Treatment for candida during pregnancy. Urogenital candidiasis during pregnancy. Safe treatments

Thrush during pregnancy is a fairly common occurrence. Up to 40 percent of pregnant women regularly visit a gynecologist with complaints of candidiasis.

Expectant mothers are more likely to develop thrush, which is due to the peculiarity of their hormonal background and natural immunosuppression.

Candidiasis in non-pregnant women, of course, is not the most pleasant phenomenon, but, in any case, its consequences are not terrible, which cannot be said about pregnant women.

During pregnancy, candidiasis requires compulsory treatment. there is a risk of spreading inflammation from the vagina higher - into the uterine cavity, to the membranes.

Fortunately, in most cases, candida is not aggressive, the process is limited to the vaginal mucosa, but you should not tempt fate, at the first manifestations you need to go to the treating doctor.

The difficulties of treating thrush during pregnancy lie in the limited choice of drugs - not everything is allowed for pregnant women.

For the treatment of VVC in this group of patients, only local antifungal drugs are used, drugs for oral administration adversely affect the fetus, therefore, are prohibited.

Thrush during pregnancy is not much different from that outside the pregnant state, except in the approaches to treatment.

The main complaints and symptoms of IHC are itching, burning, discharge.

Itching and burning intensify in the afternoon towards evening, the condition is aggravated by prolonged walking. Most often, the labia and vulva are involved in the inflammatory process, the itching in this area is intense, accompanied by scratching.

In the absence of treatment, the manifestations increase, which can lead to a violation of the general condition, to the development of neurosis, insomnia.

Urination, especially if scratching is present, becomes painful and dysuria may appear.

Soreness and burning sensation intensify during sexual activity, in addition, with PA with thrush during pregnancy, the risk of infection from the vagina increases, therefore, with vulvovaginitis during pregnancy, it is recommended to refrain from sexual activity.

Vaginal discharge is often classic, cheesy, yellowish. In the presence or attachment of a secondary infection, the discharge acquires a yellow-green color, a thick, creamy consistency, and an unpleasant odor.

Chronic vulvovaginal candidiasis is characterized by a smoothed course, the manifestations of inflammation are less pronounced, the discharge may be absent or become watery with curdled-tiny blotches.

If the infection spreads to the skin, there is swelling, redness in the labia majora, perineum, and anus. The tissues are covered with a small-point rash, itching joins.

Thrush during pregnancy is a fairly frequent guest and this is due to the restructuring of the hormonal background, a decrease in immunity. Candidiasis can appear already in the first weeks of pregnancy.

The fetus for the mother's body is a foreign object that needs to be disposed of. To prevent the immune system from terminating pregnancy, the body is rebuilt, the system for recognizing foreign proteins is partially blocked, and protection is reduced.

Also, an increase in the hormone progesterone is of some importance, it is necessary to maintain pregnancy, but in a certain way changes the composition of the vaginal microflora, making it less protected from pathogenic microorganisms.

Therefore, early pregnancy and thrush are a very common combination.

Thrush in early pregnancy, and in late pregnancy, is diagnosed by the same methods as in non-pregnant women. Diagnostics can be carried out in several ways. The first, most common and most affordable method is smear microscopy.

At the same time, material is taken on the glass slide using a Volkmann spoon or with the help of a cytobrush, which is dried, fixed with special solutions and stained. Then the laboratory assistant examines it under a microscope.

With acute thrush, a large number of leukocytes and cell forms are found in the smear. In a chronic process, the accumulation of pseudomycelium predominates.

The culture method of research, or culture, plays an important role when it is difficult to make a diagnosis or select the right treatment.

With its help, it is possible not only to detect the pathogen, but also to find out which drugs it is more sensitive to. The disadvantage of this method is the long wait for the results and the need for a specialized laboratory.

Polymerase chain reaction is a highly sensitive, informative method for diagnosing various infections.

However, it is rarely used in the diagnosis of vulvovaginal candidiasis, firstly because of the relatively high cost of the study, and secondly because of the high risk of overdiagnosis. The method allows detecting even debris of cells when the infection itself no longer requires treatment.

You can diagnose thrush and using serological tests - for this method, blood serum is used. But in the presence of simpler diagnostic methods, the data are used extremely rarely.

Another method that is gaining popularity in recent years is the rapid diagnostic test. Ready-made tests are sold in a pharmacy and allow, without involving laboratory workers, to confirm the diagnosis of thrush within 12 hours after the onset of the first symptoms.

Treatment of thrush during pregnancy causes certain difficulties. Firstly, one of the links in the fight against thrush suffers significantly - immunity decreases.

Secondly, specialists are very limited in medicines, because pregnancy is such a period in a woman's life when there are too many drug bans.

For example, everyone's favorite fluconazole is prohibited in pregnant women. he has a proven harmful effect on the fetus. Itraconazole is prohibited for the same reasons.

Of the tablet forms, pimafucin and nystatin are allowed in pregnant women, however, their appointment for vulvovaginal candidiasis is not advisable - they are not absorbed from the intestinal lumen and act only locally, with the intestinal focus of infection.

A number of local drugs are also prohibited during pregnancy. Expectant mothers in the first trimester of pregnancy may be prescribed pimafucin or betadine for the treatment of thrush.

In the second and third trimesters, the list expands slightly: clotrimazole, butoconazole, econazole, miconazole (active ingredients). Of the complex drugs, the drug terzhinan is widely used from the second trimester.

Medication for thrush

As mentioned above, the list of antifungal drugs allowed during pregnancy is very limited. This is due to the toxic effect of drugs on the mother's body and on the fetus.

For the treatment of thrush during pregnancy, local forms are used. they are practically not absorbed from the vagina and do not have a systemic effect. The minimum systemic absorption is confirmed by clinical studies.

Based on many years of research and clinical experience, we can state that miconazole, econazole and clotrimazole are the safest for the fetus from the imidazole group.

Also, a number of studies allow us to conclude that for the treatment of vulvovaginal candidiasis in pregnant women, local imidazoles are more effective than the same forms of nystatin.

In addition, they are much more convenient with a shorter course of treatment (the recommended duration of treatment with nystatin is 14 days).

For effective treatment of candidiasis in pregnant women, the minimum course of taking local forms should be 7 days.

In pregnant women, alternative methods can also be used to combat candidiasis, but there are certain limitations.

Firstly, douching is strictly contraindicated for expectant mothers.

During its implementation, there is a risk of the penetration of secretions and pathogens from the vagina into the cervical canal and above, which can lead to the spread of infection to the membranes.

Secondly, sessile baths are also not recommended, due to a local increase in the temperature of the pelvic organs, and there is also a risk of fungal penetration into the deeper layers of the epithelium after soaking the already edematous plentiful mucosa. All that remains is washing away.

