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Decipher the smear on the flora
A smear on the flora is the most common analysis that the obstetrician-gynecologist appoints, and during pregnancy, the expectant mother will have to undergo this examination more than once. Why do this and how to properly prepare before taking the material to avoid the wrong results of the analysis?
Elena Trifonova Doctor obstetrician-gynecologist, Ph.D. honey. Sciences, FGBU National Center of Obstetrics, Gynecology and Perinatology. acad. VI Kulakova Ministry of Health and Social Development, Moscow
For this study, the doctor, while examining the woman in the gynecological chair, takes the vaginal contents from the posterior fornix (this space that is located between the posterior vaginal wall and the cervix), the cervical canal and the discharge urethra, applies the material to the slide and directs him to the lab. A smear test on the flora in the laboratory is conducted by a laboratory diagnosis doctor under a microscope. This study allows to determine the nature of the microflora of the vagina (microorganisms of the vagina), the canal of the cervix and urethra, to reveal the inflammatory process in the genital organs of a woman, in a number of cases, it is also possible to determine the causative agent of this inflammatory process (for example, gonococcus, Trichomonas).
When do they give a smear to the flora?
During pregnancy, each woman gives a smear to the flora. Mandatory analysis is done during registration in the antenatal clinic and at 30 weeks of pregnancy, one more time a swab for flora is taken at 36-37 weeks to assess the condition of the vaginal microflora before childbirth.
In these terms the analysis is given even in cases when the pregnant patient does not bother. This is done to identify the underlying (no symptoms of the disease) inflammatory process of the genital organs, which can lead to serious complications during pregnancy. During pregnancy, due to changes in the hormonal background and a decrease in immunity (this is due to the fact that the fetus is half foreign to the mother's body and the decrease in immunity protects it from attacks of the immune system), there is a much more frequent exacerbation of chronic genital infections and candidiasis (thrush). Any inflammatory process in the vagina during pregnancy can lead to serious complications: premature discharge of amniotic fluid (water poured before the onset of labor), premature birth (labor until 37 weeks), malnutrition (amount of amniotic fluid less than 500 ml) or polyhydramnios (the amount of water is more 1.5 liters), intrauterine growth retardation, etc. The detection of pathology allows timely treatment and avoid complications.
In the presence of complaints in a pregnant woman - the appearance of copious secretions from the genital tract, itching, burning or discomfort in the genital area - a smear on the flora must be given regardless of the gestational age in order to clarify the cause of the symptoms and, if necessary, to treat. After 1-2 weeks after the end of the treatment of the inflammatory process prescribed by the doctor, a repeated smear on the flora must be submitted in order to evaluate the effectiveness of the treatment.
For some pathological conditions, for example, in the presence of miscarriages associated with infectious complications of pregnancy in the past, cervical insufficiency (ischemic cervical insufficiency, in which the cervix is shortened, softened, and its canopy ajar), a smear on the flora is taken once a month , and after 30 weeks once in two weeks, because in these conditions even a small inflammatory process can lead to serious complications - termination of pregnancy, infection of membranes. Taking a material for a smear is absolutely safe and painless procedure and does not lead to any complications, so it can be done at any time of pregnancy.
What indicators are examined when smearing the flora?
1. The epithelium - flat epithelium - this is the cells of the superficial layer of the vaginal mucosa and cervix. He should meet in a smear in a moderate amount.
Deviations from the norm. The presence of a large number of flat epithelium in the smear can indicate an inflammatory process. The absence of epithelium in the smear indicates a violation of the hormonal background.
2. Leukocytes Are white blood cells involved in the destruction of pathogens. Leukocytes are able to actively penetrate the wall of blood vessels in the tissues of the body and participate in the fight against infectious agents. Normally, the smear on the flora of the vagina is present no more than 10, from the cervical canal no more than 15 leukocytes in the field of vision, from the urethra - up to 2 white blood cells in the field of vision.
Deviations from the norm. An increase in the white blood cell count in the smear is a sign of inflammation, and the more white cells in the smear, the more pronounced inflammatory process.
3. Erythrocytes. These are red blood cells. Normally, in a smear, the flora can have single red blood cells - 1-2 in the field of vision.
Deviations from the norm. An increase in the number of red blood cells indicates the presence of a chronic inflammatory process, and in addition, it can be a sign of trauma or latent bleeding, for example, in the presence of cervical ectopia (so-called erosion, when the vaginal part of the cervix is covered with a cylindrical epithelium, normally lining the inside of the neck).
