Ureaplasma during pregnancy what to do. Ureaplasma and ureaplasmosis in pregnant women

Ureaplasma belongs to conditionally pathogenic microorganisms. It gets to the vaginal mucosa from a carrier partner sexually, and long time may not make itself felt, being in a latent state. Very often, it is pregnancy that becomes the influencing factor that provokes the development of ureaplasmosis. How dangerous is the disease for future mother and the fetus? What are the symptoms? And how is an infection treated during pregnancy?

What is ureaplasmosis

More than thirty types of microorganisms are present on the vaginal mucosa. Most of them are beneficial lactobacilli, which form the basis of the normal flora of the female genital organs. The active development of pathogenic and conditionally pathogenic microflora is observed when, for some reason, the protective functions weaken immune system.

Ureaplasmosis is an infectious disease caused by the bacterium ureaplasma. Its constant presence on the mucous membranes of a healthy woman is uncharacteristic - the bacillus is referred to as a transistor microflora of the human genitourinary system. The infection enters the body mainly through sexual contact and develops on the mucous membrane of the internal genital organs.

The bacterium ureaplasma belongs to the conditionally pathogenic microflora of the mucous membranes, which means that it provokes inflammation only with weakened local immunity

About half of the women and men on the planet are infected with this bacillus. Inflammation of the mucous membrane of ureaplasma causes when the balance of the vaginal microflora is disturbed.

And this happens:

with concomitant infection - infection of the mucous membrane with other pathogens (gardnerella, chlamydia, fungi of the genus Candida) changes the ratio of beneficial and pathogenic bacteria, which entails the development of inflammation;
with a weakening of immunity, including against the background of pregnancy;
with frequent colds and hypothermia;
with active sexual activity and frequent washing (douching);
with chronic fatigue, exhaustion of the body, after stress.

In scientific circles, to this day there is debate about the classification and pathogenicity of ureaplasma. The question of the influence of these microorganisms on the bearing of pregnancy also remains open.

Characteristics of the pathogen

Ureaplasma parvum and Ureaplasma urealyticum are the smallest specific bacteria, in the classification of microorganisms they occupy an intermediate position between unicellular microbes and viruses. They belong to mycoplasmas (Mycoplasmataceae), but are distinguished into a separate genus due to their ability to break down urea to ammonia.

Ureaplasmosis is diagnosed when the concentration of bacteria in a smear on the flora significantly exceeds the permissible norm. The presence of ureaplasma on the vaginal mucosa within the normal range is an indicator not of a disease, but only of infection. At the same time, a woman is a carrier of the infection and can infect her sexual partner.

Against the background of active reproduction of ureaplasma, inflammation of the mucous membrane of the internal genital organs develops, which is reflected in the indicators of the urogenital smear: it will reveal an increased content of leukocytes - immune blood cells that are designed to fight the inflammatory process.

Ureaplasma infection occurs mainly with unprotected intercourse

Ways of entry of bacteria into the body

Ureaplasma infection in the vast majority of cases occurs through sexual contact - with unprotected sexual intercourse. Moreover, oral sex can also cause infection, but in this case, the mucous membrane of the oropharynx will become the site of infection.

Domestic methods of transmission of the pathogen, when pathogens get on the mucous membranes while visiting a bath or swimming pool, public toilet, swimming in open water, etc., are unlikely. It is extremely rare to find cases of infection with the bacillus through personal items.

During pregnancy, there can be several ways of transmitting ureaplasma infection from mother to child.

Ascending or vertical. From the vagina, the ureaplasma vertically spreads into the cervical canal, uterus, and appendages. Then, through the amniotic sac, bacteria penetrate into amniotic fluid and the lungs of the embryo. Infection in this way occurs more often on early dates.
Transplacental pathway. When bacteria enter the placenta from the mother's systemic circulation. In theory, this can happen at any stage of pregnancy.
Intrapartum transmission of infection to the fetus. In the presence of ureaplasma in the mother's vagina, it is implemented much more often than previous methods. The mucous membranes of the child become infected during childbirth - during the passage of the birth canal.

The penetration of ureaplasma to the fetus by the ascending and transplacental pathways is very rare. After the birth of the child, a complete examination is carried out, including the presence of ureaplasma infection on the mucous membranes of the newborn (genitals, nasopharynx, respiratory tract), upon detection of which treatment is prescribed immediately.

Intrauterine infection of the fetus most often occurs when a woman becomes infected with ureaplasma during gestation.

Video: when to treat ureaplasmosis - Dr. Komarovsky and gynecologist Sergey Baksheev

Infection and pregnancy

After numerous studies, scientists have come to the conclusion that ureaplasma may well cause miscarriage and fetal pathologies. And the impetus for the multiplication of bacteria on the mucous membranes is often precisely the conception and development of the child in the mother's womb.

The weakening of immunity during pregnancy is a physiological phenomenon. The protective functions of the immune system must not interfere with implantation fetal egg into the wall of the uterus. But just at this time, the ureaplasma, which was previously in a state of remission, can begin to actively develop, causing inflammation of the mucous membranes. It is important to cure ureaplasmosis in the expectant mother at the stage of pregnancy planning or before delivery. This will significantly reduce the risk of infection of the baby during childbirth and prevent deeper infection of the woman.

