It must be said that the microbiological feature of the GDH in obstetrics, gynecology and neonatology is the polymicrobial etiology of these diseases. Conditionally pathogenic enterobacteria (E.coli, Klebsiella spp., Proteus spp.) Dominate among the pathogens of the uvogenital tract in pregnant women and puerperas, often in association with obligate anaerobes of the bacteroid family – Prevotella spp. and anaerobic cocci. In recent years, the role of enterococci in the aetiology of the GDV in obstetrics and neonatology has increased, which is apparently due to the resistance of these bacteria to cephalosporins, widely used in obstetric practice.
In inflammatory diseases of the female genital organs, the ascending pathway of infection prevails. Invasion of the microbes that inhabit the vagina into the internal genital organs can occur during various surgical interventions, the introduction of intrauterine contraceptives, the implementation of invasive diagnostic methods. With the development of the GDH after childbirth, in most cases the vaginal microflora penetrates into the internal genital organs. An important role is played by the degree of colonization by the microorganisms of the vagina and the cervical canal: massive contamination contributes to the development of the infection process. Thus, a high degree of colonization of the vagina with aerobic and anaerobic bacteria before abdominal delivery increases the risk of postoperative purulent-inflammatory complications, in particular, endometritis, peritonitis after cesarean section. The factors contributing to the activation of the microflora of the vagina and the subsequent development of the infectious process include reduction of systemic and local immunity, changes in hormonal status, and irrational administration of antimicrobial drugs that disrupt the natural relationship of microorganisms in the vaginal microcenosis.
The general patterns of the dynamics of the etiological structure of the GDH allow us to say that in each hospital there is a certain epidemiological situation, biological features of pathogens and their sensitivity to antibiotics, and therefore local monitoring of the species composition and antibiotic resistance of the secreted microorganisms is necessary, determining the choice of drugs for the prevention and treatment of the disease .
The use of antibacterial drugs in obstetric practice has a number of features that should be considered for the effective treatment of infectious and inflammatory diseases in pregnant women and puerperas. Antibacterial therapy of the GDH in obstetrics and gynecology can be effective only taking into account their clinic, etiology, pathogenesis and a number of features that occur in the body of pregnant women and determine the correct choice and adequate use of antibacterial drugs.
First of all, you should know whether the drug has embryotoxic and teratogenic effects. The presence of such properties is a contraindication for the use of medicinal substances in obstetrics. Of great importance is the transplacental transition of antibiotics. The level of the drug, which is created in the tissues of the fetus and in the amniotic fluid when it is introduced into the maternal organism, determines the possibility for its therapeutic use during intrauterine infection and chorioamnionitis.