Ùå â 1892 ðîö³ À.Äîäåðëåéíîì âïåðøå áóëè îïèñàí³ ëàêòîáàöèëè, ÿê ïåðåâàæàþ÷à ñêëàäîâà íîðìàëüíî¿ âàã³íàëüíî¿ ì³êðî­ôëîðè.  äàíèé ÷àñ âñòàíîâëåíî, ùî íîðìàëüíèé ì³êðîáíèé ñêëàä ôëîðè ï³õâè âêëþ÷ຠá³ëÿ 60 øòàì³â áàêòåð³é ³ çàëåæèòü â³ä áàãàòüîõ ôàêòîð³â: â³êó æ³íêè, ôàçè ìåíñòðóàëüíîãî öèêëó, ñåêñóàëüíî¿ àêòèâíîñò³, íàÿâíîñò³ âàã³òíîñò³, âèêîðèñòàííÿ ñïåðì³öèä³â, ÂÌÑ, àíòèá³îòèê³â, ãëþêîêîðòèêî¿ä³â, öèòîñòàòèê³â, íàÿâíîñò³ äåÿêèõ åêñòðàãåí³òàëüíèõ çàõâîðþâàíü ³ ò.ä. Àëå îçíàêîþ çäîðîâ'ÿ ââàæàºòüñÿ ïåðåâàæàííÿ ëàêòîáàöèë /äî 95%/ â ì³êðîáíîìó ïåéçàæ³ ï³õâè [1].

Ìàòåð³àë ³ ìåòîäè äîñë³äæåííÿ.

Âèõîäÿ÷è ³ç âèùå ñêàçàíîãî, ìè âèð³øèëè ïðîàíàë³çóâàòè õàðàêòåð ì³êðîôëîðè ï³õâè ó âàã³òíèõ ³ç çàãðîçîþ ïåðåðèâàííÿ âàã³òíîñò³, ñàìîâ³ëüíèìè âèêèäíÿìè òà ïåðåä÷àñíèìè ïîëîãàìè, âçÿâøè çà îñíîâó äàí³ ì³êðîñêîﳿ ìàçê³â ³ç âì³ñòó ï³õâè. Ìàçêè ïðèãîòîâëÿëè çà ñòàíäàðòíîþ ìåòîäèêîþ; øëÿõîì ôàðáóâàííÿ 1% âîäíèì ðîç÷èíîì ìåòèëåíîâîãî ñèíüîãî. Ïðîâåäåíèé ðåòðî­ñïåêòèâíèé àíàë³ç 1894 ³ñòîð³é õâîðîá ³ ðîä³â âàã³òíèõ ³ç çàãðîçîþ ïåðåðèâàííÿ âàã³òíîñò³, ñàìîâ³ëüíèìè âèêèäíÿìè òà ïåðåä÷àñíèìè ïîëîãàìè, êîòð³ çíàõîäèëèñÿ íà ñòàö³îíàðíîìó ë³êóâàíí³ â Êîëîìèéñüêîìó ïîëîãîâîìó áóäèíêó çà ïåð³îä 1995-1999 ðîêè.

Ðåçóëüòàòè äîñë³äæåíü òà ¿õ îáãîâîðåííÿ.

Âñòàíîâëåíî, ùî ÷àñòîòà íåâèíîøóâàííÿ âàã³òíîñò³ â ñåðåäíüîìó ñêëàäຠ15,8%. Ñåðåä îáñòåæåíèõ â ïåðøîìó òðèìåñòð³ áóëî 850 æ³íîê /44,9%/, â äðóãîìó òðèìåñòð³ - 455 /24%/, â òðåòüîìó òðèìåñòð³ - 589 /31,1%/. ²ç 1894 îáñòåæåíèõ æ³íîê ó 1045 /55,2%/ âàã³òí³ñòü áóëà çáåðåæåíà. Íåçâàæàþ÷è íà ïðîâåäåíå ë³êóâàííÿ âàã³òí³ñòü ïåðåðâàëàñÿ ó 849 æ³íîê, ùî ñêëàäຠ44,8%. Äàí³ ïðî ê³ëüê³ñíèé ñêëàä âàã³òíèõ ïî òðèìåñòðàõ âàã³òíîñò³ íàâåäåíî â òàáëèö³ 1.

Òàáëèöÿ 1.

