足月胎膜早破孕妇阴道微生态及B族链球菌感染情况与母儿结局的关系分析

发布时间：2018-05-26 15:35

本文选题：足月胎膜早破 + 阴道微生态　；参考：《重庆医科大学》2016年硕士论文

【摘要】：目的:通过分析比较足月胎膜早破和足月未破膜孕妇阴道微生态以及B族链球菌(GBS)感染情况,探究足月胎膜早破阴道微生态改变以及GBS感染与母儿结局的关系。方法:收集2015年01月到2016年03月在重庆医科大学附属第二医院产科住院生产的,足月胎膜早破孕妇74例为tPROM组。随机选取同期收治入院的正常足月未破膜孕妇74例为对照组。比较分析两组阴道微生态情况及母儿结局,将胎膜早破组中74例研究对象根据GBS感染情况及阴道微生态情况分为GBS阳性组、GBS阴性组、微生态正常组及微生态失调组,再分析比较四组的新生儿病理性黄疸、新生儿败血症、产褥感染的发生情况。结果:1.t PROM组孕妇在阴道微生态失调率、阴道pH异常(pH4.5)发生率、乳杆菌优势改变率明显大于对照组(p0.05),差异有统计学意义。2.t PROM组主要优势菌为G+球菌(39.18%),对照组主要优势菌为G+杆菌(52.70%)。3.tPROM组与对照组孕妇阴道分泌物病原微生物中BV、VVC、BV+VVC的发生率比较,差异都无统计学意义(p0.05)。两组GBS感染率相比较,两者的差异具有统计学意义(p0.05),其中tPROM组GBS感染为16.22%,对照组GBS感染为5.41%。4.tPROM组与对照组新生儿出生后1min、5min Apgar评分以及新生儿血气pH异常的比较,差异不具有统计学意义(p0.05),tPROM组新生儿病理性黄疸及产褥感染发生率高于对照组,差异具有统计学意义(p0.05)。5tPROM组中微生态正常组与失调组的母儿不良结局无差异(p0.05)6.tPROM组中GBS阳性组与阴性组新生儿血气p H异常发生率比较,差异并没有统计学意义(p0.05)。GBS阳性组新生儿病理性黄疸率及产妇产褥感染率都明显高于GBS阴性组,差异具有统计学意义(p0.05)。结论:足月胎膜早破孕妇阴道微环境稳态发生了改变,重点表现在乳杆菌优势改变、优势菌由G+杆菌变为G+球菌及阴道p H的改变;足月胎膜早破的发生可能与阴道微环境的改变、GBS的感染有关。足月胎膜早破的发生可能引起新生儿病理性黄疸及产褥感染的不良结局,而GBS的感染可能在其中发挥着很大的作用,其不良结局的发生与阴道微生态的失调关系不明显。
[Abstract]:Objective: to compare the vaginal microecology and group B streptococcus infection in pregnant women with term premature rupture of membranes and term unbroken membranes, and to explore the relationship between GBS infection and maternal and fetal outcome. Methods: from January 2015 to March 2016, 74 pregnant women with premature rupture of membranes were enrolled in tPROM group. 74 normal term unbroken pregnant women admitted to hospital at the same time were randomly selected as control group. According to GBS infection and vaginal microecology, 74 cases of premature rupture of membranes were divided into GBS positive group, normal group and microecological disorder group. The incidence of pathological jaundice, neonatal septicemia and puerperal infection in the four groups were analyzed and compared. Results 1. The misadjustment rate of vaginal microecology and pH of vaginal pH abnormality were 4.5% in PROM group. The dominant change rate of Lactobacillus was significantly higher than that of the control group (P 0.05). The difference was statistically significant. The main dominant bacteria in the PROM group was G cocci, and the main dominant bacteria in the control group was the G bacilli 52.70. 3. The incidence of BV VCCV VVC in vaginal secretions of pregnant women in the control group and the control group was significantly higher than that in the control group. The difference was not statistically significant (P 0.05). The difference of GBS infection rate between the two groups was statistically significant (p 0.05). The GBS infection rate in tPROM group was 16.22, and the GBS infection in control group was Apgar score and abnormal blood gas pH at 1 min after birth between 5.41%.4.tPROM group and control group. The incidence of neonatal pathological jaundice and puerperal infection was higher in the group of p0.05 and tPROM than that in the control group. There was no significant difference in maternal and fetal adverse outcomes between microecologically normal group and maladjusted group in p0.05 + .5tPROM group. The incidence of abnormal blood gas pH in GBS positive group and negative group was higher than that in control group. The rate of pathological jaundice and puerperal infection rate of puerpera in the positive group were higher than those in the negative group of GBS, and the difference was statistically significant (P 0.05). Conclusion: the stable state of vaginal microenvironment in pregnant women with premature rupture of term membranes has changed, especially in the changes of Lactobacillus dominant bacteria from G bacillus to G coccus and vaginal pH. The occurrence of term premature rupture of membranes may be related to the change of vaginal microenvironment and the infection of GBS. Premature rupture of full-term membranes may lead to pathological jaundice of newborns and adverse outcome of puerperal infection, and GBS infection may play a great role in it. The relationship between the occurrence of premature rupture of membranes and the imbalance of vaginal microecology is not obvious.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.433

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