妊娠晚期阴道菌群与妊娠结局的关系
摘要
目的
通过对妊娠晚期孕妇阴道菌群的研究,探讨阴道菌群的分布情况,及其与不良妊娠结局的关系,指导今后合理的进行检查及治疗思路,减少不良妊娠结局的发生。
方法
对我院1280例妊娠晚期孕妇产前常规进行阴道假丝酵母菌、滴虫、细菌性阴道病(BV)、衣原体、淋菌检查,部分病例同时行白带需氧菌培养。共筛检出阳性患者204例,根据自觉症状有无分为有症状组91例和无症状组113例,同时随机选取200例上述检查阴性者做为正常对照组,比较三组不良妊娠结局发生情况。
结果
1、有症状组与无症状组在胎膜早破、产褥感染、新生儿感染及病理性黄疸方面有显著差异(P<0.05),而在早产、低出生体重儿发生率方面差异无统计学意义(P>0.05)。
2、有症状组与正常对照组相比较,胎膜早破、产褥感染及新生儿感染发生率显著升高(P<0.05),而在早产、低出生体重儿及新生儿病理性黄疸发生率方面无显著差异(P>0.05)。
3、无症状组与正常对照组在上述不良母儿结局方面均无显著差异(P>0.05)。
结论
1.妊娠晚期阴道菌群失调与不良妊娠结局密切相关。
2.有症状者更易引发不良妊娠结局,必须重视孕妇阴道局部症状。
3.为减少不良妊娠的发生,建议对有症状的孕妇进行针对性的检查和治疗；而对无症状孕妇不建议进行常规筛查和治疗。
Objective:
To investigate the correlation ship of vaginal microflora in the third-trimester and adverse outcomes of pregnancy.
Methods:
There were1280cases of pregnant women in our hospital who were in the third-trimester taken prenatal routine vaginal candida, trichomonas, bacterial vaginosis (BV), chlamydia and gonococcal check, some of them gotten aerobic training of vaginal discharge.204cases showed abnormal pathogenes, then further divided them into two groups:symptomatic group(91cases) and asymptomatic group(113cases), while200negtive patients were randomly selected as control group, and compared these three groups on adverse outcomes.
Results:
1、Symptomatic group and asymptomatic group had significant differences in premature rupture of membranes, puerperal infection, neonatal infection and neonatal jaundice (P<0.05), while there were no significant differences in premature delivery, caesarean section rates, fetal distress and the incidence of low birth weight infants (P>0.05).
2、On the items of premature rupture of membranes, puerperal infection and neonatal infection rate, symptonmatic group was significantly higher than control group (P<0.05). While in the premature labor, cesarean section rate, fetal distress, low birth weight infants and the incidence of neonatal jaundice were no significant differences (P>0.05).3. There were no significant differences in the above adverse pregnancy outcomes between asymptomatic group and control group (P>0.05).
Conclusion:
Vaginal microbial disturbances in the third-trimester were closely associated with adverse outcomes, particularly those who were with symptoms should conduct a comprehensive examination and aggressive treatment to reduce the incidence of adverse pregnancy outcomes.
通过对妊娠晚期孕妇阴道菌群的研究,探讨阴道菌群的分布情况,及其与不良妊娠结局的关系,指导今后合理的进行检查及治疗思路,减少不良妊娠结局的发生。
方法
对我院1280例妊娠晚期孕妇产前常规进行阴道假丝酵母菌、滴虫、细菌性阴道病(BV)、衣原体、淋菌检查,部分病例同时行白带需氧菌培养。共筛检出阳性患者204例,根据自觉症状有无分为有症状组91例和无症状组113例,同时随机选取200例上述检查阴性者做为正常对照组,比较三组不良妊娠结局发生情况。
结果
1、有症状组与无症状组在胎膜早破、产褥感染、新生儿感染及病理性黄疸方面有显著差异(P<0.05),而在早产、低出生体重儿发生率方面差异无统计学意义(P>0.05)。
2、有症状组与正常对照组相比较,胎膜早破、产褥感染及新生儿感染发生率显著升高(P<0.05),而在早产、低出生体重儿及新生儿病理性黄疸发生率方面无显著差异(P>0.05)。
3、无症状组与正常对照组在上述不良母儿结局方面均无显著差异(P>0.05)。
结论
1.妊娠晚期阴道菌群失调与不良妊娠结局密切相关。
2.有症状者更易引发不良妊娠结局,必须重视孕妇阴道局部症状。
3.为减少不良妊娠的发生,建议对有症状的孕妇进行针对性的检查和治疗；而对无症状孕妇不建议进行常规筛查和治疗。
Objective:
To investigate the correlation ship of vaginal microflora in the third-trimester and adverse outcomes of pregnancy.
