妊娠晚期女性B族链球菌携带情况及对母婴妊娠结局的影响
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摘要
目的观察妊娠晚期女性B族链球菌携带情况及对母体和胎儿妊娠结局的影响。方法以温州中西医结合医院2016年12月—2018年12月就诊的966例妊娠晚期女性为研究对象,均进行阴道及直肠分泌物B族链球菌检测,观察B族链球菌携带情况,跟踪妊娠结局,统计不同组研究对象母体和胎儿妊娠结局水平差异。结果本研究全部966例受试者GBS感染率为9.52%,不同年龄、流产史和生育史受试者GBS感染率差异均无统计学意义(均P>0.05);GBS阳性未干预组胎膜早破、羊膜炎、宫内感染、产褥感染、新生儿感染、胎儿窘迫和新生儿窒息发生率均显著高于GBS阴性组水平(均P<0.05),而GBS阳性干预组羊膜炎、宫内感染、产褥感染、新生儿感染、胎儿窘迫和新生儿窒息发生率均显著低于GBS阳性未干预组水平(均P<0.05),且GBS阳性干预组在羊膜炎、宫内感染和新生儿感染发生率均显著高于GBS阴性组水平(均P<0.05);3组受试者新生儿Apgar评分、早产、剖宫产和产后出血发生率差异不具有统计学意义(均P>0.05)。结论妊娠晚期孕妇GBS感染可导致胎膜早破、羊膜炎、宫内感染、产褥感染、新生儿感染、胎儿窘迫和新生儿窒息等母体和胎儿不良妊娠结局发生率增加,实施抗菌药物预防性治疗可在一定程上降低母婴不良妊娠结局发生率,妊娠晚期孕妇进行产前GBS筛查,具有较高的临床价值。
Objective To observe the carriage of group B streptococcus(GBS) in pregnant women and its effect on the pregnancy outcome of the mother and fetus. Methods A total of 966 cases of late pregnancy women were as research subjects. Vaginal and rectal secretion of GBS were detected in all subjects. The carrying status of GBS were observed. The pregnancy outcomes of different groups were traced. The difference of pregnancy outcome between the maternal and fetal groups was analyzed statistically. Results The GBS infection rate of all 966 subjects in this study was 9.52%, and there was no significant difference in the rate of GBS infection among the subjects of different ages, abortion history and reproductive history(all P>0.05). The incidence of premature rupture of membranes, amnionitis, intrauterine infection, puerperium infection, neonatal infection, fetal distress and neonatal asphyxia were significantly higher in GBS positive group than in the GBS negative group(all P<0.05). The incidence of amnionitis, intrauterine infection, puerperium infection, neonatal infection, fetal distress and neonatal asphyxia in GBS positive intervention group were significantly lower than that of GBS positive group(all P<0.05). The incidence of amniotic inflammation, intrauterine infection and neonatal infection in GBS positive intervention group was significantly higher than that in GBS negative group(all P<0.05). There was no significant difference in the Apgar score, preterm delivery, cesarean section and postpartum hemorrhage between the three groups(all P>0.05). Conclusion GBS infection in pregnant women in late pregnancy can lead to premature rupture of membranes, amnionitis, intrauterine infection, puerperal infection, neonatal infection, fetal distress and neonatal asphyxia. The incidence of maternal and fetal adverse pregnancy outcomes is increased. The incidence of maternal and infant undesirable pregnancy outcomes can be reduced on a certain course and late pregnancy in the late pregnancy by the implementation of antibiotic prophylactic treatment. Prenatal GBS screening for pregnant women is of high clinical value.
Objective To observe the carriage of group B streptococcus(GBS) in pregnant women and its effect on the pregnancy outcome of the mother and fetus. Methods A total of 966 cases of late pregnancy women were as research subjects. Vaginal and rectal secretion of GBS were detected in all subjects. The carrying status of GBS were observed. The pregnancy outcomes of different groups were traced. The difference of pregnancy outcome between the maternal and fetal groups was analyzed statistically. Results The GBS infection rate of all 966 subjects in this study was 9.52%, and there was no significant difference in the rate of GBS infection among the subjects of different ages, abortion history and reproductive history(all P>0.05). The incidence of premature rupture of membranes, amnionitis, intrauterine infection, puerperium infection, neonatal infection, fetal distress and neonatal asphyxia were significantly higher in GBS positive group than in the GBS negative group(all P<0.05). The incidence of amnionitis, intrauterine infection, puerperium infection, neonatal infection, fetal distress and neonatal asphyxia in GBS positive intervention group were significantly lower than that of GBS positive group(all P<0.05). The incidence of amniotic inflammation, intrauterine infection and neonatal infection in GBS positive intervention group was significantly higher than that in GBS negative group(all P<0.05). There was no significant difference in the Apgar score, preterm delivery, cesarean section and postpartum hemorrhage between the three groups(all P>0.05). Conclusion GBS infection in pregnant women in late pregnancy can lead to premature rupture of membranes, amnionitis, intrauterine infection, puerperal infection, neonatal infection, fetal distress and neonatal asphyxia. The incidence of maternal and fetal adverse pregnancy outcomes is increased. The incidence of maternal and infant undesirable pregnancy outcomes can be reduced on a certain course and late pregnancy in the late pregnancy by the implementation of antibiotic prophylactic treatment. Prenatal GBS screening for pregnant women is of high clinical value.
