The influence of the coronavirus disease transmitted during pregnancy on the course of gestation and changes in the main biotopes of a woman’s organism

Abstract

The article presents literature data on the peculiarities of the pregnancy course and changes in the main biotopes in women who suffered from COVID-19 in different periods of gestation. Certain regularities regarding the association of perinatal complications with the severity of the disease, the presence of somatic and gynecological pathology in these pregnant women, in particular, obesity and chronic inflammatory diseases of the genital organs, were observed.According to research conducted on the basis of the department of pathology of pregnancy and childbirth of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after academician O. M. Lukyanova of the National Academy of Sciences of Ukraine», the risk group of a severe course of the coronavirus disease includes all the same factors as for any other diseases, not related to pregnancy: age over 35 years; the presence of concomitant pathology (diabetes, obesity, hypertension), work, lifestyle or housing conditions that increase the risk of infection. More frequent manifestations of obstetric pathology were found in older women and primipara women.Complicated obstetric anamnesis, namely, medical abortions and miscarriages, cervical pathology, previous inflammatory diseases, especially of the genital organs, are considered to be risk factors. The course of pregnancy and childbirth are accompanied by such complications as the threat of early miscarriage; anemia; combination of placental dysfunction, polyhydramnios and fetal distress; anomalies uterine activity, which increases the frequency of pathological childbirth in this contingent of women and requires repeated hospitalization during pregnancy.A review of scientific publications in recent years demonstrates the significant impact of COVID-19 on the composition of biotopes of the human organism. There are convincing data on the close relationship between the infection of the mucous membranes of the upper respiratory tract and the infection of the lungs with the SARS-CoV-2 virus. Lung hypoxia, typical for this infection, causes the growth of anaerobes and facultative anaerobes, which are part of the mentioned microbiomes during a person’s life. A significant number of observations have found the correlation of changes in the microbiocenosis of the respiratory tract and intestines in patients with SARS-CoV-2 and convalescents. At the same time, there is also a disorder in the vaginal microbiocenosis after the coronavirus disease, especially during pregnancy. A conclusion was made regarding the correlation between the severity of COVID-19 course and the number of lactobacilli in the vaginal biotope: the more severe course, the worse of the microflora composition. The gestation period is more often complicated by the threat of early pregnancy loss, placental dysfunction, polyhydramnios, fetal distress, and the threat of premature birth in those women who suffered a coronavirus infection in the I trimester. A large rate of polyhydramnios in most cases indicates the risk of intrauterine infection, so such women should be carefully monitored both for the impact of COVID-19 and for the activation of latent infections in the background of reduced immunity and, first of all, violations of the vaginal biotope. At the same time, a high frequency of obesity was found among these women, which worsens the course of infectious processes and the condition of the main biotopes.Therefore, for this contingent of women, the issue of timely detection and correction of violations of the genital tract microbiocenosis as a prevention of perinatal and obstetric complications becomes relevant. In order to avoid the negative impact of changes in the vaginal microbiocenosis on the condition of a woman and her child in the future, modern universal and safe preparations during pregnancy and lactation should be used for local treatment and strengthening of regenerative processes, which do not contain an antibacterial component, do not cause antibiotic resistance and are effective, available and convenient to use. The clinical experience of recent years allows to recommend for wide use in obstetrics and gynecology the complex safe and effective local preparations, which include chlorhexidine, chlorophyllipt and preparations with hyaluronic acid and plant extracts.