Methods:
There were1280cases of pregnant women in our hospital who were in the third-trimester taken prenatal routine vaginal candida, trichomonas, bacterial vaginosis (BV), chlamydia and gonococcal check, some of them gotten aerobic training of vaginal discharge.204cases showed abnormal pathogenes, then further divided them into two groups:symptomatic group(91cases) and asymptomatic group(113cases), while200negtive patients were randomly selected as control group, and compared these three groups on adverse outcomes.
Results:
1、Symptomatic group and asymptomatic group had significant differences in premature rupture of membranes, puerperal infection, neonatal infection and neonatal jaundice (P<0.05), while there were no significant differences in premature delivery, caesarean section rates, fetal distress and the incidence of low birth weight infants (P>0.05).
2、On the items of premature rupture of membranes, puerperal infection and neonatal infection rate, symptonmatic group was significantly higher than control group (P<0.05). While in the premature labor, cesarean section rate, fetal distress, low birth weight infants and the incidence of neonatal jaundice were no significant differences (P>0.05).3. There were no significant differences in the above adverse pregnancy outcomes between asymptomatic group and control group (P>0.05).
Conclusion:
Vaginal microbial disturbances in the third-trimester were closely associated with adverse outcomes, particularly those who were with symptoms should conduct a comprehensive examination and aggressive treatment to reduce the incidence of adverse pregnancy outcomes.
引文
[1]解亚斌,宋迎春,田雪梅,等.围生期下生殖道感染与妊娠结局的研究[J].中国妇幼保健,2007,22(4)：509
[2]李兰娟,主编.感染微生态学[M].人民卫生出版社,2002：422-424.
[3]肖冰冰,张岱,廖秦平,等.妊娠期阴道菌群的微生态评价[J].中国妇产科临床杂志,2007,8(6)：414
[4]凌秀凤.外阴阴道念珠菌感染研究进展[J].国外医学.妇幼保健分册,2003,14(3)：153-155
[5]Jeff M. Denney, Jennifer F. Culhane, Bacterial vaginosis:A problematic infection from both a perinatal and neonatal perspective[J]. Seminars in Fetal & Neonatal Medicine.2009,14(4):200-203
[6]FITZROY A. ORRETT. Colonization with Group B streptococci in pregnancy and outcome of infected neonates in Trinidad[J]. Pediatrics International.2003,45(3): 319-323.
[7]Phillip Hay, Andrew E. Czeizel,Asymptomatic trichomonas and candida colonization and pregnancy outcome[J]. Best Practice & Research Clinical Obstetrics and Gynaecology 2007,21(3):403-409.
[1]李兰娟,主编,感染微生态学[M].人民卫生出版社,2002：422-424
[2]石一复.重视阴道微生态与阴道炎诊治的关系[J].中华妇产科杂志,2009,4(1)：3
[3]樊璐,吴佳聪,任慕兰.妊娠期女性阴道微生态状况的分析[J].江苏医药,2011,37(2)：205-207
[4]肖冰冰,张岱,廖秦平,等.妊娠期阴道菌群的微生态评价[J].中国妇产科临床杂志,2007,8(6)：414。
[5]Romero R,Avila C,Sepulveda W.The role of systemic and intraute-rine infection in preterm labor.In:Fuchs AR,Fuchs F,Stubblefield PG,et al.Preterm birth:cause, prevention, and ma-nagement[M].2nded.McGraw Hill,1993:97-136.