Ureaplasma in the early stages becomes the cause of the development of chorioamnionitis (inflammation of the membranes of the fetus), bronchopulmonary dysplasia in the fetus. In the first trimester of pregnancy, with acute infection and the development of inflammation, the formation of the embryo may stop and its intrauterine death may occur. Then a missed pregnancy is diagnosed.

In the second and third trimesters, against the background of inflammation caused by ureaplasma, and deep infection of the mother's body, the cervix becomes loose, and the external pharynx softens and opens. Why the expulsion of the fetus from the uterus begins prematurely - premature birth.

Against the background of ureaplasmosis, fetaplacental insufficiency develops - deficiency nutrients and oxygen from the placenta to the fetus. Why the child has intrauterine growth retardation, he is born prematurely - weak, "immature", with low weight. During childbirth, the baby passes through the birth canal, the mucous membranes of which are infected with ureaplasma. If the child has not been infected in utero, the bacillus gets to him during childbirth.

When a newborn is infected intranatally, ureaplasma can affect not only mucous membranes, but also enter the bloodstream, provoking the development of a generalized infection in an infant - meningitis, pyelonephritis, pneumonia, sepsis. In the postpartum period, ureaplasmosis causes endometriosis in the mother (inflammation of the uterine lining), salpingo-oophoritis (chronic inflammation of the appendages, with an ascending infection), which in the future leads to infertility or the onset of ectopic pregnancy.

Infection with ureaplasma during gestation (or detection of an infection after conception) is not a reason for terminating it. Timely diagnosis and a properly developed treatment strategy will help a woman to bear and give birth to a completely healthy baby.

Video: ureaplasma, its effect on pregnancy and fetus - expert opinion

Types and symptoms of the disease

Referring to opportunistic microorganisms, ureaplasma, after penetrating the mucous membranes, may not manifest itself at all for a long time or give out very weak symptoms. Often it is found during the planned delivery of a smear for microflora, and the woman herself does not even suspect that she is a carrier of the infection. The incubation period after infection with ureaplasma lasts 4 weeks.

Then you may see:

vaginal discharge - mucous, transparent or whitish, not very abundant (and more often in the morning), and therefore, in most cases, remains unnoticed;
itching and burning of the external genital organs - these sensations are the result of the irritating effect on the skin of vaginal discharge;
cramps during urination - this symptom appears more often in men, but it also occurs in women;
a feeling of discomfort during intercourse - the ureaplasma developing on the mucous membrane of the genital organs cause its inflammation, swelling and increased sensitivity to mechanical stimuli;
minor pains in the lower abdomen are precursors of an incipient inflammatory process;
rarely, an increase in body temperature and signs of intoxication of the body with waste products of pathogenic microflora.

Just a few days later, the manifestations of the disease gradually weaken, and the infection settles on the mucous membrane in anticipation of conditions favorable for its development - first of all, a weakening of local immunity. It may take several years before the next relapse.

The symptoms of ureaplasmosis differ depending on individual characteristics the woman's body, the stage of its development (acute, recurrent), location, complications of the course of the disease and concomitant infections. If the mucous membranes of the oropharynx are affected by ureaplasma, the bacteria cause sore throat, which is accompanied by all its characteristic signs - redness and swelling, pain when swallowing, an increase in body temperature, and if a secondary infection joins, then a purulent plaque.

With damage to the mucous membranes of the genitourinary system, the symptoms will differ as the infection spreads from the vagina to the uterus, bladder, and kidneys.

Ureaplasmas can cause inflammation of the vaginal mucosa - colpitis (vaginitis). Symptoms of this pathology are redness and swelling of the vaginal mucosa, itching, discomfort, mucous membranes or bloody issues, pain during sexual intercourse.
Getting from the vagina into the uterus, the infection causes inflammation of its walls - endometritis (after childbirth). Then the woman has severe pains in the lower abdomen, fever, foul-smelling discharge, signs of intoxication.
The inflammatory process caused by ureaplasma in the urethra and bladder has characteristic signs urethritis and cystitis - frequent urge to urination, itching and cramps when passing urine, discharge from the urethra, redness of the urethra.
From the bladder, bacilli enter the kidneys, causing inflammation of the parenchyma and pelvis - pyelonephritis (rare). Its manifestations are lower back pain, impaired outflow of urine from the kidneys, increased blood pressure, edema.

The longer the infection is in the body and the further (deeper) it penetrates, the worse it responds to treatment and the more complications it causes. Even being in a latent state, without exacerbation, ureaplasma creates a favorable background for the development of other pathogens.

Weak on initial stages the symptomatology does not force an infected woman to see a doctor. As a result, the disease is diagnosed already when inflammatory process, summoned by him, is in full swing.

It is necessary to treat ureaplasma during pregnancy only when characteristic symptoms of inflammation of the mucous membranes of the internal genital organs appear

Diagnostics

In Russia today, all pregnant women, without exception, are not examined for ureaplasmosis. Analyzes are prescribed for women who have a history (medical history) of premature birth or miscarriage, and also if the attending physician, when examining the expectant mother, suspects that she is infected with ureaplasma (taking into account the symptoms).

