Vaginitis in pregnancy

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    vaginitis disease common pregnancy including vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) and trichomonas vagin

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    vaginitis disease common pregnancy including vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) and trichomonas vaginitis etc.. Many clinicians are concerned about the possible impact of drugs on the fetus and failure to update their knowledge in a timely manner. This article introduces the interaction between vaginitis and pregnancy and the current treatment of vaginitis in pregnancy.

1 the interaction between vaginitis and pregnancy

1.1 vulvovaginal candidiasis   pregnancy estrogen increased vaginal Candida provides high concentrations of glycogen growth, but also can increase the ability of estrogen to the vaginal mucosa albicans adhesion of epithelial cells. The presence of estrogen receptors on the surface of Candida albicans, the combination of Candida and estrogen, and the increase in the formation of Candida hyphae by estrogen. Therefore, pregnant women are easy to merge with VVC, resulting in vaginal Candida carrying rate and incidence of VVC increased, the highest incidence of VVC in late pregnancy. The cure rate of VVC decreased during pregnancy. In a multicenter study involving 13914 pregnant women, the prevalence of vaginal candidiasis in pregnancy was 22%, and no vaginal candidiasis was associated with preterm birth ([1]). However, Czeizel et al. Found that topical treatment with VVC in the treatment of pregnancy can reduce the preterm birth rate by [2]. There have been reports in the literature, can cause VVC infection of Candida albicans, and may cause fetal infection, leading to fetal death [3].

1.2 bacterial vaginosis in a   including 13747 cases of pregnancy 23 ~ 26 gestational weeks of pregnant women, detection rate of BV is 16.3%, which is 6.1% Asian pregnant women, 5.8% pregnant women were Caucasian, Hispanic women was 15.9%, African American pregnant women for 22.7%[4]. BV can lead to increased risk of amniotic membrane inflammation, premature rupture of membranes, preterm birth and low birth weight infants. BV patients with vaginal bacteria through the fetal membrane into the amniotic cavity, leading to chorioamnionitis and chorioamnionitis, and can develop into premature rupture of membranes and premature birth, etc.. The incidence of premature delivery in combination with BV and BV was 6.3% to 6.8% and from 1.1% to 4.2%, respectively. BV can also lead to postpartum endometritis and wound infection after cesarean section. Surgical BV patients with cesarean section after abdominal wound infection and the incidence of endometritis compared with non BV patients. From these patients with postpartum endometritis can produce parts often associated with BV and Gardiner vaginal bacteria anaerobic bacteria such as Prevotella spp., Streptococcus [5-6] digestion.

1.3 trichomonas vaginitis   the incidence of trichomonal vaginitis was similar in pregnant and non pregnant. Studies have shown that trichomonas vaginitis and premature occurrence. But for pregnant women in routine screening of trichomonas vaginitis can not reduce the incidence of preterm birth. Even the study found in asymptomatic trichomoniasis treatment increases the preterm birth rate, the release of inflammatory mediators in the death of the Trichomonas may occur with the treatment process, leading to premature [7].

2 treatment of vaginitis

2.1 of vulvovaginal candidiasis in pregnancy VVC   antifungal treatment of slow onset, and the disease is easy to relapse. Most of the local effective regimen for pregnant women with vulvovaginal candidiasis, prolong the treatment time (1 weeks) can improve clinical efficacy and eradication of VVC. Nystatin and several commonly used topical antifungal agents can be used throughout pregnancy. Oral antifungal drugs should be avoided during pregnancy. Sexual partners do not need to treat [8] at the same time.

The following recommended therapy: miconazole: 200mg, 1 night, vaginal drug, 7 days. The Clotrimazole Suppositories 100mg, 1 times every night, vaginal drug, 7 days. The nystatin, 100 thousand units, 1 times every night, vaginal drug, 14 days. Because of the long duration of nystatin treatment, the patient's compliance is poor, and there are a lot of guidelines for the treatment of VVC in pregnant women.

2.2 bacterial vaginosis   in preterm low risk population, prenatal screening and treatment of BV can reduce the incidence of preterm birth, but can reduce the incidence of patients with puerperal infection rate and postpartum endometritis. Screening and treatment of BV during pregnancy can reduce the incidence of preterm birth. At present, it is not necessary to carry out BV screening for all pregnant women, but should have a history of preterm birth screening for pregnant women, in order to early diagnosis and treatment of BV, prevention of premature labor [9-11]. Due to the local drug clearance may be upstream of the infection, ineffective prevention of preterm birth, it does not advocate the medicine on the vagina. Sexual partners need not be treated simultaneously.