Ãðóïè îáñòåæåíèõ	ʳëüê³ñòü îáñòåæåíèõ æ³íîê, %
	1 òðèìåñòð	2 òðèìåñòð	3 òðèìåñòð
Âàã³òí³ñòü çáåðåæåíà	365 /43%/	369 /81%/	311 /52,8%/
Âàã³òí³ñòü ïåðåðâàëàñÿ	485 /57%/	86 /19%/	278 /47,2%/

Ç íàâåäåíèõ äàíèõ âèïëèâàº, ùî ÷àñòîòà íåâèíîøóâàííÿ âàã³òíîñò³ íàéâèùà â ïåðøîìó òðèìåñòð³, à íàéíèæ÷à â äðóãîìó òðèìåñòð³, ùî â³äïîâ³äຠäàíèì ë³òåðàòóðè [1,2]. Ïðîâåäåíèé àíàë³ç ñâ³ä­÷èòü ïðî òå, ùî íàéá³ëüø ÷àñòî íåâèíîøóâàííÿ âàã³òíîñò³ â³ä­ì³÷àºòüñÿ ó æ³íîê ó â³ö³ â³ä 18 äî 25 ðîê³â â ïåðøîìó òðèìåñòð³ âàã³òíîñò³.

Ñï³ââ³äíîøåííÿ ì³æ ìåøêàíöÿìè ì³ñòà ³ ñåëà áóëî â³äïîâ³äíî òàêèì: 710 /37,5%/ ³ 1184 /62,5%/, ùî â³äð³çíÿºòüñÿ â³ä ë³òåðà­òóðíèõ äàíèõ, äå âêàçóºòüñÿ íà ïåðåâàæàííÿ æèòåëüîê ì³ñòà. Öå î÷åâèäíî ïîâ'ÿçàíî ç îñîáëèâîñòÿìè íàñåëåííÿ Êîëîìèéñüêîãî ðàéîíó íàøî¿ îáëàñò³. Ïåðøîâàã³òí³ ñêëàäàþòü 958 /50,6%/, à ïîâòîðíîâàã³òí³ - 936 /49,4%/ âèïàäê³â. Ó 890 /46,9%/ âàã³òíèõ â³äì³÷àëàñÿ àíåì³ÿ ð³çíîãî ñòóïåíÿ âàæêîñò³ .Ó ãðóï³ äîñë³äæåí­íÿ ïåðåâàæàëè äîìîãîñïîäàðêè 1042 /55%/ ³ æ³íêè, ÿê³ âèêîíóâà­ëè âàæêó ô³çè÷íó ïðàöþ 388 /20,5%/.

Ïðîàíàë³çóâàâøè ðåçóëüòàòè ì³êðîñêîï³÷íîãî äîñë³äæåííÿ ³ç âì³ñòó ï³õâè íà ôëîðó, íàìè âèÿâëåíî ð³çêå çá³ëüøåííÿ ÷àñòîòè âèïàäê³â òðåòüîãî ³ ÷åòâåðòîãî ñòóïåí³â ÷èñòîòè ï³õâè ó âà­ã³òíèõ ³ç çàãðîçîþ ïåðåðèâàííÿ âàã³òíîñò³ ïîð³âíÿíî ³ç êîíòðîëåì â 3,2 ðàçà /ð < 0,01/. ßêùî çâåðíóòè óâàãó íà ÿê³ñíèé ñêëàä ôëîðè, òî ñïîñòåð³ãàºòüñÿ çíà÷íå çíèæåííÿ ê³ëüêîñò³ ëàêòîáàöèë /äî 45%/ ³ çðîñòàííÿ êîêîâî¿ ôëîðè /äî 36%/ ïî â³äíîøåííþ äî êîíòðîëüíî¿ ãðóïè âàã³òíèõ ³ç íîðìàëüíèì ïåðå­á³ãîì âàã³òíîñò³.

