modern medicine. The incidence of this labour complication does not tend to decrease, while the impact on quality of life of women, as well as on the financial costs of the health care system, is steadily increasing. This, in turn, leads to necessity for timely prediction and effective prevention of perineal injuries.

The aim of the study was to investigate the effect of violations of the vaginal biocenosis during pregnancy on vaginal wall and perineal muscles when they are damaged during childbirth.

Material and methods. On the basis of the branch of the State Clinical Hospital # 1 named after N.I. Pirogov “Maternity Hospital # 25” a randomized prospective study was conducted. The study included 152 women and was conducted between September 2020 and April 2022. Clinical observation of patients began from the day of the first appearance of patients in maternity welfare centre and continued throughout pregnancy and postpartum period. Particular attention was paid to a comprehensive perineological examination.

Results. According to the data obtained, the frequency of violations of the vaginal biocenosis occurring during pregnancy was 75%. This complication of pregnancy was recurrent. A decrease in elastic properties of perineal tissues under the influence of vaginal dysbiosis leads to an increased risk of subsequent trauma in labor. The frequency of perineal injury in primiparas was 60%, in multiparous 70%. Morphological examination of perineal tissues in primiparas revealed an inflammatory reaction in 70% of biopsies, and fibrous changes in 25% of biopsies. In multiparous patients, morphological examination revealed an inflammatory reaction in 100% of cases, and fibrosis in 80% of cases.

Conclusion. Vaginal microbiocenosis violations is a proven risk factor for obstetric perineal injury. Vaginal dysbiosis leads to changes in morphological properties of perineal tissues due to: alkalization of the vaginal environment; decrease in muscle tone of the perineum; deterioration in the contractility of the pelvic floor muscles.

Keywords:vaginal microbiocenosis; dysbiosis; obstetric perineal injury; tissue morphological properties; fibrosis; inflammatory changes

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