Hypothesis/aims of study. Miscarriage is a significant medical and social problem. The etiology of pregnancy losses is diverse and depends on many factors. It is believed that dysbiotic disorders of the vagina are one of the main causes of this pathology. While the etiopathogenesis of miscarriage is actively studied, many questions still remain open. The aim of the study was to investigate anamnestic and microbiological predictor factors of miscarriage. Study design, materials, and methods. In a prospective cohort study, 159 pregnant women were examined in the first trimester of pregnancy: the anamnesis, course of pregnancy, vaginal microflora, and present pregnancy outcome were studied. The vaginal microflora was analyzed using microscopic, bacteriological and quantitative real-time PCR methods. Depending on the present pregnancy outcome, the patients were divided into two groups: those delivered at term and women with early and late miscarriage. The analysis of predictors of miscarriage of the ongoing pregnancy was performed depending on the period of delivery. Results. The rate of miscarriage in women was 13%. The independent predictors of early miscarriage were chronic endometritis (OR 10.54; 95% CI 2.54 to 43.64), the dominance of Lactobacillus iners in the vaginal microflora (OR 8.52; 95% CI 2.07 to 35.05), and the prevalence of non-Lactobacillus species in microscopy of vaginal preparations (OR 4.50; 95% CI 1.02 to 19.69). The dominance of Lactobacillus crispatus was a significant protective factor of late miscarriage (OR 0.20; 95% CI 0.04 to 0.99). Conclusion. The undertaken analysis revealed significant associations of a number of anamnestic and microbiological predictor factors with miscarriage, which will enable to substantiate approaches for predicting pregnancy outcomes at different gestational age and to develop methods of pre-conception care and treatment in women with different risk of miscarriage.

Hypothesis/aims of study. Dysbiotic disorders of the vagina are one of the main risk factors of miscarriage. The analysis of vaginal microbiota during pregnancy in women having a history of miscarriage may contribute to understanding the importance of specific types of vaginal flora in the development of processes resulting in spontaneous abortion or preterm birth. This study was undertaken to evaluate the vaginal flora in the 1st trimester of pregnancy in women having a history of miscarriage. Study design, materials, and methods. To participate in the study, 160 individuals in the 1st trimester of pregnancy with and without a history of miscarriage were invited. Group 1 included 100 women with a history of miscarriage, group 2 consisted of 60 women without a history of miscarriage. The vaginal flora was analyzed with microscopic, bacteriological, and quantitative real-time PCR methods. Results. In patients with a history of miscarriage, the frequency of dysbiotic disorders of the vaginal flora was three times higher (11.0% and 3.3%) and pH value of the vaginal fluid was significantly higher. Along with a significant reduction of the proportion of the Lactobacillus flora in the 1st trimester of pregnancy in patients having a history of miscarriage, there was a significant increase in the abundance of opportunistic microorganisms, mostly aerobic flora, such as Enterobacteriaceae, Streptococcus spp., and Staphylococcus spp. Furthermore, there was a significant predominance of Ureaplasma spp. and Candida spp. in women with a miscarriage history. Conclusion. The vaginal microbiota in the 1st trimester of pregnancy in women having a history of miscarriage is characterized by higher pH values of the vaginal fluid, the prevalence of opportunistic microorganisms, a decrease in the abundance of the Lactobacillus flora, and a higher concentration of aerobic bacteria, Ureaplasma spp., and Candida spp. These findings indicate dysbiotic disorders of the vaginal microbiocenosis in women having a history of miscarriage, which can lead to late miscarriage and pretem birth.

Hypothesis/Aims of study. Premature birth in multiple pregnancies remains an important object of research, since it is the main factor in poor perinatal outcomes, and their heterogeneous mechanisms determine the ineffectiveness of prediction and prevention methods. In the pathogenesis of premature birth, as is known, one of the leading links is inflammation caused by infections of the lower genital tract (40%). In multiple pregnancies, which in most cases occur as a result of assisted reproductive technology treatment (70%) and are mainly accompanied by complications, pregravid preparation and antenatal observation include more careful control and correction of local infectious and inflammatory processes. In this regard, the persisting high rate of premature birth in multiple pregnancies (about 54%) demonstrates the ambiguity of the opinion about the suppressive role of the infectious factor in the induction of premature birth and determines the need for studying its contribution to multifactorial genesis. The aim of this study was to conduct an integral assessment of markers of the local infectious and inflammatory process in women with PB in multiple pregnancies. Study design, materials and methods. We performed a comprehensive study of the bacteriological composition of the lower genital tract discharge using microscopic, bacteriological, and molecular biological methods (Femoflor 16 test) and assessed the local inflammatory status (ImmunoQuantex test) in 30 pregnant women with dichorionic diamniotic twins. The main group consisted of women with premature birth (n = 13), the control group comprising those with term birth (n = 16), while patients with induced premature birth (n = 2) were not included in the comparative analysis. Results. This study was the first to determine the features of vaginal microbiocenosis and the local immune status in women with premature birth in multiple pregnancies. In general, the study cohort had a low inflammatory status and normal or intermediate types of vaginal biotope. The most common disruptions (24.1%) were vaginal dysbiosis, expressed in a small amount of Lactobacillius spp., and non-specific vaginitis associated with Mycoplasma hominis. The local immune status of women with premature birth was characterized by a relative decrease in the mRNA expression of such innate immunity genes as IL1B, TNF, TLR4, and GATA3. An integrated assessment of the studied parameters based on the data obtained allowed us to build a mathematical model for predicting premature birth with the probability of 87.6%. Conclusion. The integral assessment of infectious and inflammatory markers is important from the standpoint of not only their possible identification as predictors, but also a general understanding of the genesis of premature birth.