For this procedure, you can use a soda solution (it is believed that soda disrupts the balance of microflora in the vagina of a pregnant woman, however, we do not share it, with adequate use of the benefits of the procedure more than harm), soda and iodine, decoctions of chamomile, oak bark, birch kidneys, etc.

Prevention of thrush

Thrush during pregnancy is a fairly frequent guest, it is difficult to deal with it, therefore, you need to carefully engage in prevention. It consists in observing the rules of personal hygiene, adherence to proper nutrition, and timely treatment of concomitant diseases.

A pregnant woman should wash her genitals 1-2 times a day with clean running water without soap, change her underwear daily, limit the use of panty liners that constrain synthetic panties, and be especially careful when visiting public toilets, baths, swimming pools.

From the diet, you need to exclude flour, sweets (or reduce the use to a minimum). Preference should be given to boiled, stewed dishes, cereals, vegetables, fresh meat.

An important point in prevention is to treat the exacerbation of chronic diseases in time.

A pregnant woman who first encounters candidiasis is often upset and worried about the health of her unborn baby. At the same time, almost every woman encounters thrush during the period of bearing a baby. Usually this unpleasant companion of pregnancy is considered a signal of trouble and a decrease in immunity in a woman in an "interesting position." Why does candidiasis occur so often in pregnant women, how dangerous is it, and in what ways can you get rid of this unpleasant ailment?

Usually, the news of her candidiasis shocks the expectant mother. At the same time, most women are trying to find an answer to the question: why did this trouble happen to her at such an important moment for her and the baby. However, gynecologists and experienced mothers know that thrush in pregnant women is the most common occurrence. And if, according to statistics, almost every third pregnant woman suffers from candidiasis, then in reality, almost every expectant mother notices signs of candidiasis. Why does insidious candidiasis overtake a woman precisely at the most important moment for her of bearing a fetus?

As you know, the causative agent of thrush (or candidiasis) is a yeast with the luxurious name "Candida" (Candida). This microorganism is called conditionally pathogenic. Similar mushrooms are found in the body of a healthy woman, but their number is scanty and does not lead to disease. In the body of a woman "in an interesting position" there are factors that contribute to the active reproduction of this microorganism and the displacement of the beneficial microflora of the vagina.

First of all, this is due to natural changes in the body of a pregnant woman, the main ones of which are a decrease in immunity and hormonal changes.

A decrease in immunity at the time of pregnancy (immune depression) is a natural process, otherwise the mother's body would perceive the embryo as a foreign object and destroy it.

It is completely natural during pregnancy and hormonal shift. An increase in the amount of estrogen and progesterone in the body of a pregnant woman leads to an increase in the acidity of the vagina.

As a result, a combination of factors of low immunity and hormonal shift serve as a "push mechanism" for the appearance of candidiasis during pregnancy.

Additional factors for the appearance of thrush

• the consequences of the transfer of Candida microorganisms from the intestines of a woman (with dysbiosis of the digestive system);
• due to vaginal dysbiosis existing before pregnancy;
• infection at the time of sexual intercourse from a partner (in 20% of cases);
• a woman eating sweets and flour dishes in excessive quantities;
• treatment with hormones or antibiotics, birth control or immunosuppressive drugs;
• increased levels of female hormones;
• inflammatory ailments of the genitourinary sphere;
• some chronic endocrine pathologies (diabetes, obesity, thyroid diseases);
• lingering chronic ailments (heart disease, chronic, hepatitis, tuberculosis, cancer, etc.);
• vitamin deficiency;
• mechanical microtraumas and hygienic violations (dirt from hands or linen, friction of tight underwear, rough sex, etc.);
• HIV infection;
• stressful situations;
• poor living conditions (high humidity and poor ventilation of the premises, inability to carry out female intimate hygiene at a normal level).

Usually, several of the above factors lead to the disease at once.

Thrush is especially common in the last trimester. There is also a high risk of candidiasis in women who have already had this ailment before pregnancy.

Candidiasis can affect various organs in a woman, but vulvovaginal candidiasis is the most common. It is he who is called among the common people a thrush. With this ailment, the external genital organs (vulva and vagina) of the expectant mother are affected by the fungus.

In order not to face thrush during pregnancy, it is important for a woman and her partner to undergo a full medical examination at the time of planning offspring. And if the suspicion of candidiasis is confirmed, both partners need to undergo treatment, and before it ends, they need to protect themselves from pregnancy.

The main symptoms of candidiasis in pregnant women

The symptomatology of candidiasis in expectant mothers differs little from the manifestation of this pathology in non-pregnant women. And if a woman suffered from thrush earlier, then she will not discover anything new for herself during this disease during pregnancy.

The most typical manifestations of candidiasis in women in position are the following symptoms:

• redness and swelling of the external genital organs;
• whitish cheesy discharge (flakes) from the vagina with a sour odor;
• itching and burning in the genitals, aggravated by urination or after sexual intercourse;
• manifestations of candidal urethritis in the form of pain and burning sensation during urination or discharge from the urethra.

Summing up, all of the above symptoms significantly complicate the life of a pregnant woman.

Often in pregnant women, thrush occurs in an erased form and becomes chronic.

Hygiene measures can temporarily relieve symptoms of itching and pain. In some cases, candidiasis is accompanied by other genital infections that are more dangerous for the fetus.

Diagnosis of candidiasis

Common diagnostic methods for thrush are:

• collecting anamnesis on data on the woman's previous ailments before pregnancy;
• information on medication treatment;
• general and gynecological examination;
• blood tests (general and biochemical);
• chest x-ray;
• examination of narrow specialists.

For the early detection of vulvovaginous candidiasis, each pregnant woman must carry out a set of studies on this pathology. The complex diagnostics during pregnancy necessarily includes a smear on the flora, which is produced at least three times during pregnancy.

If a woman informs the gynecologist about suspicious symptoms in the genital area, she will immediately be offered a smear. This analysis allows you to detect even candidiasis with an erased course.

Less often, pregnant women are prescribed a culture method (cultural method), when the doctor can be sure with 100% accuracy that the patient has candidiasis, and not another similar infection.

Recently, the PCR method (polymer chain reaction) has also appeared, as the most accurate and modern diagnostic method.

Bacterioscopic smear on microflora: in this case, vaginal discharge is collected on a disposable spatula inserted into the vagina. After that, the material is placed on a sight glass, dried and examined under a microscope. This allows you to identify various fungi, bacteria or and count their number, which allows the doctor to make a correct diagnosis. With thrush, there will be many fungal bacteria and leukocytes in the vaginal smear, which will reveal this ailment.