The following recommended treatment: metronidazole: 200mg orally 3 times a day, a total of 7 days; the metronidazole 400mg orally 2 times a day, a total of 5 to 7 days; the clindamycin: 300mg orally, 2 times a day, a total of 7 days.

2.3   of trichomonas vaginitis; asymptomatic pregnant women, there is no evidence to recommend routine screening for Trichomonas vaginitis. Stress sexual partners need to be treated simultaneously.

Recommended treatment options are as follows: first choice: metronidazole, 200mg, 3 times a day, a total of 5 ~ 7 days; metronidazole, 400mg, the 2 / day, from 5 to. Treatment failure: metronidazole, 400mg, 3 times / day, 7 days. Treatment of sexual partners: metronidazole, 2G, orally; or tinidazole, 2G, orally.

3 the safety of the treatment of vaginitis during pregnancy

The safety of metronidazole in pregnancy has been proven and widely accepted in recent years. According to the U.S. Food and Drug Administration (FDA), metronidazole is a class B pregnancy drug, which allows the use of metronidazole during pregnancy to treat [8]. The U.S. Centers for Disease Control and Prevention (CDC) guidelines for treatment of sexually transmitted diseases guidelines for treatment of sexually transmitted diseases and the British Society of reproductive medicine have made during pregnancy can choose topical azole antifungal agents in the treatment of vulvovaginal candidiasis. The classification of antifungal drugs FDA pregnancy is as follows: clotrimazole (class B), nystatin (class B), miconazole (CM). There were two articles reported during pregnancy (including early pregnancy) pregnancy outcome of oral itraconazole and fluconazole in patients with accident, accident found no oral itraconazole or fluconazole increased malformation rate. Nevertheless, the pregnancy continued to demand for, do not choose oral itraconazole or fluconazole in the treatment of vulvovaginal candidiasis.

It is worth noting that, although the vast majority of countries in the world recognize the FDA classification of drugs, and drug use during pregnancy according to this classification, but the country does not recommend medication in full accordance with the FDA classification of drugs, especially many drug instructions on pregnant women with caution or disable these drugs. Because of vaginitis itself and drugs have a potential risk to the pregnancy, but in many cases, vaginitis disease on pregnancy risk is far greater than the potential risk of pregnancy drugs, in clinical practice, patients informed, choose whether treatment, treatment methods and regimens of [8].

Reference:

1 Cotch MF, Hillier SL, Gibbs RS, et al. and associated moderate to Candida colonization during Am J Obstet Gynecol, 1998178 (2): 374 - 380 - pregnancy[J]. (Epidemiology) heavy with

2 Czeizel AE, Rochenbauer M.A rate preterm after clotrimazole during Paediatr perinat Epidemiol pregnancy[J]., 1999, 13 (1): 58-64. lower (therapy) birth

3.Kirkham C, Harris S, Grzybowski S. prenatal Third-trimester and prevention infectious diseases[J].Am Fam Physician, 2005,71 (8): 1555-1560. Evidence-based (of) care

4.Goldenberg RL, Klebanoff MA, Nugent R, et al. colonization the during pregnancy four groups[J]. Am J Obstet Gynecol, 1996, 174 (5): 1618 - 1621 (Bacterial) vagina (ethnic) in

5 fan Peng. Bacterial vaginosis. See Cao Zeyi. Chinese Journal of Obstetrics and gynecology (Second Edition) [M], people's Medical Publishing House, 20041352-1358.

6 Fan Gang, Liu Xiaoping. Research progress of bacterial vaginosis [J]. Chinese Journal of Obstetrics and Gynecology, 2006, 7 (3):224-226.

7 Fan Shangrong, Liu Xiaoping. Etiology of premature labor [J]. Chinese Journal of general medicine, 2007, 10 (4):263-265.

8 CDC. Sexually diseases guideline 2006[J].MMWR, 2006, 55 (RR-11): 1-94. transmitted (treatment)

9 Ugwumadu A, Manyonda I, Reid F, et al.Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis:a randomised controlled trial[J].Lancet, 2003, 361 (9362): 983-988.

10 Kiss H, Petricevic L, Husslein P.Prospective controlled of infection screening to reduce rate of preterm delivery[J].BMJ, 2004329 (7462): 371-374. randomised (programme), the an

11.Kekki M, Kurki T, Kotomaki T, et al.Cost-effectiveness of screening and treatment for bacterial vaginosis in early pregnancy among women at low risk for preterm birth[J].Acta Obstet Gynecol Scand, 2004,83 (1): 27-36.

                                                                                           

 

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