Ó çâ'ÿçêó ç òèì, ùî ÷³òêî ïðîñòåæóºòüñÿ ïàòîëîã³ÿ áàêòå­ð³àëüíî¿ ôëîðè ï³õâè ïðè çàãðîç³ ïåðåðèâàííÿ âàã³òíîñò³, ñàìîâ³ëüíèõ âèêèäíÿõ òà ïåðåä÷àñíèõ ïîëîãàõ, ìè ïðîàíàë³çóâàëè ÿê³ñíèé ñêëàä ôëîðè âì³ñòó ï³õâè çà äàíèìè ì³êðîñêîﳿ /ïåðå­âàæàííÿ ëàêòîáàöèë, êîêîâî¿, çì³øàíî¿ ôëîðè, íàÿâí³ñòü äð³æäæî­âèõ ãðèáê³â, òðèõîìîíàä, ãîíîêîê³â/ ó æ³íîê ³ç çàãðîçîþ ïåðå­ðèâàííÿ âàã³òíîñò³, äå âîíà áóëà çáåðåæåíà ³ ó æ³íîê ³ç ñàìî­â³ëüíèìè âèêèäíÿìè òà ïåðåä÷àñíèìè ïîëîãàìè. ˳êóâàííÿ çàãðî­çè ïåðåðèâàííÿ âàã³òíîñò³ ó âñ³õ âèïàäêàõ ïðîâîäèëîñü áåç â³äïîâ³äíî¿ ñàíàö³¿ ï³õâè íàñòóïíèì êîìïëåêñîì ïðåïàðàò³â: çàñïîê³éëèâèìè ñåðåäíèêàìè /åêñòðàêò âàëåð³àíè, ïåðñåí, ñàíàñîí/, ñïàçìîë³òèêàìè /íî-øïà, ïàïàâåðèí, ïëàò³ô³ë³í, áàðàëã³í, ìàãí³ÿ ñóëüôàò/, ãîðìîíàìè /ôîë³êóë³í, ïðîãåñòåðîí, õîð³îí³÷íèé ãîíàäîòðîï³í, äåêñàìåòàçîí, ïðåäí³çîëîí/, áåòà-àäðåíîì³ìåòèêàìè /ïàðòóñèñòåí, ã³í³ïðàë/, áëîêàòîðàìè êàëüö³ºâèõ êàíàë³â /³çîïò³í/, ³íã³á³òîðàìè ïðîñòàãëàíäèíñèíòåòàçè /³íäîìåòàöèí/, äåñåíñèá³ë³çóþ÷èìè ïðåïàðàòàìè /ä³ìåäðîë, ñóïðàñòèí/, â³- òàì³íîòåðàï³ÿ, ñåðêëÿæ øèéêè ìàòêè, àëîòðàíñïëàíòàö³ÿ ëîñêóòà øê³ðè ÷îëîâ³êà. Ó âèïàäêàõ, äå âàã³òí³ñòü áóëà ïðîëîíãîâàíà, ïåðåâàæàííÿ ëàêòî-áàöèë ñêëàäàëî 42,3% âèïàäê³â, êîêîâî¿ ôëîðè - 20,5%, çì³øàíî¿ - 17,1%, ãðèáêè âèçíà÷àëèñÿ ó 15,4%, òðèõîìîíàäè - 4,7%. Ó æ³íîê, äå âàã³òí³ñòü íå âäàëîñÿ çáåðåãòè, ñêëàä ì³êðîôëîðè áóâ, â³äïîâ³äíî, òàêèì: 14,2%, 38,7%, 30,7%, 12,2%, 4,2%. Ïåðøèé òà äðóãèé ñòóïåí³ ÷èñòîòè ï³õâè â 3 ðàçè ÷àñò³øå ñïîñòåð³ãàþòüñÿ ó âà­ã³òíèõ, ó ÿêèõ âäàëîñÿ ïðîëîíãóâàòè âàã³òí³ñòü. À òðåò³é ³ ÷åòâåðòèé ñòóïåí³ ÷èñòîòè ï³õâè çóñòð³÷àþòüñÿ â 1,8 ðàçè ÷àñò³øå ó âèïàäêàõ, äå âàã³òí³ñòü çàê³í÷èëàñÿ ñàìîâ³ëüíèì âèêèäíåì ÷è ïåðåä÷àñíèìè ïîëîãàìè, íåçâàæàþ÷è íà ïðîâåäåíå êîìïëåêñíå ë³êóâàííÿ. Ó 13,5% âèïàäê³â âèÿâëåíî âíóòð³øíüîóòðîáíå ³íô³êóâàííÿ íîâîíàðîäæåíèõ.

Âèñíîâêè.