The cultural method is used not only for diagnosis, but also for the selection of effective drugs for thrush. In this case, the biomaterial taken from the genitals is transplanted into a favorable environment, and then examined through a microscope. It takes several days to get an answer with this diagnostic method, which is not always convenient for the timely start of treatment.

It is rarely used in pregnant women. This method is expensive, and during pregnancy it is not always effective, as it can give false positive results.

The danger of candidiasis in pregnant women

Many women are convinced that thrush is absolutely harmless to her and her unborn baby. However, this insidious ailment cannot be ignored categorically.

Any infection for a pregnant woman can be dangerous. Candidiasis is no exception. Microorganisms with this pathology can be in a woman's body for many years.

What complications can cause candidiasis during pregnancy?

For a pregnant woman, an ailment can lead to:

• erosion of the cervix;
• adhesions of the genitals;
• accession of a secondary infection with damage to important organs (inflammation of the kidneys, mixed pneumonia, etc.);
• anemia;
• increased risk of bleeding during childbirth;
• complications after a cesarean section (infection and the need for serious treatment after surgery);
• isthmic-cervical insufficiency;
• miscarriage and premature birth;
• the prohibition of breastfeeding a newborn.

For a fetus or newborn, maternal thrush can lead to:

• prematurity;
• general weakening of the body;
• candidal stomatitis;
• penetration of infection into vital organs with the development of candidal sepsis and fetal death.

Description of the consequences of the disease

Often, thrush can increase the risk of cervical erosion. When Candida gets inside the genitals, the infection can spread further and further. As a result, adhesions appear in the genitals of a woman, which are especially dangerous during the period of gestation.

As you know, for the normal development of the fetus and successful childbirth, good elasticity of the tissues of the female genital organs is important. And adhesions significantly limit these processes and make independent childbirth of a woman impossible.

Another possible complication of women with candidiasis is the risk of developing iron deficiency anemia, especially in the second half of pregnancy. Anemia during this period of a woman's life is extremely undesirable, since the lack of important trace elements weakens the body of the mother and the unborn baby, contributing to premature birth or the birth of a weakened child.

Another serious pathology of pregnant women is isthmic-cervical insufficiency. It is this diagnosis that is often made to women who have repeated miscarriages or premature pregnancies.

With this pathology, the cervix softens and shortens, becoming loose. Such a structure of the uterus in most cases does not allow the pregnancy to be carried out before the due date. This pathology often becomes the cause of infant mortality.

Many gynecologists note a close connection between isthmic-cervical insufficiency with the diseases of the mother. Thrush belongs to one of these pathologies.

For a newborn, untreated candidiasis in the mother during pregnancy is also dangerous due to the high risk of candidal stomatitis in the newborn. This pathology often appears in the second week of a baby's life, causes him a lot of trouble and complicates feeding. It is also possible damage to the eyes or the respiratory system of the newborn with Candida fungi.

A rare, but quite real complication of candidiasis in a pregnant woman is the penetration of infection into the body of the fetus and its vital organs, with consequences in the form of deformities or developmental pathologies. Usually, such a complication of thrush is possible when a woman's body is weakened due to various diseases, conditions or her asocial lifestyle.

That is why it is impermissible for pregnant women to ignore thrush.

How is candidiasis treated in pregnant women?

In no case should a woman independently engage in the treatment of candidiasis during the period of "interesting situation". Otherwise, the drugs used thoughtlessly can lead to serious changes in the fetus.

Therefore, when treating thrush, a pregnant woman has her own limitations in the selection of medicines. The main principles for the selection of therapy for candidiasis during pregnancy are the criteria:

• safety for the unborn baby and mother;
• low toxicity and absorption;
• minimum side effects;
• maximum microbial activity.

For the treatment of candidiasis in pregnant women, a number of antimycotics (antifungal drugs) of local and general effects are used. Pregnancy is the period in which local antimycotics are predominantly prescribed with a minimum degree of absorption.

With candidiasis in pregnant women, antifungal drugs of the group are prescribed:

1. Polienov (such as Nystatin, Levorin, Pimafucin, etc.).
2. Triazolines (such as Fluconazole, Itraconaol, etc.)
3. Imidazolines (such as Clotrimazole, Ketoconazole, Miconazole, etc.)
4. Combined drugs (such as Pimafukort, Mikozhinaks, etc.).

The choice of a drug for the treatment of thrush should be dealt with by a doctor. He must also recommend treatment regimens. Spontaneous treatment for candidiasis is unacceptable. It is the doctor who should recommend to the pregnant woman the most effective and at the same time the safest treatment regimen for candidiasis for her.

Drugs for the treatment of candidiasis by trimester

Depending on the period of pregnancy, various medications are available for the treatment of thrush. With an uncomplicated course, they try to use local drugs that give minimal side effects for the woman's body and the unborn baby.

I trimester

With uncomplicated forms of thrush, it is sufficient to use Clotrimazole in the form of a cream in a dose of 500 mg (often even a single dose).

For systemic (general) treatment for this period of pregnancy, drugs are more often used: Pimafucin, Viferon.

• Pimafucin is considered a first-line (leading) drug during this period. It is considered to be minimally toxic to the fetus. The effectiveness of this drug is usually high, although it is imperative to take into account the sensitivity of microorganisms in the patient. Most often, Pimafucin is taken according to the scheme and calculation: 1 tablet 4 times a day for a course of 10-20 days.
• Viferon is also used in the first trimester. This antiviral drug serves to maintain the immunity of a pregnant woman and is used 2 times a day for 5-10 days (or longer, if the doctor decides) rectally. Viferon is perfectly compatible with any antifungal drugs.

II and III trimesters

At this stage of pregnancy, in addition to Pimafucin and Viferon, drugs are used: Nystatin, Fluconazole.

The drugs Pimafucin and Viferon can also be used in the second and third trimesters as priorities.

Nystatin is more often used for candidiasis of the oral cavity, esophagus and intestines. It is used when first-line drugs are ineffective. The drug has insignificant absorption from the stomach and intestines, and basically eliminates candidal foci, localization in the digestive tract.

When prescribing Nystatin, the doctor must be sure that the benefits of treatment with this drug for the mother's body outweigh the risk to the fetus.

The treatment regimens for Nystatin may be different, but the daily dose should not be higher than 6 million units.

Fluconazole is used as a tablet (usually 150 mg by mouth) and as an intravenous injection. The form of administration is selected in accordance with the prevalence of pathology, the degree of tissue damage and the form of the disease.

Fluconazole tablets or capsules are used for vulvovaginal candidiasis or lesions of the digestive tract.

Fluconazole in a solution of 100 and 200 ml is used intravenously and only in a hospital.