At the stage of pregnancy planning, it is recommended that both spouses be tested for ureaplasma. Laboratory studies of biomaterial taken from the mucous membranes of the internal genital organs - a smear on the flora, to detect the bacterial DNA, a polymerase chain reaction is carried out to detect the bacterial DNA, blood is donated from a vein to detect the infection, determine the degree of infection and the sensitivity of bacilli to antibiotics. The most reliable results will be different types studies, the combination of which is chosen by the doctor.

PCR method

The polymerase chain reaction reveals the presence of ureaplasma DNA on the mucous membranes of the internal genital organs. For the study, samples of mucus (smears) are taken from the vagina, cervical and urethra. After 5 hours, conclusions can be drawn about the infection.

However, the degree of development of pathogenic microflora and its sensitivity to antibiotics cannot be determined by this method. The effectiveness of the treatment of ureaplasmosis also cannot be assessed using PCR, since for another 2-3 weeks after therapy, traces of the pathogen's DNA may remain on the mucous membranes.
Bacteriological culture allows you to determine the degree of activity of ureaplasma and make an antibioticogram

Culture method or bacteriological culture

For laboratory research, morning urine is collected, and a urogenital smear is also done - the biomaterial is taken from the mucous membrane of the vaginal vaults, cervical canal and urethra. The collected samples are placed in an artificial nutrient medium (each separately), where microflora develops within 48 hours.

10⁵ bacteria in the field of view under a microscope - the norm of the content of ureaplasma in a smear, if this number is much higher, ureaplasmosis is diagnosed. Bacterial culture allows you to determine the degree of infection activity, the location of the inflammatory process caused by ureaplasma, and the sensitivity of pathogens to antibiotics. Based on the results of the analysis, the doctor selects the most appropriate drugs for the treatment of the disease. In addition, with the help of cultural analysis, it is possible to track the effectiveness of therapy over time.

Detection of antibodies in the blood or serological method

To determine the presence of antibodies to the ureaplasma antigen in the body, blood is donated from a vein for analysis. The characteristic structures of bacteria in the blood are identified to diagnose the causes of miscarriage, infertility in women, as well as the development of inflammatory diseases of the reproductive and urinary systems in the postpartum period.

The serological method is used to diagnose relapses of the disease. Control of the cure of ureaplasmosis is carried out after the end of treatment - 2-3 weeks later - by the culture method and using PCR.

How to treat ureaplasmosis in a future mother

In the absence of serious complications and the threat of termination of pregnancy in the early stages, the diagnosed ureaplasmosis in the expectant mother begins to be treated after 20 weeks, when the fetal organs are already fully formed. Since in most cases, a baby is infected with ureaplasma during delivery, ureaplasma should be treated before the onset of labor.

Many doctors consider it advisable to start treatment of ureaplasmosis at 30 weeks (with a successful pregnancy). Then the risks of infection of the child while passing through the birth canal will be minimal. If there is a threat of miscarriage or complications of the course of pregnancy develop, treatment of ureaplasmosis begins immediately, regardless of the duration of pregnancy.

Therapy of the disease necessarily includes antibacterial agents, which in the first trimester can cause disturbances in the development of the embryo. In parallel, treatment is prescribed for the spouse ( sexual partner) women. It is recommended to refrain from sexual intercourse during the course of therapeutic measures. With the threat of termination of pregnancy due to a progressive ureaplasma infection in the early stages, treatment begins immediately.

Therapy of ureaplasmosis in pregnant women is always complex, it can be carried out in a hospital or on an outpatient basis, with the obligatory regular monitoring of its effectiveness. The doctor selects drugs individually, depending on the history, gestational age, stage and location of the disease.
If the treatment of ureaplasmosis during pregnancy is necessary, it is started no earlier than 20 and no later than 30 weeks of the period

Treatment involves the use of:

antibiotics - fluoroquinolones, macrolides (Erythromycin,) - to combat ureaplasma infection;
preparations for restoring the microflora of the intestinal mucosa and vagina - Linex, Lacidophil, Bifidumbacterin - antibiotics kill not only pathogenic bacteria, but also useful ones, disrupting the balance of microorganisms, therefore, the mucous membranes have to be populated with useful lactobacilli to restore their protective function;
vaginal suppositories - Geksikona, Terzhinan, Livarola - for the treatment and prevention of the development of secondary infection;
immunomodulators - Viferon, Interferon - to enhance the immune response to the development of pathogenic microflora in the body;
medicines to improve placental blood flow - Magne B6 or iron preparations - in order to increase the delivery of nutrients and oxygen to the fetus to normalize growth and development processes;
vitamin complexes - for overall strengthening the body of the expectant mother and get well soon- Elevit Pronatal, Vitrum Prenatal.

It is important to follow the prescribed regimen exactly and complete the course of treatment. The transferred ureaplasmosis does not form stable immunity, and therefore re-infection and development of the disease is possible. After antibiotic therapy, it is necessary to check whether the treatment was effective.