引文
[1] 梅艳,张萍,金敏菲,等.妊娠相关B族链球菌感染的研究进展[J].中华围产医学杂志,2017,20(12):895-898.
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[10] 李洪英,沈亚娟,余俊峰,等.妊娠期妇女B族链球菌感染对母儿预后影响的研究[J].中国实用妇科与产科杂志,2017,33(8):850-852.
[11] 徐一鸣,韩宁,刘琰,等.孕妇生殖道B族链球菌感染对妊娠结局的影响研究[J].中华医院感染学杂志,2016,26(9):2128-2130.
[12] 刘荃,汤晓忠,韦芳琴.妊娠晚期B族链球菌携带对妊娠结局的影响[J].中国妇幼保健,2014,29(21):3411-3413.
[13] 米阳,王艳霞,郭娜,等.孕妇生殖道B族链球菌感染对母儿预后的影响研究[J].中国妇幼保健,2015,30(7):1065-1066.
[14] 陈小平,王惠姣,俞北伟,等.B族链球菌产前筛查在母婴感染防控中的应用[J].检验医学,2016,31(4):266-269.
[15] 杨振莉,姜贻乾,来汉江.孕妇B族链球菌感染对母婴结局的影响分析[J].浙江医学,2018,40(7):709-711,716.
[16] 李仲瑞.妊娠晚期孕妇B族链球菌带菌对妊娠结局的影响[J].中国实用医药,2015,10(14):130-131.
[17] 韦艳芬,张珊珊,廖少霞,等.B族链球菌筛查与治疗对妊娠结局的影响[J].广西医科大学学报,2018,35(3):356-359.
[18] KENCHINGTON A L,LAMONT R F.Group B streptococcal immunisation of pregnant women for the prevention of early and late onset Group B streptococcal infection of the neonate as well as adult disease[J].Expert Rev Vaccines,2017,16(1):15-25.
[2] 江敏,汪伟山.孕妇B族溶血性链球菌带菌状况与母婴预后的研究[J].中华全科医学,2012,10(4):506,623.
[3] 黄树峰,朱艳宾,薛凤霞.孕晚期女性感染B族链球菌对新生儿影响的研究[J].中国妇幼保健,2014,29(21):3415-3417.
[4] 鲜恩英,付振琳,何春华,等.1000例产前B族链球菌筛查的临床分析[J].重庆医学,2017,46(14):1986-1988.
[5] 杨林东,杨露,孙丽洲.围生期新生儿不同血清型B族链球菌感染及其预防研究现状[J].中华妇幼临床医学杂志(电子版),2017,13(6):621-626.
[6] 骆俏珍,陈健.孕晚期妇女B族溶血性乳链球菌感染对妊娠及新生儿结局的影响[J].中国性科学,2017,26(12):108-110.
[7] 郑丽君,王云霞,易辉,等.孕妇妊娠早期生殖道GBS筛查及干预对围产结局的影响[J].国际检验医学杂志,2017,38(6):818-819.
[8] 王莉钦,吴兰芬,韦云龙.孕期生殖道B族溶血性链球菌感染检测的临床意义[J].中华医院感染学杂志,2014,24(7):1763-1765.
[9] KWATRA G,CUNNINGTON M C,MERRALL E,et al.Prevalence of maternal colonisation with group B streptococcus:a systematic review and meta-analysis[J].Lancet Infect Dis,2016,16(9):1076-1084.
[10] 李洪英,沈亚娟,余俊峰,等.妊娠期妇女B族链球菌感染对母儿预后影响的研究[J].中国实用妇科与产科杂志,2017,33(8):850-852.
[11] 徐一鸣,韩宁,刘琰,等.孕妇生殖道B族链球菌感染对妊娠结局的影响研究[J].中华医院感染学杂志,2016,26(9):2128-2130.
[12] 刘荃,汤晓忠,韦芳琴.妊娠晚期B族链球菌携带对妊娠结局的影响[J].中国妇幼保健,2014,29(21):3411-3413.
[13] 米阳,王艳霞,郭娜,等.孕妇生殖道B族链球菌感染对母儿预后的影响研究[J].中国妇幼保健,2015,30(7):1065-1066.
[14] 陈小平,王惠姣,俞北伟,等.B族链球菌产前筛查在母婴感染防控中的应用[J].检验医学,2016,31(4):266-269.
[15] 杨振莉,姜贻乾,来汉江.孕妇B族链球菌感染对母婴结局的影响分析[J].浙江医学,2018,40(7):709-711,716.
[16] 李仲瑞.妊娠晚期孕妇B族链球菌带菌对妊娠结局的影响[J].中国实用医药,2015,10(14):130-131.
[17] 韦艳芬,张珊珊,廖少霞,等.B族链球菌筛查与治疗对妊娠结局的影响[J].广西医科大学学报,2018,35(3):356-359.
[18] KENCHINGTON A L,LAMONT R F.Group B streptococcal immunisation of pregnant women for the prevention of early and late onset Group B streptococcal infection of the neonate as well as adult disease[J].Expert Rev Vaccines,2017,16(1):15-25.