An approximate treatment regimen for urogenital candidiasis in the II and III trimesters can be:

1. Topically: Pimafucin, Clotrimazole or Terzhinan in the form of vaginal tablets, cream or suppositories for 10-12 days.
2. Immunocorrective therapy: Viferon (suppositories) 2 times a day for 10 days in the II trimester and 10 days in the III trimester with control (smear on flora or gynecological culture) after 2 weeks.

Additional medicines

Antifungal drugs are quite toxic even to the body outside of pregnancy. If they have to be used during pregnancy, then the doctor is obliged to protect the woman's body as much as possible, thanks to the parallel appointment of probiotics and vitamins.

Probiotics allow you to normalize bowel function, creating unfavorable conditions for the reproduction of the causative agent of thrush. Often it is the gastrointestinal tract that serves as the "factory" for the production of candida.

As pre- or probiotics, drugs such as Linex, Hilak forte, Bifiform, Laktiale, Maksilaka, Enterojermina, etc. are used.

Vitamin complexes are prescribed to most women for the purpose of an additional source of vitamins and microelements, as well as for the prevention of certain congenital fetal anomalies (such as a defect in the breathing tube, etc.) In the treatment of candidiasis, these drugs also prevent the harmful effects of antifungal drugs on the woman's body and the fetus.

Among multivitamin complexes, drugs such as Elevita Pronatal, Fembion Natalkea (I or II), Vitrum Prenatal are more often used.

Memo for pregnant women in the treatment of candidiasis

In the treatment of candidiasis, the behavior of the pregnant woman herself is important. The effectiveness of the treatment of thrush largely depends on this. Important points of behavior of a pregnant woman are:

• Compliance with daily hygiene measures: daily change of linen (underwear and bed linen), washing in hot water and ironing.
• Daily wet cleaning of premises with ventilation.
• Exclusion of sexual activity during the treatment of thrush.
• Exclusion of sweet and flour products, limitation of dairy dishes (except for fermented milk), taking fish and meat dishes, seasonal vegetables and fruits as the basis of the menu.
• It is also important to get treatment for the partner of the pregnant woman. This will increase the effectiveness of candidiasis treatment. In this case, the man is allowed more drugs than his pregnant partner. The choice of drugs and the calculation of their dose should be dealt with by a doctor. Usually, the partner is given the simultaneous administration of topical and systemic medications.

The prognosis for systemic candidiasis in a pregnant woman is serious and depends on the timeliness and quality of treatment. Treatment of candidiasis should be systemic and last until the complete elimination of symptoms and negative test results. And even if the tests are negative and the treatment turned out to be as effective as possible, you should not relax.

Candidiasis very often has a recurrent course and can return when any imbalance appears in the body. However, you should not panic when detecting candidiasis in a pregnant woman. With a timely visit to a doctor and strict compliance with all the instructions, most women manage to quickly get rid of thrush, while maintaining their own health and their baby's.

According to statistics from the World Health Organization, 75% of women experience vaginal candidiasis at least once in their lives. Thrush during pregnancy is not uncommon - this is a risky period when a chronic infection may worsen or a new one may appear. Most often, she begins to bother with the approach of the moment of childbirth. Are there ways to deal with fungus safely and effectively? What is the threat of lack of treatment?

Progesterone works to maintain pregnancy, but it also reduces immunity. Therefore, up to 50% of women in the 3rd trimester, when the concentration of the hormone reaches maximum concentrations, go to the doctor with complaints of cheesy discharge. If treatment is started on time, then there is a chance that by the time of delivery the vagina will be sanitized and it will be possible to avoid infection of the baby when passing through the birth canal.

Those who are planning a pregnancy and have not treated thrush should be aware of the possible danger to the fetus. Conception should be postponed until a period of remission or complete recovery.

Causes of pathology

The most common cause of thrush in pregnant women is the yeast-like fungi of the species Candida albicans. But in 5% of cases, candidiasis is caused by other fungi, of which there are a large number, but they are conditionally combined into the Candida non-albicans group. Their feature is resistance to drugs traditionally used in the treatment of candidiasis.

Candida non-albicans is more common in women with additional pathologies that dramatically reduce immunity. It can be:

• diabetes;
• HIV infection;
• oncological pathologies.

Fungi of the genus Candida are part of the normal microflora of the vagina, but are there in minimal concentrations. They like an environment rich in glycogen, which serves as the main substrate for their metabolism. But with a lack of glucose, mushrooms can switch to the processing of fatty acids, acetic and lactic acid.

Under normal conditions, candida reproduction is inhibited by the immune system. But with its weakening, fungi are able to multiply more actively. They usually do not penetrate deeper than the vaginal epithelium, which is the ideal environment. But with deep immunosuppression, candida can overcome the epithelial barrier, connective tissue and enter the bloodstream.

The following factors contribute to the onset of candidiasis:

• use of sanitary napkins;
• poor nutrition;
• change of sexual partner;
• uncontrolled antibiotic treatment.

Features of the development of thrush during pregnancy

During pregnancy, ideal conditions are created for the onset or recurrence of thrush. The woman's body works to preserve the fetus, but often against herself. The following factors contribute to the activation of the fungus.

• Estrogen Along with progesterone, an increase in the concentration of estrogen is noted during the period of gestation. This leads to an increased accumulation of glycogen in the vaginal epithelium. Glucose should serve as a breeding ground for lactobacilli, which play a protective role. But the fungus also feeds on the processing of glycogen.
• Immunity. A natural decrease in the body's defenses is necessary for bearing a child, which is 50% genetically foreign to the mother's body. But suppression of immunity leads to the activation of a latent infection.
• Vaginal environment. The increased blood flow to the genitals leads to an increase in temperature. Also, in pregnant women, the amount of vaginal discharge may increase. A warm and humid environment is ideal for fungal growth.

In non-pregnant women of reproductive age, the symptoms of thrush are pronounced, distressing and uncomfortable. In pregnant women, the disease is usually erased, but with frequent relapses.

Forms

Depending on the reactivity of the body, thrush can occur in several clinical forms.

• Carriage. Before pregnancy, this condition is considered a variant of the norm, but only in the absence of symptoms and detection of no more than 104 CFU / ml of fungi in the smear. In this case, the main flora should be represented by lactobacilli, there are no signs of inflammation. But such an analysis in the early stages of gestation should be a reason for increased attention.
• Vulvovaginal candidiasis... The disease is characterized by a pronounced clinical picture. More than 104 CFU / ml of Candida is found in the smear, lactobacilli are normal (more than 106 CFU / ml), other flora is not detected.
• Thrush and bacterial vaginitis... The disease is caused by a combined infection - a fungus and opportunistic flora. This form is most often observed during pregnancy: a decrease in immunity contributes to the reproduction of not only the fungus, but also the facultative flora.