Table: medicines for treatment

Name of the drug	Pharmacological group	Active substance	Indications	Contraindications	Features of use during pregnancy
Macrolide antibiotic with bacteriostatic and bactericidal effect		Hypersensitivity to macrolide antibiotics, severe liver dysfunction	During pregnancy, it is used only as directed by a doctor, after a careful analysis of the balance of benefits and harms. Better after 20 weeks, when the organs of the fetus are formed. The course of treatment is 7-10 days (according to indications). The drug is recommended to be taken one hour before meals (or 2 hours after a meal) and washed down with a sufficient amount of liquid - 150-200 ml
Macrolide is an antibacterial agent for systemic use	Josamycin	Infections of the genitourinary system, including ureaplasmosis	Hypersensitivity to macrolides or other components of the drug, dysfunction of the liver and biliary tract	To date, there is no data on the embryotoxic effect of the drug, however, during pregnancy, it is recommended to use it only as directed by a doctor (after a thorough risk analysis) and preferably in the second half of the term. The tablets should be swallowed without chewing between meals and washed down with plenty of water. The course of treatment - up to 10 days
Combined preparation that contains three types of lyophilized viable lactic acid bacteria, which are part of the normal intestinal flora	Lactobacillus acidophilus, Bifidobacterium infantis, Enterococcus faecium	Dysbacteriosis of the intestines and mucous organs of the genitourinary system, including those caused by taking antibiotics - maintain and regulate the physiological balance of microflora	Hypersensitivity to drug components	Recommended to be taken with meals, but not washed down with hot drinks. To increase the effectiveness, the drug is taken 3 hours after taking antibiotics.
Means for restoring the microflora of mucous membranes, normalizing the activity of the gastrointestinal tract, which has immunomodulatory properties	Dried microbial mass of live bifidobacteria, which are part of the normal microflora of the intestine and mucous organs of the genitourinary system	Intestinal dysbiosis, including those caused by taking antibiotics, sanitation (elimination and prevention of diseases) of the female genital tract, prenatal preparation of pregnant women with violation of the purity of vaginal secretions	Individual intolerance to the components	The drug during pregnancy is used orally (inside in the form of a solution), as well as intravaginally (in the vagina - in the form of tampons soaked in a solution)
Hexicon (candles)	Antiseptic and disinfectant	Chlorhexidine	Prevention of sexually transmitted infections, including ureaplasmosis	Individual hypersensitivity to the components of the drug	During pregnancy, use only when the expected benefit to the mother outweighs the potential risk to the fetus
Livarol (candles)	Antimicrobial and antiseptic agent for use in gynecology	Ketoconazole	Prevention of fungal infections of the vagina with reduced resistance of the body and against the background of treatment with drugs that disrupt the normal microflora of the vagina	Increased individual sensitivity to components. If hypersensitivity reactions develop, the drug should be discontinued and a doctor should be consulted. Should not be used in the first trimester of pregnancy	In the II-III trimester of pregnancy, the drug should be used only when the expected benefit to the mother outweighs the potential risk to the fetus
Viferon (candles)	Complex immunostimulating drug	Recombinant human interferon alpha-2b, tocopherol acetate	Treatment and prevention of intrauterine and urogenital infections	Individual intolerance to the components of the drug	The use of suppositories is permissible from the 14th week of pregnancy
Complex of B vitamins with minerals	Magnesium lactate dihydrate, pyridoxine hydrochloride	Hypertonicity of the uterus during pregnancy, the threat of miscarriage, delayed fetal development	Hypersensitivity to drug components, severe renal failure	The simultaneous use of Magne B6 during pregnancy and iron or calcium-containing preparations reduces the absorption of each of them
Multivitamins with micronutrients for pregnant women	A complex of vitamins and minerals necessary for the normal course of pregnancy	Prevention of vitamin and mineral deficiency in women during pregnancy	Hypersensitivity to the components of the drug, hypervitaminosis, impaired renal function, stomach ulcer (duodenal ulcer)	The duration of use and dosage is determined by the doctor individually. Do not exceed the recommended dose! A dose of vitamin A greater than 10,000 IU may have teratogenic effects on the fetus.

Control over the cure of ureaplasmosis in pregnant women is carried out:

with the help of the cultural diagnostic method - on the 7-8th day after the end of the antibiotic intake;
by means of polymerase chain reaction - 2-3 weeks after treatment.

In order to prevent the growth of bacteria on mucous membranes from the 14th week of pregnancy, the doctor may prescribe Viferon suppositories to a pregnant woman. Possessing immunostimulating properties, they prevent intrauterine infection of the fetus. That creates the preconditions for the birth of a healthy, strong baby, even with ureaplasma found in the mother.

Photo gallery: medicines used in the complex therapy of ureaplasmosis in expectant mothers

Linex - a complex remedy for restoring the normal microflora of the intestinal mucosa and internal genital organs Bifidumbacterin - normalizes the microflora of the intestinal mucosa and vagina during antibacterial therapy Erythromycin - an antibiotic approved for use for the treatment of ureaplasmosis during pregnancy Magne B6 - soothes, relaxes, relieves the tone of the muscles of the uterus prevents termination of pregnancy, improves placental blood flow and the supply of the fetus with useful substances Geksikon - used in the complex therapy of ureaplasmosis for the local treatment of infection Livarol - suppositories prescribed for the prevention of secondary infection with ureaplasmosis Viferon - a preparation of human interferon, an immunomodulatory agent Vilprafen - an antibiotic that is prescribed to pregnant women for the treatment of ureaplasmosis - Vitrum vitamins and minerals for pregnant women, strengthening the immune system and accelerating recovery

Most women know that they need to get tested for STIs and visit a gynecologist at least once a year. But not everyone does it. Even before conception, not all girls are examined. In this case, the chances of getting a "clean" smear during pregnancy are reduced.