4. Mucus. Normally, there is no mucus in the urethra, a moderate amount of mucus is detected in the vagina, in the cervix of the uterus, mucus can be in large quantities. An increase in the amount of mucus may be a sign of an inflammatory process, but this criterion has no great diagnostic value and doctors rarely rely on it when diagnosing a diagnosis.
5. Bacteria. Normally, in the urethra, the flora should not be detected, a rod-shaped flora is detected in a moderate amount in the vagina and cervix of the uterus. Stem flora are microorganisms that are rod-shaped, and most often they are represented by lactobacilli, which are 95% normal vaginal flora. They actively colonize the vagina and create an acidic environment in it, preventing the growth and reproduction of pathogenic bacteria. In addition to lactobacilli, other rod bacteria, such as Escherichia coli, bacteroides, as well as various cocci, bacteria that are spherical, can be present in the vagina. To this group of bacteria are streptococci, staphylococci, enterococci. In a small amount, they are normally present in the vagina.
Deviations from the norm. If the number of cocci increases sharply against the background of the death of normal lactobacilli (the number of rods decreases), this can lead to the development of an inflammatory process. Unfortunately, according to the results of a routine smear on the flora, it is impossible to determine which bacteria and in what quantities are present in the vagina. Therefore, with a pronounced inflammatory process, and also when a large number of coccal flora is found in the smear on the flora, the doctor prescribes an additional analysis for planting the correct diagnosis - planting on the flora with the definition of sensitivity to antibiotics.
6. Conditionally pathogenic flora. Conditionally pathogenic flora are microorganisms that live in the human body in a small amount without causing harm, but under certain conditions can lead to the onset of an inflammatory process. To such microorganisms, found in the smear on the flora, are fungi of the genus Candida and Gardnerella.
7. Gardnerelli. Gardnerelli normally live in the vagina in a small amount, without causing symptoms of the inflammatory process.
Deviations from the norm. With a decrease in local immunity, which is often found during pregnancy, there is an increase in the proportion of these bacteria in the microflora of the vagina, there is a disease - bacterial vaginosis (which, if called gardnerella, also called gardnerelosis). At the same time, in the smear, the "key" cells are found in the flora-cells of the vaginal mucosa that are stuck with gardnerella and other bacteria. Gardnerelli themselves in the usual smear on the flora are not visible. They can be detected only when staining smears with special dyes. During pregnancy, bacterial vaginosis is treated - candles are assigned to the vagina.
8. Mushrooms. Fungi of the genus Candida are part of the normal microflora of the vagina of most healthy women. Therefore, in some women, a small number of fungi can be detected in the vaginal smear, which do not cause an inflammatory process. In the absence of complaints, the patient does not receive treatment for this condition.
Deviations from the norm. Identification of a large number of fungi of the genus Candida in the smear on the flora allows to diagnose the candidiasis (or thrush) that needs to be treated.
9. Pathogenic flora. There are microorganisms that, under normal conditions, should not be present in the vagina of a healthy woman and the detection of which in a smear on the flora indicates the presence of a serious sexually transmitted disease. Of these infections in the smear, Trichomonas and gonococci are most often detected.
10. Трихомонады. Identification in a smear on the flora of Trichomonas indicates the presence of a sexually transmitted disease - trichomoniasis. Trichomoniasis in a pregnant woman increases the risk of premature birth, premature discharge of amniotic fluid, intrauterine growth retardation. In addition, there is a risk of infection of the baby when passing through the birth canal of a sick mother, so when a trichomonad in a smear is found, antibacterial treatment is mandatory during pregnancy.
11. Gonocoki. Detection in the smear of gonococci allows the doctor to diagnose - gonorrhea. This is a sexually transmitted disease, which must also be cured if detected during pregnancy. Gonorrhea leads to the following complications: spontaneous abortion, premature birth, premature discharge of amniotic fluid, infection of the placenta and membranes, and in addition, when the baby passes through the birth canal of a sick woman, the newborn's eyes gonococcal.
Detection of smears on the flora of pathogens of other sexually transmitted infections is very difficult. Therefore, in the presence of an inflammatory process according to the smear on the flora, the doctor recommends testing for sexually transmitted infections by another, more sensitive method - PCR.
Rules for preparation for swab smearing on flora
That the result of a smear on flora was authentic, before delivery of the given analysis it is necessary to observe a number of the important conditions. During 2-3 days you can not use any vaginal suppositories or creams, contraindicated douches with any solutions, because they change the composition of the vaginal microflora, make it difficult to identify the pathogen of inflammation. In addition, within 2 days it is desirable to refrain from sexual intercourse. This is also due to the fact that spermatozoa and residual seminal fluid in the vagina can lead to the wrong result of a smear on the flora.