Sometimes thrush is combined with bacterial vaginosis. Microorganisms create a special film on the surface of the vaginal mucosa, which protects them from the action of antibacterial agents.

By the nature of the course, three forms of thrush are distinguished.

1. Sharp. The disease occurs once, the duration of the disease does not exceed two months.
2. Chronic relapsing... There are more than four cases of exacerbation of thrush per year, despite treatment.
3. Persistent. The woman is worried about the persistent symptoms of thrush, periods of improvement are observed only with the use of antifungal drugs.

Symptoms

The main symptom of thrush is discharge. They can be curdled, milky, or creamy. The amount ranges from moderate to abundant. Leucorrhoea usually has a sour odor.

Itching and burning in pregnant women may be absent or insignificant. Sometimes women do not attach importance to them. Symptoms may worsen after intercourse or hygiene. Severe vaginal involvement is accompanied by dyspareunia. Sometimes the urethra is involved in the process, there is pain when urinating.

Dangerous complications

Thrush is dangerous during pregnancy with possible complications for the child and additional changes in the immune system. Fungi can be present in different forms - in the form of individual cells, filamentous forms. In response, B-lymphocytes are produced, which cannot produce specific immunoglobulins. Therefore, there is a gradual sensitization - an increase in sensitivity with the development of an allergic reaction.

Carrying out a pregnancy can be complicated by the following conditions:

• termination of pregnancy (in the 1st trimester);
• intrauterine infection;
• hypotrophy and low fetal weight;
• placental insufficiency;
• premature birth (late);
• early rupture of amniotic fluid;
• complications in childbirth (bleeding, trauma to the birth canal);
• infection of the baby during childbirth.

Women who have not received treatment for thrush during pregnancy are more likely to develop postpartum endometritis. Newborns infected by the mother may develop oral candidiasis. Girls have vulvovaginitis, and boys have balanoposthitis. The increase in the number of sick children has led to the fact that, according to German standards of therapy, all pregnant women diagnosed with candidiasis must undergo antifungal treatment.

Best diagnostic methods

Non-pregnant women often go to a doctor for symptoms of candidiasis themselves. But in pregnant women, the clinical picture can be erased, so an examination is necessary.

• Smear microscopy... Candidacy cannot be established using this method, but in the presence of symptoms, a smear can determine the presence of pseudomycelium of the fungus and individual cells. Associated flora and inflammatory response can also be identified.
• Cultural research... If there are symptoms of candidiasis, but there is no pathogen in the smear, then this method allows you to grow fungal colonies on a nutrient medium. The method allows to identify Candida non-albicans, as well as to determine its sensitivity to antifungal drugs. The disadvantage of this method is the long wait for the result - at least three days.
• PCR diagnostics. With its help, the DNA of the pathogen is detected in vaginal secretions. The method is highly sensitive and can be used in case of candidacy.

Modern real-time PCR technique allows not only to detect the genetic material of the pathogen, but also to determine its amount. This makes it possible to make the correct decision about the need for treatment.

Safe treatments

Treatment options for thrush during pregnancy are limited. It is necessary to take into account not only the sensitivity of the fungus to drugs, but also the risk of possible effects on the developing fetus. Medicines for thrush should have no teratogenic, toxic effects. Topical forms are used to reduce systemic exposure. Tablets are not used. But treatment should lead to full recovery in order to reduce the risk of thrush becoming a chronic process.

How to treat thrush during pregnancy can only be determined by a doctor, based on the diagnostic result and anamnesis. Most often, drugs of the following groups are used:

• polyene antibiotics- drugs with natamycin;
• imidazole derivatives- "Clotrimazole", "Miconazole", "Econazole";
• triazoles - Terconazole.

Clinical guidelines indicate the primary use in pregnant women of "Pimafucin" suppositories based on natamycin. They have a fungicidal effect and are not contraindicated for pregnant women at any time. Home treatment lasts three to six days. One suppository is used per day at night.

A good effect in the treatment of acute and chronic forms is given by "Clotrimazole". But its use is allowed only from the 2nd trimester. According to reviews, the elimination of itching occurs after the first use of suppositories.

Another drug from the group of imidazole derivatives is ketoconazole, on the basis of which "Livarol" suppositories are produced. But their use is also limited to the second to third trimesters. The duration of the course is seven days. But with chronic recurrent candidiasis, the duration can be changed up to 14 days.

After giving birth, your doctor may decide on additional therapy. For six months, once a week for prophylaxis, one suppository of natamycin is administered or once a month for a suppository of "Clotrimazole".

When candidiasis is combined with another nonspecific infection, combined drugs are used. From the second trimester, treatment is allowed:

• "Terzhinan";
• "Polygynax";
• "Neo-Penotran";
• "Klion-D".

A similar approach to therapy continues in the third trimester.

Douching with soda, herbs and other folk remedies for pregnant women is prohibited. Before laying suppositories, you can use antiseptic solutions (for mechanical removal of secretions):

• Miramistina;
• Chlorhexidine;
• Fluomisin;
• Betadine.

How to supplement therapy with diet

For the successful reproduction of yeast fungi, a nutritious substrate is needed - glucose. With a sufficient amount of it, they can synthesize the rest of the necessary substances and maintain an optimal state of the environment for themselves.

An increase in the concentration of glucose in the blood (hyperglycemia) leads to its increased accumulation in tissues. For the vaginal flora, an excess of glucose is just as harmful as a deficiency. The acidity of the environment changes, the protective properties decrease, the number of lactobacilli decreases. They are gradually replaced by conditionally pathogenic flora, in particular - candida.

Chronic hyperglycemia lowers local immunity, impairs the processes of mucous membrane restoration. During pregnancy, the negative effect is complemented by an excess of progesterone, corticosteroids, estrogen and a lack of insulin.

To increase the effectiveness of treatment, you need to deprive the fungus of the substrate for reproduction. This can be done by changing the food type. The diet for thrush should be based on the following rules.

• Prohibited foods... Simple carbohydrates, sugar-containing foods and fructose-based sweets, as well as alcohol, whole milk are excluded from the diet. Yeast-based products are prohibited - beer, kvass, baked goods. They contain maltose, which can be used by mushrooms along with glucose. Caffeinated drinks will dramatically increase blood glucose and should be avoided as well. The same applies to marinades, dyes, smoked meats, spicy dishes that irritate the digestive tract.
• The basis of the diet. Fermented milk products should be the main ones. They contain acidophilic flora, which changes the state of the intestinal biocenosis, affects immunity and helps restore the vaginal microflora. There should also be enough fresh vegetables and fruits rich in fiber.
• Antifungal products... They are able to influence the growth and reproduction of the fungus. First of all, fresh garlic. But it is used with caution in the presence of heartburn and gastritis, which is not uncommon during pregnancy.