In smears in women during gestation, a very different (both conditionally pathogenic and frankly pathogenic) microflora is found, including ureaplasma. Ureaplasma during pregnancy is diagnosed in more than 70% of cases. How dangerous is the detection of this microorganism in women carrying a child? And is it necessary to treat a pregnant woman who has these bacteria?

Ureaplasma and ureaplasmosis

In the human body, there are two types of these microorganisms: urealiticum and parvum. Both belong to the category of conditionally pathogenic, that is, they are able to peacefully coexist with the natural microflora of the vagina, and only under certain conditions cause an inflammatory disease - ureaplasmosis.

The risk of developing this ailment in women are subject to:

Vagina.
Appendages.
Uterus.

A microorganism called ureaplasma urealiticum is responsible for the development of ureaplasmosis. It is he who most often leads to unpleasant symptoms of the disease. However, the detection of a small amount of ureaplasma in a smear is not considered ureaplasmosis.

This diagnosis is made only when inflammation of the genital organs is found in a woman and other opportunistic or pathogenic microorganisms have not been identified.

Ureaplasmosis, as an independent disease, is rare. Most often (in about 80% of cases), mix infections (combined growth of colonies of opportunistic and pathogenic pathogens: gonococci, Trichomonas, gardnerella, etc.) lead to inflammatory processes of the urogenital tract. Such communities of microorganisms make the vaginal environment more suitable for the development of anaerobic flora and inhibit the growth of Dederlein rods.

Whether to treat ureaplasma?

This microorganism in biological science has caused a lot of controversy and continues to cause. It was referred to as mycoplasma and was isolated into a separate group. The disease caused by ureaplasma was classified as venereal and was excluded from this group. The number of microorganisms found in the smear, which is considered normal, is constantly being reviewed.

To date, the treatment of ureaplasma is carried out only in two cases:

If pregnancy is planned.
And if there are signs of inflammation of the reproductive organs.

In all other cases, modern medical trends do not provide for the adoption of therapeutic measures. It is recommended only to periodically monitor the growth of colonies of these bacteria using analyzes.

The microorganism can live for years in the human body without disturbing the biocenosis. It is necessary to control the number of bacteria because ureaplasmosis (an inflammatory process provoked by ureaplasma) can proceed latently, with minimal symptoms. And, as a result, it is diagnosed already at the stage of development of complications.

Transmission routes

The routes of transmission of infection include:

Sexual (main).
Household (when using underwear and towels of a sick person).
Intrauterine (through amniotic fluid infected with bacteria).
During childbirth (when the fetus passes through birth canal women contaminated with microorganisms).

Ureaplasma is detected most often in patients from 14 to 30 years old. This is the age of increased sexual activity, so the main route of transmission of infection is used with particular ease. The situation is aggravated by early sexual experience and promiscuous relationships.

Symptoms

Ureaplasmosis during pregnancy does not differ symptomatically from the manifestations of this disease outside of gestation. The symptoms, unfortunately, are not specific, they bother the patient with colpitis (vaginitis), vulvovaginitis or cervicitis of any etiology. Patients complain about:

Pain during sexual intercourse.
Pain in the lower abdomen.
Frequent and painful urination.
Itching and burning varying degrees intensity.

Similar signs appear only in acute ureaplasmosis, when the number of bacteria reaches enormous levels, and lactobacilli becomes much less than the norm. More often, the disease is asymptomatic, in a chronic form.

Ureaplasma and pregnancy

Treatment of ureaplasma during pregnancy is complicated by the fact that many medications are not recommended for admission. And the treatment can be carried out with permitted means only after 20 weeks of gestation.

Ureaplasma does not belong to the category of especially dangerous microorganisms, nevertheless, its presence in the body can complicate the course of pregnancy, affect the condition and development of the fetus. Therefore, if the biocenosis of the vagina is "enriched" with this microorganism, it is recommended to be treated before conception.

The natural decrease in immunity during pregnancy and the high content of hormones that support pregnancy in the blood lead to the fact that the peaceful neighborhood of conditionally pathogenic bacteria and Dederlein sticks ends. It is pregnancy that is one of the factors leading to an exacerbation of ureaplasmosis.

Many women aspiring to become mothers ask whether pregnancy is possible with ureaplasma. The microorganism itself does not interfere with conception in any way. Untreated ureaplasmosis entails the same changes as the inflammatory process of any other etiology (adhesions of the mucous lining of the uterus and its cervix, disorders of the endometrial layer, etc.). Indirectly, such conditions can affect the ability to conceive.

Regardless of the fact that it is possible to conceive a child even with ureaplasmosis, experts advise to be treated before pregnancy in order to exclude the consequences of the negative influence of microorganisms on the gestation processes and the fetus.

Danger

Why is it that a microorganism that lives peacefully on the mucous membranes of the urogenital tract can be dangerous? How does ureaplasma affect pregnancy, and how is the microorganism dangerous for a child growing in the womb?

The main threat to developing pregnancy:

Spontaneous interruption.
The birth of small and premature babies.