[6]皮丕湘,陈伟梅.妊娠期生殖道感染与妊娠并发症及结局分析[J].医学临床研究,2006,23(8)：1237-1238
[7]Kamara P, HyltonKong T, Brathwaite A, et al. Vaginal infectionsin pregnant women in Jamaica:prevalence and risk factors. Int J STD AIDS,2000,11: 516-520
[8]谷晔红,吴连方.阴道假丝酵母菌感染母婴传播及预后[J].中国实用妇科与产科杂志,2005,21(6)：342
[9]黄艳丽.沙眼衣原体感染与妊娠结局的临床观察[J].中华医院感染学杂志,2001,11(2)：111-112.
[10]Magaly M Blas, Fredy A Canchihuaman, Isaac E Alva,et al. Pregnancy outcomes in women infected with Chlamydia trachomatis:a population-based cohort study in WashingtonState[J]. Sex Transm Infect,2007,83(4)314-318.
[11]方嵘,胡庆伟,潘立瑾.妊娠合并衣原体、支原体感染的母婴结局分析[J].浙江医学,2009,31(5)：708
[12]Kekki M, Kurki T, Kotomaki T,et al.Cost-effectiveness of screening and treatment for bacterial vaginosis in early pregnancy among women at low risk for preterm birth[J].Acta Obstet Gynecol Scand,2004,83 (1):27-36.
[13]Larsson P-G,Platz-Christensen JJ.Enumeration of clue cells in rehydrated air-dried vaginal wet smears for the diagnosis of bacterial vaginosis[J].Obstet Gynecol,1990,76:727-730
[14]Leitich H, Bodner-Adler B, Brunbauer M, et al. Bacterial vaginosisas a risk factor for preterm delivery; a meta-analysis[J].Am J Obstet Gynecol,2003,189: 139-147.
[15]Donde GGG, Vereecken A, B osmans E, et al. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis:aerobic-vaginitis[J]. Br J Obstet Gynaecol,2002,109(1):34-43.
[16]薛凤霞.需氧菌性阴道炎的诊治进展[J].实用妇产科杂志,2010,26(2)：83-85.
[17]贺晶,韩秀君.B族链球菌感染的母婴传播及其预后[J].中国实用妇科与产科杂志,2005,21(6)343-345.
[18]曹泽毅,主编,中华妇产科学临床版[M].人民卫生出版社,2010：234-236
[19]Phillip Hay, Andrew E. Czeizel,Asymptomatic trichomonas and candida colonization and pregnancy outcome[J]. Best Practice & Research Clinical Obstetrics and Gynaecology 2007,21(3):403-409
[20]Jeff M. Denney,Jennifer F. Culhane, Bacterial vaginosis:A problematic infection from both a perinatal and neonatal perspective[J]. Seminars in Fetal & Neonatal Medicine.2009,14(4):200-203
[2]李兰娟,主编.感染微生态学[M].人民卫生出版社,2002：422-424.
[3]肖冰冰,张岱,廖秦平,等.妊娠期阴道菌群的微生态评价[J].中国妇产科临床杂志,2007,8(6)：414
[4]凌秀凤.外阴阴道念珠菌感染研究进展[J].国外医学.妇幼保健分册,2003,14(3)：153-155
[5]Jeff M. Denney, Jennifer F. Culhane, Bacterial vaginosis:A problematic infection from both a perinatal and neonatal perspective[J]. Seminars in Fetal & Neonatal Medicine.2009,14(4):200-203
[6]FITZROY A. ORRETT. Colonization with Group B streptococci in pregnancy and outcome of infected neonates in Trinidad[J]. Pediatrics International.2003,45(3): 319-323.