The duration of the diet is at least three months without disruptions and indulgences. It must be combined with antimycotic treatment.

Before treating thrush during pregnancy, it is necessary to undergo a quality examination. If the cause of candidiasis is not Candida albicans, then this will require adjusting the therapy regimen in accordance with the sensitivity of microorganisms to antimycotic drugs.

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Thrush - this disease is well known to every third woman, which is "said" by statistics. The growth and reproduction of fungi such as Candida (Candida) provokes the development of this pathology, therefore, in medicine, thrush is called candidiasis. Pathology can also appear during pregnancy - more careful monitoring of the woman's condition and a more careful selection of medicines will be required.

Reasons for the development of thrush during pregnancy

We recommend reading:

There are two main reasons for the onset of symptoms of candidiasis during the period of bearing a child:

Doctors also differentiate some factors that can trigger the development of thrush:

• long-term use of antibacterial drugs (antibiotics) before conception - for example, if during pregnancy planning a woman was undergoing treatment for infectious or inflammatory diseases;
• chronic diseases characterized by frequent exacerbations - diabetes mellitus, iron deficiency anemia, pathological processes in the organs of the gastrointestinal tract and the endocrine system;
• a previously diagnosed chronic inflammatory process in the vagina - it is called colpitis, must be cured before conception occurs;
• regular violation of the food intake schedule, insufficient amount of vitamins and microelements entering the body - especially often diagnosed against the background of severe toxicosis.

Symptoms of thrush during pregnancy

The fungal disease in question has pronounced symptoms, which can be used to diagnose thrush in private:

1. Itching of the external genitals. This symptom is so pronounced that a woman becomes irritable, she is constantly nervous, and insomnia appears.
2. Increased discharge of leucorrhoea from the vagina. Their structure is pathologically changed - they look like thick milk or curd flakes, in some cases they can have a yellowish tint. note: leucorrhoea with thrush never have blood impurities.
3. Discomfort during intercourse. A woman will experience cramps, itching and even pain syndrome when the penis penetrates into the vagina, and when trying to have a full sexual intercourse, a strong spasm of the vaginal muscles may occur.
4. Burning sensation when urinating. This symptom is not typical, but some women notice discomfort immediately at the time of urine outflow.
5. Foul-smelling vaginal discharge. It has a sour tint and can only appear if the thrush remains untreated and develops without any hindrance.

In more detail about the symptoms of thrush - in the video review:

Diagnostic measures

Despite the overly pronounced symptoms and easy diagnosis, thrush during pregnancy must be confirmed by a gynecologist.

The doctor, already at the usual examination of the patient on the gynecological chair, will find all the signs of the fungal disease in question:

• the perineum will have redness, perhaps there will be traces of itching - scratched skin;
• on the walls of the vagina, fungi colonies are visually detected - in the form of a white dense plaque;
• the vulva (the entrance to the vagina) is swollen.

But not a single doctor will put an end to the diagnosis without a laboratory examination of a vaginal smear - spores of the Candida fungus will be found in it.

Treatment of thrush during pregnancy

If, in the normal state of a woman, the treatment of thrush can be carried out with the most powerful modern antifungal drugs, then during pregnancy, the therapy regimen should be individually selected.

Treatment of thrush during early pregnancy

It is most difficult to treat the disease in question in the first trimester of pregnancy - it is during this period that all organs and systems of the child are “laid down”. Fortunately, in the first three months of pregnancy, thrush is diagnosed very rarely - the hormonal background of the body is still corrected by nature, immunity remains at its usual level. But if symptoms of candidiasis appear, the doctor will definitely prescribe the following drugs:

• Pimafucin - 1 suppository per day for 6 days;
• Betadine - 1 candle per day for 6 days in a row.

This does not mean that you need to use both drugs for treatment - the doctor will choose one of the listed ones.

Suppositories from thrush during pregnancy in the 2nd and 3rd trimesters

In the second and third trimester, treatment can be carried out more extensively, and at the discretion of the gynecologist, the following antimycotics can be prescribed:

• Pimafucin - 6 candles;
• Betadine - 6 candles;
• Clotrimazole - 7 suppositories;
• Gino-Pevaril - 6 candles;
• Applicator vaginal Gynofort - once.

note: Treatment of thrush during pregnancy must be carried out fully. The fact is that some women stop the course of therapy immediately after the disappearance of severe symptoms - this happens on the 2-3 day of treatment. But the absence of symptoms is not an indicator of complete getting rid of the fungal disease - after a short time, the symptoms will resume, and even brighter.

A specialist tells more about modern methods of treating thrush during pregnancy:

Traditional methods

Traditional medicine can help relieve the symptoms of thrush, but it will never cure the disease. Therefore, doctors recommend using alternative treatment methods simultaneously with drug therapy. The most effective recipes:

• From 1 tablespoon of dry thyme or sage and 300 ml of water, prepare a decoction (cook in a water bath for at least 15 minutes) and wash it twice a day;
• brew dry oak bark (according to the principle of brewing ordinary tea) - use the resulting solution for washing once a day.

note: during pregnancy, it is strictly forbidden to douch without a gynecologist's prescription! And even if the pregnancy proceeds without complications and any peculiarities, and douching is recommended by a gynecologist as an auxiliary therapeutic agent, manganese, lemon juice and any aggressive substances cannot be used for the procedure.

As a folk remedy, you can use a baby cream with a few drops of tea tree oil. They lubricate the external genitalia, which helps to relieve irritation, reduce the swelling of the labia majora, and ensures that itching subsides. But keep in mind: make sure that the cream does not get on the mucous membrane of the vulva, because this can cause a strong allergic reaction or, at least, irritation and increased itching.

Features of the treatment of thrush during pregnancy

Pregnancy is a special condition of the female body, therefore, the treatment of the fungal disease in question should be carried out taking into account some of the nuances:

• the most effective and safe will be local treatment - suppositories, vaginal tablets, creams, applicators and gels;
• Of all the vaginal suppositories available in the "arsenal", Pimafucin is considered the safest - even their use in large quantities does not have a negative effect on the development of the fetus;
• the tablet form of drugs of the antimycotic group can be used strictly as prescribed by the gynecologist and only in the second or third trimester;
• some women, after the introduction of the first suppository, may experience a burning sensation in the vulva (the entrance to the vagina) - this is a physiological feature, it is not necessary to stop treatment.

Just undergoing a course of treatment for thrush and forgetting about the problem will not work:

note: when diagnosing thrush, the husband / partner of the pregnant woman must also undergo treatment - a fungal disease can be sexually transmitted.