Ureaplasma during pregnancy for the fetus is threatened:

Infection of the membranes and placenta. This leads to hypoxia and related problems (retardation of development, tissue formation defects).
Seeding during childbirth. This can cause damage by microorganisms to the gastrointestinal tract, conjunctiva and respiratory system of the child. SARS may develop within a month after giving birth.
If the baby becomes infected during childbirth, the urogenital tract of the newborn may be affected. The genitals are more commonly affected in girls.
Influence intrauterine infection after birth, it most often manifests itself in pathologies of the central nervous system. Such children suffer from headaches, they are diagnosed with hyperactivity syndrome, in adolescence they are prone to dystonia and instability nervous system.

Considering possible complications, it is necessary to treat the disease in the gestational period.

If ureaplasma urealiticum is found in smears in a woman during pregnancy, this is considered more dangerous. But ureaplasma parvum during pregnancy is also subject to treatment.

Ureaplasmosis, as a disease, is not well understood in terms of its effect on the mother and fetus. Therefore, doctors tirelessly remind that it is imperative to treat this disease while carrying a baby.

Diagnostics and treatment

Ureaplasma during pregnancy is diagnosed using the same methods as outside of gestation. The main methods are:

Bacterial sowing.
Detection of antibodies to the pathogen.

The most popular is PCR. But to determine quantitative characteristics (the number of microorganisms) and track the effectiveness of treatment, it is better to use bacterial culture.

Therapy for any sexually transmitted disease requires treatment for both partners. Otherwise, the whole process is meaningless. Time of gestation is no exception to this rule. Treatment of ureaplasma during pregnancy can be started from 20-22 weeks.

For the purpose of therapy, several groups of drugs are prescribed:

Antibacterial agents.
Vitamin preparations.
Immunostimulating and immunomodulating drugs.
Means for restoring normal vaginal biocenosis.

Of the antibiotic drugs that are allowed for pregnant women, and to which these microorganisms are sensitive, macrolides (Erythromycin) are most often used. During therapy, women are advised to follow a diet with a predominance of lactic acid products and plant foods.

The therapeutic course lasts 14 days. Ureaplasma during pregnancy is considered to be successfully cured if the smear remains "clean" 2-3 months after treatment.

Self-treatment of the disease, especially during gestation, is inappropriate. Refusal of treatment can lead to the consequences described above.

Pregnancy often causes a weakening of the immunity of the expectant mother. Discovered can have the most tragic consequences for a child. What is the danger of ureaplasma infection and how it affects the course of pregnancy, we will consider below.

The causative agents of ureaplasmosis

Pregnancy is often a provoking factor for the exacerbation of chronic diseases and the activation of facultative microflora, which in turn causes the appearance of new diseases that have a negative effect on the fetus. One of these infections is ureaplasmosis:

The mechanism of development of the disease

The main cause of infection is neglect of barrier contraceptives during sexual intercourse. In this case, the source of the pathogen is the carrier of ureaplasma, who is asymptomatic. Infection is possible through contaminated household items.

Ureaplasmas can exist for a long time on the surface of the mucous membrane of the vagina and urethra. Since the rearrangement of the hormonal background during pregnancy often leads to a change in the reaction of the environment on the surface of the epithelium, which negatively affects the obligate microflora that populates the surface of the mucous membranes, and destroys the local protective barrier. This promotes the penetration of ureaplasmas and reproduction in epithelial cells.

Pathological reproduction and accumulation of the pathogen in cells causes inflammatory processes in the vagina, on the surface of the cervix and in the urethra, which are called "ureaplasmosis". Against the background of pathological multiplication of pathogen cells, diseases such as cystitis, urethritis, pyelonephritis can develop, and what is most dangerous for a pregnant woman:

Often, ureaplasmosis accompanies infections such as gonorrhea and chlamydia. A complication of ureaplasma infection can be:

arthritis;
infertility;
spontaneous termination of pregnancy;
infection of the fetus in the womb.

Most often, the accumulation of the pathogen is asymptomatic and is detected only during routine examinations of pregnant women. Clinical manifestations ureaplasmosis is typical for all STDs:

burning;
pain when urinating;
aching pains in the genital area;
colorless discharge.

Availability clinical picture is the reason for additional examination for ureaplasmosis: smear microscopy, polymerase chain reaction, enzyme immunoassay and bacterial inoculation on selective media. As a result of the tests, the serotype of the pathogen, the degree of infection and the sensitivity of pathogens to antibiotics are revealed.

Influence on the course of pregnancy and the fetus

The vertical route of infection from mother to fetus can cause miscarriage, premature birth and intrauterine infection child.

In this case, the infection ascends to the fetus vertically - from the vaginal mucosa through the cervical canal into the uterus and ovaries.

In the early stages of pregnancy, ureaplasma penetrates the amniotic fluid through the amniotic membrane and affects the child. In the first weeks of pregnancy, the embryo may freeze - "miscarriage". In this case, the infection affects the process of fetal formation and leads to a cessation of its development and subsequent death. An infectious agent is dangerous and the possibility, although quite rare, to infect the lungs of the embryo, which subsequently leads to the development of broncho-pulmonary dysplasia - a chronic disease of the lungs and respiratory failure.

