妊娠中晚期B组溶血性链球菌感染对妊娠结局的影响

发布时间：2018-01-01 23:29

本文关键词：妊娠中晚期B组溶血性链球菌感染对妊娠结局的影响　出处：《苏州大学》2016年硕士论文　论文类型：学位论文

【摘要】：B族溶血性链球菌(Group B Streptococcus,GBS)是与产妇及新生儿的发病率及死亡率相关的一种病原体,是新生儿早发性严重感染及严重并发症的主要原因。对孕35-37周孕妇进行产前筛查并进行相应的预防抗生素使用的研究很多,但对中孕期的GBS产前筛查与妊娠结局的相关性,报道国内外尚不多见。GBS感染存在地区差异性,在上海地区未见类似报道。因此,本研究拟在孕中、晚期产前检查时进行宫颈分泌物B族溶血性链球菌(GBS)检测,并观察其妊娠结局,为制定妊娠期GBS的防治策略提供依据。研究目标:探讨不同孕周B族溶血性链球菌(GBS)感染与妊娠结局的相关性。研究方法:2015年9月至2016年8月于上海市浦东医院产科门诊定期产检孕妇744人,选取宫颈分泌物GBS检测阳性并在本院分娩的孕妇共104例作为研究组,再按GBS检测的孕周分为4个亚组:A组19例(孕20-24周检测GBS);B组35例(孕24-28周检测GBS);C组27例(孕28-34周检测GBS);D组23例(孕周34周检测GBS)。同期选取本院门诊产检、宫颈分泌物GBS检测阴性的孕妇46例为对照组。两组孕妇均无其他妊娠合并症和并发症。随访各组妊娠各组妊娠结局包括分娩孕周、有无胎膜早破、羊水污染、产后出血、新生儿窒息、新生儿体重及母婴感染情况,分娩后送病理检查是否存在绒毛膜羊膜炎。结果:1.研究组和对照组的一般资料无显著性差异(P0.05)。2.本研究孕妇GBS总带菌率为14.0%(104/744),不同孕周GBS检测带菌率分别为12.4%(A组)、15.6%(B组)、14.4%(C组)、13.1%(D组),各孕周GBS带菌率基本相同,无统计学差异(p0.05)。3.研究组和对照组孕妇的不良妊娠结局发生率分别为47.1%和19.6%。其中,胎膜早破分别为41.4%和17.4%;绒毛膜羊膜炎分别为10.6%和4.4%;产前感染分别为28.9%和6.5%;早产分别为15.4%和6.5%,研究组明显均高于对照组,并有统计学差异(P0.05)。4.GBS阳性的研究组孕妇,各亚组胎膜早破、产后出血、羊水污染发生率无统计学差异(P0.05)。A组和B组孕妇中产前感染发生率分别为(52.6%和28.6%)、新生儿感染分别(15.8%和17.1%)、死胎或流产(10.5%、8.6%)比较C组和D组孕妇产前感染发生率(18.5%和21.7%)、新生儿感染(3.7%和0%)、死胎或流产(3.7%和0%),均明显升高;A组和B组在这几种不良妊娠结局中的发生率高于C组及D组;A、B、C组中孕妇中绒毛膜羊膜炎(10.5%、17.1%、14.8%)、早产率(15.8%、17.1%、18.5%)的发生率高于D组发生率(分别是8.7%、8.7%)(P0.05)。结论:孕期生殖道GBS定植会导致不良妊娠结局,长时间感染可能会增加母婴感染率,重视产前筛查、及早发现、及时治疗GBS感染,可能会改善妊娠结局。
[Abstract]:Group B hemolytic streptococcus group B Streptococcus GBSis a pathogen associated with maternal and neonatal morbidity and mortality. It is the main cause of early severe infection and serious complications of newborns. There are many studies on prenatal screening of pregnant women at 35 to 37 weeks of gestation and corresponding prevention of antibiotic use. However, for the relationship between prenatal screening and pregnancy outcome during pregnancy, it is reported that there is no regional difference in GBS infection at home and abroad, and no similar report has been found in Shanghai. Therefore, this study is intended to be in pregnancy. The cervical secretion group B hemolytic streptococcus (GBS) was detected during the late prenatal examination and its pregnancy outcome was observed. Objective: to study the prevention and treatment strategy of GBS in gestational period. Objective: to study the prevention and treatment of Group B hemolytic streptococcus in different gestational weeks. The relationship between infection and pregnancy outcome. Methods: from September 2015 to August 2016, 744 pregnant women were examined regularly in the obstetrical outpatient clinic of Shanghai Pudong Hospital. A total of 104 pregnant women with GBS positive cervical secretion and delivered in our hospital were selected as the study group. According to the gestational weeks detected by GBS, 19 cases were divided into 4 subgroups: group A (20-24 weeks gestation); Group B 35 cases (24-28 weeks of gestation); Group C 27 cases (28-34 weeks gestation); Group D 23 cases (34 weeks of gestational age) were tested for GBSN. At the same time, the outpatient department of our hospital was selected for birth examination. There were 46 pregnant women with negative GBS detection of cervical secretion as control group. There were no other pregnancy complications and complications in both groups. The pregnancy outcomes of each group were followed up including delivery gestational weeks, premature rupture of membranes. Amniotic fluid contamination, postpartum hemorrhage, neonatal asphyxia, neonatal weight and maternal and infant infection. Results: 1. There was no significant difference in general data between the study group and the control group (P0.05). 2.The total bacterial rate of pregnant women with GBS was 14.010 / 744). The rate of carrying bacteria detected by GBS in different gestational weeks was 12.4B and 15.6B, respectively. The rate of GBS carrying in group B was the same as that in group C (13.1g / D). There was no significant difference between the two groups. The incidence of adverse pregnancy outcomes in the study group and the control group was 47.1% and 19.6respectively. Premature rupture of membranes was 41.4% and 17.4 respectively. The chorioamnionitis was 10.6% and 4.4 respectively. Antepartum infection was 28.9% and 6.5, respectively. The number of premature delivery was 15.4% and 6.5 respectively, the study group was significantly higher than the control group, and there was statistical difference in the study group with positive P0.050.4.The premature rupture of membranes and postpartum hemorrhage were observed in each subgroup. There was no statistical difference in the incidence of amniotic fluid contamination. The incidence of prenatal infection in pregnant women in group A and group B was 52.6% and 28.6%, respectively. The incidence of antenatal infection in group C and group D was 18.5% and 21.7g respectively, compared with that of group C and D (15.8% and 17.1%, respectively). The neonatal infection rate of 3.7% and 0%, stillbirth or abortion 3.7% and 0% were significantly increased. The incidence of adverse pregnancy outcomes in group A and group B was higher than that in group C and group D. In group A BU C, 10.5% of the pregnant women had chorioamnionitis and 17.1% were involved in 14.8.The rate of premature delivery was 15.810% or 17.1%. The incidence of GBS implantation in pregnancy was higher than that in group D (8.7%). Conclusion: GBS colonization of reproductive tract during pregnancy may lead to adverse pregnancy outcome. Long-term infection may increase the infection rate of mother and child, pay attention to prenatal screening, early detection, timely treatment of GBS infection, may improve the outcome of pregnancy.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.251

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