Danger of thrush during pregnancy

Thrush poses a certain danger to women and children:

1. As a result of constant irritation of the vaginal mucosa and cervix, erosion of the latter may develop. This is fraught with a decrease in the elasticity of the cervical tissue, which provokes difficulties during childbirth: the uterus will open slowly and incompletely, cervical ruptures may appear, and in especially severe cases, a woman undergoes a cesarean section (operative / surgical delivery).
2. If thrush is not cured before childbirth, then when the child passes the birth canal, it becomes infected with a fungal disease. This leads to the development of thrush in the baby's oral cavity, which affects nutrition - he will not be able to suck on the breast or nipple due to severe pain.
3. Thrush, or rather a fungal infection, can spread throughout a woman's body. After all, medicine knows cases when this infection affects the umbilical cord connecting the fetus and the mother - this always leads to the death of the latter.

Thrush during pregnancy is classified as a dangerous disease - modern medicine has every opportunity to treat even advanced forms of this fungal disease. What is required of a woman:

• planning a pregnancy and undergoing a full examination before conception - this will eliminate chronic forms of candidiasis, conduct a full course of therapy;
• closely monitor your health during the period of bearing a child and when the first symptoms of thrush appear, immediately seek help from a gynecologist;
• fulfill all doctor's prescriptions and complete a full course of treatment without self-withdrawal of medications;
• regularly, throughout pregnancy, undergo control examinations for the "return" of candidiasis.

The considered fungal disease that occurs during pregnancy has a favorable prognosis - no complications, with proper treatment, the woman and the child are not diagnosed. After childbirth and the rehabilitation / recovery period (at least 5 months), candidiasis does not bother a woman.

Tsygankova Yana Aleksandrovna, medical columnist, therapist of the highest qualification category.

Is a type of fungal infection caused by fungi of the genus Candida (these are unicellular organisms, subdivided into more than 180 species), most often Candida albicans (Candida white).

Representatives of this type of microflora are classified as conditionally pathogenic microorganisms, that is, they are normally present in the human body in a certain small concentration. Fungi of the genus Candida are found on the skin and mucous membranes of healthy people.

Pregnancy is a state of natural immune depression in the body. Thus, nature allows the mother's body to bear the fetus (not to reject it, since the fetus is an independent, and therefore alien organism).

A decrease in immunity overtakes absolutely all pregnant women, but this manifests itself in everyone in different ways.

Candidiasis is very common and the most common form is vulvovaginal candidiasis. Within the framework of this article, we will consider the systemic manifestations of candidiasis, how the disease threatens you and your baby and what should be done about it, and we will talk about vulvovaginal candidiasis in the article "Thrush during pregnancy".

Causes of candidiasis during pregnancy

The risk factors for systemic and vulvovaginal candidiasis are largely similar, but we will keep in mind that systemic candidiasis is a much more severe condition.

Systemic candidiasis will NEVER develop against the background of normal immunity, therefore this condition is always an indicator of significant immunodeficiency. But thrush (vulvovaginal candidiasis) is a frequent companion of pregnancy.

Causes:

1) Natural immune suppression during pregnancy.

2) The presence of chronic diseases:

Chronic anemia (the lower the hemoglobin level, the weaker the woman's immunity, and the longer this state lasts without hemoglobin correction, the deeper the changes remain);

Chronic diseases of the cardiovascular and bronchopulmonary systems with the formation of circulatory failure and respiratory failure (some heart defects, pulmonary hypertension, arterial hypertension, bullae and bronchiectasis in the lungs);

Endocrine diseases (primarily in the risk group of women with diabetes mellitus, including gestational diabetes mellitus);

Tuberculosis, oncological diseases, chronic hepatitis;

HIV - infection (pregnancy for HIV - positive women should be a carefully planned step, since the changes in immunity can be very significant);

Current or past intravenous drug dependence.

3) Taking various medications:

Antibiotics

Glucocorticoid hormones (prednisone, metipred and others)

Immunosuppressants (for systemic rheumatological diseases, after organ and tissue transplantation, etc.)

4) Poor nutrition and digestive disorders. Excessive consumption of foods containing sugar and yeast contributes to the spread of fungal infections. Long-term constipation also contributes to this.

5) Unfavorable living conditions... High humidity and lack of ventilation in the room, irregular cleaning, lack of conditions for timely hygiene of a pregnant woman create the prerequisites for the spread of an infection that has already begun, since fungi willingly breed in a warm, humid environment (sweat and other secrets are a breeding ground)

Symptoms of candidiasis during pregnancy

1. Fungal deposits on the affected area (skin, mucous membranes, etc.), detected visually or by instrumental examination.

Plaques are represented by a dense, thick, curdled mass. A characteristic sour, unpleasant odor is determined, which is characterized by many as yeast. So there is itching of varying severity in the affected area.

The picture of esophageal candidiasis, detected with EGD

2. General symptoms (fever, manifestations of intoxication, weight loss, secondary allergization of the body).

3. Symptoms from the affected organ (signs of pneumonia, hepatitis, nephritis ...).

The effect of candidiasis on the fetus

The vast majority of people first encounter a fungal infection in the first year of life. A child's contact with an infection can occur through the amniotic fluid, the placenta and membranes, seeded with a fungus, during the passage of the birth canal (contact of the mucous membranes of the birth canal with the skin, the oral cavity of the child) and breastfeeding.

Possible consequences of candidiasis for the fetus:

- the threat of spontaneous abortion in the early stages (a high level of intoxication provokes an increase in the tone of the uterus);

- threatening premature birth for the same reason;

- delayed growth and development of the fetus (systemic intoxication disrupts the nutrition of the fetus, which entails the birth of low birth weight children with weak adaptive capabilities);

Intrauterine infection of the fetus occurs in the case of a widespread and / or untreated infection. This condition is serious and is characterized by the development of candidal sepsis in the fetus, even in the intensive care unit, such babies rarely survive. First of all, all therapeutic measures are aimed at preventing this condition;

Infection of the fetus with candida during childbirth is characterized by the development of candidiasis of the oral and nasal cavities, esophagus and skin (previously often "diaper dermatitis" was recorded, now it has been found that one of the reasons may be thrush in the mother);

The consequences of candidiasis during pregnancy for a woman

The accession of any bacterial infection always complicates the course of systemic candidiasis and often requires the use of drugs that are dangerous for pregnant women (mixed pneumonia, kidney damage, and so on);

Complications after a caesarean section (spread of infection, inconsistency of stitches, massive treatment after surgery, which may require the abolition of breastfeeding);

Complications in childbirth, the most formidable of which is the rupture of the uterus along the scar. If in the past there was a cesarean section or fibroid removal;

The risk of bleeding during childbirth and the postpartum period increases.