Ureaplasmosis is dangerous and for more later dates pregnancy - the infectious agent penetrates through the placenta. It is worth noting that such an effect on the fetus of ureaplasma is quite rare.

Ureaplasma and a frozen pregnancy are associated, usually through an inflammatory process. Salpingitis, endometritis, oophoritis - any of these diseases can cause the development of placental insufficiency, which in turn can cause miscarriage or premature delivery. This pathological condition leads to an insufficient supply of oxygen and nutrients to the fetus.

The embryo lags behind in development, does not gain the required mass and is born prematurely. This is facilitated by the fact that the causative agent of the infection affects the density of the cervix. Its tissues become too loose, and the external pharynx softens and opens, which leads to spontaneous premature expulsion of the fetus. These are the most frequently reported complications of ureaplasmosis.

Infection of the fetus during childbirth

Most often, the infection of a child occurs during childbirth through the mucous membranes of the respiratory tract and urinary tract. This is the so-called intranatal route of infection. The pathogen is especially dangerous for the nervous system, which has a common origin with epithelial cells. In this case, the development of meningitis is possible. Ureaplasma can also cause pyelonephritis, pneumonia and even generalized sepsis in a newborn baby. Most often, cases of infection in premature babies or newborns with insufficient body weight and a low assessment of the general condition are recorded.

If the disease was asymptomatic during pregnancy, in the postpartum period due to physiological damage to the epithelium of the uterus during childbirth, an exacerbation of infection and the development of endometritis are possible.

Chronic salpingo-oophoritis (inflammation of the ovaries and fallopian tubes) is dangerous because it can cause ectopic pregnancy or even infertility.

Despite the possibility of miscarriage and the likely effect on the fetus, during the normal course of pregnancy, doctors usually do not use antibacterial drugs, even if the tests confirm ureaplasmosis. Changes in the state of a pregnant woman and the amount of ureaplasma in her body in dynamics are monitored.

If the development of complications, the threat of infection of the fetus or termination of pregnancy is recorded, antibiotics are used - macrolides, fluoroquinolones and others. These drugs in the early stages of fetal development can cause miscarriage or have a teratogenic effect, and therefore are used only as a last resort and not earlier than 20 weeks of pregnancy.

Ureaplasmosis belongs to the group of sexually transmitted diseases (STDs). Ureaplasma and pregnancy - this issue is actively discussed in scientific circles. I will try to tell you about the most common position.
So, ureaplasma is a small microorganism that is part of the natural microflora of the body. Ureaplasmas are classified as conditionally pathogenic microorganisms, i.e. they cause diseases only under certain conditions, for example, with a decrease in the body's resistance. A person infected with ureaplasmosis may not know about it for years, but the disease will manifest itself in a stressful period for the body. Under conditions favorable for the development of ureaplasma (decreased immunity, severe somatic diseases), inflammatory processes of the internal genital organs - the uterus, fallopian tubes, ovaries - are possible.
Examination for ureaplasmosis should be carried out when planning a pregnancy. The studies carried out confirm the fact of more frequent complications of the course of pregnancy in women with identified ureaplasmosis than in those with no ureaplasmosis. If ureaplasmosis is detected before pregnancy, no one can guarantee that ureaplasma and pregnancy will peacefully coexist. If a woman has not been treated, then during pregnancy, against the background of a decrease in immunity, ureaplasma can show its aggressiveness, causing an inflammatory process in the lower parts of the genitourinary system, thereby provoking a miscarriage, premature birth, and other pathology of pregnancy. Ureaplasma does not directly affect the child in the womb. During childbirth, passing through the birth canal infected with ureaplasma, the newborn becomes infected with ureaplasmosis. The consequences can be different for an infant - from asymptomatic carriage to severe inflammatory diseases (conjunctivitis, pneumonia). The mother may develop endometritis in the postpartum period.
Diagnosis of ureaplasmosis is performed in an outpatient setting and is carried out quite simply. There are several methods for detecting ureaplasma, the doctor will prescribe the most appropriate for you. An excess of a certain number of microorganisms in bacterial culture is considered diagnostically significant. In such cases, specific antibiotic therapy is prescribed. In the case when ureaplasma is found in small quantities and the pregnancy is in the planning stage, treatment is also prescribed - to prevent complications of the course of pregnancy.
Detection of ureaplasma during pregnancy is not a reason for panic. Treatment regimens have been developed, the use of which is possible in pregnant women. But it is better to think about a full examination and treatment before pregnancy.

Ureaplasmosis is a sexually transmitted infection. Pathogenic bacteria can stay in the body for a long time, not showing themselves in any way, but if the natural microflora of the vagina is disturbed, bacteria begin to actively multiply, causing acute inflammation. Ureaplasmosis during pregnancy can cause miscarriage, negatively affect intrauterine development child, cause acute inflammation of the appendages.

Pathology has no typical manifestations, the first symptoms appear after 3-5 weeks after the infection. With strong immunity, a woman may not be aware of the existence of the disease for many years.

Signs of infection with ureaplasmosis:

frequent urge to urinate;
slight burning sensation during emptying of the bladder;
not abundant transparent vaginal discharge;
with exacerbation, pain occurs in the lower abdomen, radiating to the lower back.