[7]Phillip Hay, Andrew E. Czeizel,Asymptomatic trichomonas and candida colonization and pregnancy outcome[J]. Best Practice & Research Clinical Obstetrics and Gynaecology 2007,21(3):403-409.
[1]李兰娟,主编,感染微生态学[M].人民卫生出版社,2002：422-424
[2]石一复.重视阴道微生态与阴道炎诊治的关系[J].中华妇产科杂志,2009,4(1)：3
[3]樊璐,吴佳聪,任慕兰.妊娠期女性阴道微生态状况的分析[J].江苏医药,2011,37(2)：205-207
[4]肖冰冰,张岱,廖秦平,等.妊娠期阴道菌群的微生态评价[J].中国妇产科临床杂志,2007,8(6)：414。
[5]Romero R,Avila C,Sepulveda W.The role of systemic and intraute-rine infection in preterm labor.In:Fuchs AR,Fuchs F,Stubblefield PG,et al.Preterm birth:cause, prevention, and ma-nagement[M].2nded.McGraw Hill,1993:97-136.
[6]皮丕湘,陈伟梅.妊娠期生殖道感染与妊娠并发症及结局分析[J].医学临床研究,2006,23(8)：1237-1238
[7]Kamara P, HyltonKong T, Brathwaite A, et al. Vaginal infectionsin pregnant women in Jamaica:prevalence and risk factors. Int J STD AIDS,2000,11: 516-520
[8]谷晔红,吴连方.阴道假丝酵母菌感染母婴传播及预后[J].中国实用妇科与产科杂志,2005,21(6)：342
[9]黄艳丽.沙眼衣原体感染与妊娠结局的临床观察[J].中华医院感染学杂志,2001,11(2)：111-112.
[10]Magaly M Blas, Fredy A Canchihuaman, Isaac E Alva,et al. Pregnancy outcomes in women infected with Chlamydia trachomatis:a population-based cohort study in WashingtonState[J]. Sex Transm Infect,2007,83(4)314-318.
[11]方嵘,胡庆伟,潘立瑾.妊娠合并衣原体、支原体感染的母婴结局分析[J].浙江医学,2009,31(5)：708
[12]Kekki M, Kurki T, Kotomaki T,et al.Cost-effectiveness of screening and treatment for bacterial vaginosis in early pregnancy among women at low risk for preterm birth[J].Acta Obstet Gynecol Scand,2004,83 (1):27-36.
[13]Larsson P-G,Platz-Christensen JJ.Enumeration of clue cells in rehydrated air-dried vaginal wet smears for the diagnosis of bacterial vaginosis[J].Obstet Gynecol,1990,76:727-730
[14]Leitich H, Bodner-Adler B, Brunbauer M, et al. Bacterial vaginosisas a risk factor for preterm delivery; a meta-analysis[J].Am J Obstet Gynecol,2003,189: 139-147.
[15]Donde GGG, Vereecken A, B osmans E, et al. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis:aerobic-vaginitis[J]. Br J Obstet Gynaecol,2002,109(1):34-43.
[16]薛凤霞.需氧菌性阴道炎的诊治进展[J].实用妇产科杂志,2010,26(2)：83-85.
[17]贺晶,韩秀君.B族链球菌感染的母婴传播及其预后[J].中国实用妇科与产科杂志,2005,21(6)343-345.
[18]曹泽毅,主编,中华妇产科学临床版[M].人民卫生出版社,2010：234-236
[19]Phillip Hay, Andrew E. Czeizel,Asymptomatic trichomonas and candida colonization and pregnancy outcome[J]. Best Practice & Research Clinical Obstetrics and Gynaecology 2007,21(3):403-409
[20]Jeff M. Denney,Jennifer F. Culhane, Bacterial vaginosis:A problematic infection from both a perinatal and neonatal perspective[J]. Seminars in Fetal & Neonatal Medicine.2009,14(4):200-203