Diagnosis of candidiasis during pregnancy

1. Complaints, collection of anamnesis (information about past illnesses, operations and conditions, taking medications, etc.)
2. General examination (the presence of characteristic lesions of the skin, mucous membranes, nails, scalp)
3. Gynecological examination
4. Vaginal smear for flora
5. Crops from the skin and mucous membranes (the activity of the growth of the fungus and its sensitivity to various drugs are determined)
6. Complete blood count (we are interested in a systemic inflammatory reaction, which manifests itself in an increase in the number of leukocytes and acceleration of ESR)
7. Biochemical blood test (we evaluate the functions of organs and look at the level of C - reactive protein, which also reflects inflammation)
8. Culture of blood for sterility in the most severe cases
9. Radiography of the lungs, fibrogastroscopy, fibrobronchoscopy and other studies according to indications
10. Consultations of narrow specialists according to indications (infectious disease specialist, dermatologist, ophthalmologist, and so on)

By localization, candidiasis is distinguished

1) Focal

Urogenital (vulvovaginal candidiasis - thrush - in women, balanitis and balanoposthitis in men, which can be a source of infection for a partner, urethritis in both partners). However, candidiasis is not a sexually transmitted disease. A partner with candidiasis brings in his own flora and thereby causes dysbiosis in the partner's genital tract, thus intercourse can provoke thrush or worsen its course.

Candidiasis of the skin, appendages of the skin and mucous membranes (candidiasis of the corners of the mouth, tongue and tonsils, fungal infection of the nails and nail folds).

2) Generalized

Candidiasis spreads to the skin of the body, limbs, scalp, mucous membranes, nails are affected; the disease is difficult with the formation of granulomatous plaques in the affected area, anemia, fever and dyspeptic disorders.

3) Candidasepsis (spread of a fungal infection into the systemic circulation, this is a serious condition, there may be complications in the form of fungal pneumonia with respiratory failure, esophageal candidiasis and severe gastrointestinal disorders, candidiasis of the central nervous system, liver and kidneys).

4) Candidamikids (secondary allergic rashes that may appear with irrational treatment of focal candidiasis or frequent relapses).

5) Rare localizations (organs of vision, ENT - organs, musculoskeletal system, lymph nodes and pancreas).

6) Mixed infections (mixed - infections)

Combination with other fungi,
- a combination with a bacterial infection (tuberculous, staphylococcal, Protein, Pseudomonas aeruginosa),
- other.

By the depth of defeat

Superficial (after removing the plaque, the mucous membrane remains intact);

Deep (after removing the plaque, superficial damage remains, the mucous membrane looks smooth, red, it is eroded and vulnerable, and is more susceptible to secondary infection).

In the course of the disease

Acute candidiasis (clinical and laboratory cure within 7-14 days)
- protracted (with common lesions, cure is observed after 4 - 6 weeks from the start of treatment)

The severity of the process is determined depending on the volume and localization of the lesion, dysfunction of the affected organ, signs of general intoxication.

Treatment of candidiasis during pregnancy

Daily shower, frequent change of underwear and bed linen, exclusion of sexual intercourse during treatment are prerequisites. The room should be frequently wet cleaned and ventilated to reduce contamination by fungus. Hygiene is also the basis for the prevention of candidiasis during pregnancy.

Eliminate the consumption of foods containing sugar and yeast. Food should be rational and complete, the basis should be lean meat, fish, seasonal vegetables and fruits, various cereals (except semolina). Recently, the benefits of consuming dairy products have been discussed, at least one should not get too carried away with them.

With systemic candidiasis, treatment is much more difficult to choose than with local - thrush, it is required to use medications for oral administration, safe for the child and effective in the mother.

Medication for candidiasis during pregnancy

I trimester

Pimafucin (Natamycin)

Pimafucin tablets (1 tablet 4 times a day for 10 - 20 days). This is the only systemic drug used in the first trimeter of pregnancy and is a first-line drug. Data on toxic effects on the fetus have not been established. The effectiveness of treatment depends on the sensitivity of the microorganisms.

Viferon

It is used to treat common candidiasis, starting from the first trimester. Viferon in a dosage of 500 thousand units is applied 2 times a day rectally for 5-10 days, the duration of treatment can be significantly increased under the supervision of a physician. Combines with all antifungal drugs.

II trimester, III trimester

Nystatin

Nystatin tablets are used according to strict indications and the ineffectiveness of first-line drugs (candidiasis of the esophagus, oral cavity, intestines). The drug is little absorbed from the gastrointestinal tract and affects only the foci of candidiasis located along the digestive tract. But the intended benefit to the mother must outweigh the risk to the fetus. Treatment regimens are very different, the maximum dosage reaches 6 million units. The selection of the scheme should be carried out exclusively by the doctor, perhaps a joint decision of the obstetrician - gynecologist and infectious disease specialist on the appointment of the drug.

Fluconazole (Diflucan, Flucorus, Medoflucan, Fluomabol)

The drug is used in tablets and in the form of intravenous infusion. The choice of the form of administration of the drug is carried out depending on the prevalence, shape and depth of the lesion.

Fluconazole 150 mg (capsules, tablets) is used for candidiasis of the digestive tract and vulvovaginal candidiasis, the frequency of administration and duration of therapy will be determined by your doctor.

Fluconazole in solution (200 mg in 100 ml) is used intravenously, exclusively in stationary conditions, the duration of therapy will be determined by your doctor.

Pimafucin and Viferon can be used at any stage of pregnancy as first-line drugs.

Additional drug treatment

Multivitamins for pregnant women (Elevit Pronatal, Vitrum Prenatal, Femibion ​​Natalkea I or II, depending on the duration of pregnancy)

Preparations of pre- and probiotics (bifidumbacterin, bifidin, linex, hilak - forte, bifiform, maksilak) to normalize intestinal function, which is one of the breeding grounds for thrush fungi.

Partner treatment.

To lessen the fungal load, your partner should be treated as well. Men are prescribed local preparations in the form of creams and systemic (tablets, and in severe cases, solutions) to destroy the focus of infection in the intestine. For men, the choice of drugs is not as limited as for pregnant women, however, only a doctor will select an effective treatment. The haphazard use of drugs can lead to the formation of resistance of fungi and then it will be much more difficult to cope with them. Especially if the partner "shares" the microflora with the expectant mother.

Forecast

With systemic candidiasis, the prognosis is always serious, therefore, a lot depends on the timeliness of treatment, the regularity of observation in the antenatal clinic and careful observance of the recommendations of your doctor. Take care of yourself and be healthy!

Obstetrician-gynecologist A.V. Petrova