The discharge is observed for a short time and in most cases goes unnoticed, then all symptoms disappear and can resume with a weakening of the immune system.

Ureaplasmosis occurs in an acute or chronic form with periodic relapses. In women, the vagina, uterus and appendages suffer, vaginosis, adnexitis, colpitis develop. If the disease is not treated for a long time, the inflammatory process leads to the formation of adhesions in the tubes, which provokes infertility, ectopic pregnancy. Chronic illness can affect the urinary system, joints.

Diagnostics of the ureaplasmosis

It helps to identify the pathogenic pathogen:

immunofluorescence analysis;
cultural method;
dot hybridization;
bacteriological study of microflora.

These tests are necessarily prescribed to women at the stage of pregnancy planning. If an infection is detected, then the doctor prescribes treatment, and in the future there will be no threat to the unborn child.

Ureaplasma in women during pregnancy is confirmed by test results. To assess the composition of the microflora, a smear is taken from the mucous membranes of the vagina and cervical canal. And also examine urine for the presence of bacteria, protein, leukocytes.

PCR allows you to identify the causative agent of the infection within 5 hours after the test. Bacteriological studies are carried out within 7-10 days, such an analysis helps to assess the titer of ureaplasma and select an antibiotic to which bacteria are susceptible.

The result of PCR and culture for pregnant women should not exceed 10⁴ CFU / ml. If the titer is higher, the activity of pathogenic microorganisms is observed, there is a risk of acute inflammation and negative impact on the fetus. The importance has the presence of other infectious pathogens: chlamydia, gonococcus. Mixed type infection is most dangerous.

Why ureaplasmosis is dangerous

How does ureaplasma affect pregnancy, what consequences can the disease cause? If the pathology is detected in a woman in the early stages of pregnancy, there is a risk spontaneous abortion, frozen pregnancy. The cervix becomes loose, the external pharynx softens, and the fetus becomes infected. If intrauterine infection can be avoided, then in half of the cases, the infection gets from mother to child during childbirth. Newborns are diagnosed with pneumonia, meningitis, lesion internal organs, the central nervous system.

Ureaplasma during pregnancy affects the formation of the baby, congenital defects, defects, and developmental delays can be observed. This is especially dangerous in the early stages, when all the vital systems and organs of the fetus are laid.

Infection or exacerbation of an infectious disease in the 2nd trimester can affect the formation of the placenta, fetoplacental insufficiency is diagnosed, the child receives insufficient amounts of the necessary vitamins, minerals, experiences oxygen starvation... This can lead to premature birth and negatively affect the health of the brain.

Postponed ureaplasmosis in pregnant women is the reason for the birth of children with low weight. Perhaps the development of postpartum inflammation of the appendages, endometritis, endometriosis when bacteria enter the uterine cavity. In the presence of a high titer of ureaplasma in a smear, the risk of developing vaginal and intestinal candidiasis increases, it is easier to get STDs during unprotected intercourse.

Intrauterine infection of the fetus in the early stages ends with the death of the embryo or the formation of congenital defects. If the infection occurs in the 2nd or 3rd trimester, the child has damage to the heart muscle, dysplasia of internal organs, growth retardation and generalized inflammatory processes.

In the expectant mother, the infection can spread to the urinary system, it develops:

cystitis;
pyelonephritis;
urolithiasis disease.

Treatment methods

Pregnancy with ureaplasma in most cases does not cause severe complications. Women are most susceptible to pathology:

with a weakened immune system;
have had serious illnesses;
suffering from chronic ailments of internal organs.

Ureaplasmosis does not affect fertility, infected patients can become pregnant if the patency of the fallopian tubes is preserved, there are no hormonal disorders.

Treatment of the disease should be carried out in the presence of symptoms of inflammation, it is allowed to start therapy only in the 2nd trimester, since the effect of antibiotics on the fetus can be more likely than the infection itself. In uncomplicated pregnancy, therapy is prescribed from 20-30 weeks. Preparations are selected during bacteriological analysis individually for each woman.

Both sexual partners need to be examined and treated to avoid re-infection. In addition to antibiotics, pregnant women are shown to take:

immunomodulators;
bifidobacteria;
vitamins.

The drugs help to normalize the vaginal microflora, prevent the deficiency of nutrients in placental insufficiency. Antifungal agents are used in the form of vaginal suppositories. It is forbidden to do vaginal douching, this can lead to the ingress of pathogenic microflora into the uterine cavity and cause inflammation amniotic fluid, intrauterine infection.

On average, the course of treatment takes 10-14 days. During this period, it is recommended to refrain from sexual intercourse, eat healthy food, limit fried, spicy foods. At the end of therapy, after 14 and 30 days, a second laboratory study is carried out. Women are tested throughout the entire period of bearing a child to prevent recurrence of the disease. In case of ineffectiveness of treatment, an antibacterial drug of another group is prescribed or combined remedy, you will have to take it for another 14 days.

The consequences of ureaplasma during pregnancy can affect the intrauterine development of the child, lead to abortion, premature birth, inflammation of the uterus and appendages, infertility, and infection of the fetus. Therefore, it is important to carry out examination and treatment. infectious diseases at the stage of pregnancy planning. This is especially true for women who have a history of miscarriage, newborn mortality, infertility.