Ïðîâåäåíèé àíàë³ç ìåäè÷íî¿ äîêóìåíòàö³¿ òà ðåçóëüòàòè ì³êðîñêîï³÷íîãî äîñë³äæåííÿ âì³ñòó ï³õâè äàþòü ìîæëèâ³ñòü ï³äòâåðäèòè çíà÷íó ðîëü ³íôåêö³éíîãî ôàêòîðó ó íåâèíîøóâàíí³ âàã³òíîñò³. Ìè ââàæàºìî, ùî ö³ëåñïðÿìîâàíå âèçíà÷åííÿ õàðàêòåðó ì³êðîôëîðè âì³ñòó ï³õâè òà äîðîäîâà ñàíàö³ÿ âàã³òíèõ º îäíèì ³ç ðåçåðâ³â, ÿêèé äîçâîëèòü çíèçèòè ÷àñòîòó íåâèíîøóâàííÿ âà­ã³òíîñò³ òà ï³äâèùèòè åôåêòèâí³ñòü ë³êóâàííÿ ö³º¿ êàòåãî𳿠âàã³òíèõ.

ÑÏÈÑÎÊ Ë²ÒÅÐÀÒÓÐÈ

1. Áàêòåðèàëüíûé âàãèíîç.Ìåòîä.ðåêîìåíäàöèè.-Êèåâ,1998.

2. Ìèõàéëåíêî Î.Ò., Ñòåïàíê³âñüêà Ã.Ê. óíåêîëîã³ÿ.-Ê.:Çäîðîâ’ÿ, 1999.-520 ñ.

3.Íåâ³äêëàäíå àêóøåðñòâî /Çà ðåä.Ã.Ê.Ñòåïàíê³âñüêî¿, Á.Ì.Âåíöê³âñüêîãî.-Ê.:Çäîðîâ'ÿ,1994.-384 ñ.,³ë.

4.Íåâèíîøóâàííÿ âàã³òíîñò³. Çá³ðíèê òåç.-Êè¿â,1997.

5.Ñåðîâ Â.Í., Ñòðèæàêîâ À.Í., Ìàðêèí Ñ.À. Ïðàêòè÷åñêîå àêóøåðñòâî: Ðóêîâîäñòâî äëÿ âðà÷åé. - Ì.:Ìåäèöèíà,1989.-512 ñ., èë.

6.Òóçàíêèíà Å. Á. Ïðèíöèïû è ìåòîäû âåäåíèÿ ïðåæäåâðåìåííûõ ðîäîâ: Àâòîðåô. äèñ. ... ä.ì.í.-Ê.,1984.

Çàâ. êàôåäðîþ àêóøåðñòâà

òà ã³íåêîëî㳿 ²ÔÄÌÀ (ïðîô.ä.ì.í. Ãóäèâîê ².².)

Àñï³ðàíò êàôåäðè àêóøåðñòâà

òà ã³íåêîëî㳿 ²ÔÄÌÀ (Ñòðóê Â.Ô.)

Àäðåñè àâòîð³â.

1.Ãóäèâîê ²âàí ²âàíîâè÷ - ïðîô., ä.ì.í., çàâ.êàôåäðîþ àêóøåðñòâà ³ ã³íåêîëî㳿 ²âàíî-Ôðàíê³âñüêî¿ äåðæàâíî¿ ìåäè÷íî¿ àêàäå쳿.

76000, ì.²âàíî-Ôðàíê³âñüê, âóë.Íåçàëåæíîñò³ 36/74, òåë.2-36-50.

2.Ñòðóê Âîëîäèìèð Ôåäîðîâè÷ - àñï³ðàíò êàôåäðè àêóøåðñòâà ³ ã³íåêîëî㳿 ²âàíî-Ôðàíê³âñüêî¿ äåðæàâíî¿ ìåäè÷íî¿ àêàäå쳿.

78200, ²âàíî-Ôðàíê³âñüêà îáë., ì.Êîëîìèÿ, âóë.ѳ÷îâèõ ñòð³ëüö³â 25/8, òåë.3-40-80.

Key words: interruption of pregnancy, premature labor, microbial flora.

The Role of the Infectious Factor in the Interruption of Pregnancy.

I.I. Gudyvok, V.F. Struk

Summary

It was made a retrospective analysis of 1894 stories of diseases and deliveries of the pregnants with the threat of interruption of pregnancy, spontaneous abortion and premature labor.

The first and the second degrees of purity of vagina are observed 3 times oftener in the pregnants, whose pregnancy was managed to prolong, and the third and the fourth degrees of purity of vagina are 1,8 time oftener in the cases, where pregnancy was ended in spontaneous abortion or premature labor. We consider, that careful study, of the character of microflora of vagina and the prenatal sanation are the factors which help to lower the frequency of interruption of pregnancy.