妊娠期生殖道感染对围产结局的影响研究

发布时间：2018-07-18 08:27

【摘要】：目的：研究妊娠期生殖道感染的特征，探讨生殖道感染及其干预措施与孕产妇围产结局的关系，为妊娠期生殖道感染的防治提供依据，提高新生儿出生质量。方法：选取2012年3月～2013年2月盐城市妇幼保健院妇产科接诊的孕6-36周的妊娠期妇女进行细菌、假丝酵母菌、滴虫、衣原体、支原体、淋球菌等生殖道感染性疾病的检查。应用SPSS17.0统计学软件进行统计分析，分析不同孕周、不同年龄孕妇之间生殖道感染的类型及分布特征。结合孕妇孕周及自主要求将孕妇分为治疗组和非治疗组，治疗者根据检查结果针对性的进行抗感染治疗，记录干预治疗措施及治疗效果与安全性，非治疗组不予以处理。跟踪所有入选孕妇的围产结局，探讨分析生殖道感染、不同感染类型、不同干预措施与围产结局之间的关系。结果： 1.生殖道感染特征本研究中共1863例孕妇接受生殖道感染性疾病的检查。检查结果得出，未感染者1078例，占57.86%，存在生殖道感染者共785例，占42.14%。感染组和未感染组在年龄、孕次、流产次数方面的比较均无显著差异，无统计学意义。细菌性阴道病、滴虫、支原体、衣原体、假丝酵母菌、淋球菌、β-溶血性链球菌感染的发生机率分别为11%、2.31%、8.91%、4.03%、9.34%、1.45%、5.10%。感染者中感染类型分布如下：细菌性阴道病、滴虫、支原体、衣原体、假丝酵母菌、淋球菌、β-溶血性链球菌感染的例数分别为205（26.11%）、43（5.48%）、166（21.15%）、75（9.55%）、174（22.17%）、27（3.44%）、95（12.10%）。 2.不同孕期生殖道感染分布特征孕早期感染者297例，占37.83%；孕中期感染者250例，占31.85%；孕晚期238例，占30.32%。孕早期感染以细菌性阴道病、假丝酵母菌及支原体感染为主；细菌性阴道病感染在各孕期感染中占比最高；β-溶血性链球菌感染主要出现在孕晚期。 3.干预措施及疗效本研究中785例感染者采取治疗者439例（治疗组），未采取治疗者346例（非治疗组）。治疗组中，孕早期151例，占感染者的19.24%；孕中期146例，占18.60%；孕晚期142例，占18.09%。非治疗组中，孕早期146例，占18.60%；孕中期104例，占13.25%；孕晚期96例，占12.23%。治疗组与非治疗组在各孕期的分布方面无显著差异，具有可比性。治疗组中细菌感染者112例，滴虫性阴道炎25例，支原体感染者85例，衣原体感染者29例，外阴阴道假丝酵母菌166例，淋球菌22例。两组在生殖道感染类型方面也无显著性差异，，具有可比性。治疗组经过针对性的精心治疗后，治愈209例（47.61%），显效157例（35.76%），有效52例（11.85%），无效21例（4.78%），总的治疗有效率（治愈率+显效率）为83.37%。 4.围产结局本组1863例研究病例中，共有562例出现不良围产结局。按感染特征分类，261例出现在未感染组，不良结局的发生机率为24.21%（261/1078），301例出现在感染组，发生机率为38.34%（301/785），感染组不良结局的发生率显著高于未感染组，两者具有统计学差异（X2=43.065，P0.05）；按感染组孕产妇是否采取干预措施分类，治疗组132例出现不良围产结局，发生机率为30.07%（132/439），非治疗组169例出现不良围产结局，发生机率为48.84%（169/346），治疗组不良围产结局的发生率显著低于非治疗组，差异具有统计学意义（X2=28.853，P0.05）。结论： 1.妊娠期生殖道感染性疾病的感染率为42.14%，其中细菌性感染的发生率最高，达26.11%。 2.感染组和未感染组在年龄、孕次、流产次数方面的比较均无显著差异。 3.妊娠期生殖道感染可发生在各个孕期，各孕期总的感染率无差异，但生殖道感染的类型有所不同，孕早期感染以细菌性阴道病、假丝酵母菌感染及支原体感染为主，细菌性阴道病感染在各孕期感染中占比最高，β-溶血性链球菌感染主要出现在孕晚期。 4.妊娠期生殖道感染可得到良好的治疗效果，总的治疗有效率为83.37%。 5.妊娠期不良结局的发生机率为30.17%。 6.妊娠期生殖道感染者发生不良结局的机率（38.34%）显著高于未感染者（24.21%）。 7.妊娠期生殖道感染采取干预措施者发生不良结局的机率（30.07%）显著低于未采取干预措施者（48.84%）。
[Abstract]:Purpose :

To study the characteristics of genital tract infection during pregnancy , to explore the relationship between genital tract infection and its intervention measures and perinatal outcome , and to provide the basis for prevention and treatment of reproductive tract infection during pregnancy , and to improve the birth quality of the newborn .

Method :

The types and distribution of reproductive tract infections among pregnant women with different gestational weeks and different ages were analyzed by SPSS 17.0 . The perinatal outcomes of all selected pregnant women were analyzed . The relationship between reproductive tract infection , different types of infection , different intervention measures and perinatal outcomes was discussed .

Results :

1 . Reproductive tract infection characteristics

The incidence of bacterial vaginopathy , trichomonad , mycoplasma , chlamydia , Candida albicans , gonococcus , 尾 - hemolytic streptococcus infection were found to be 205 ( 26.11 % ) , 43 ( 5.48 % ) , 166 ( 21.15 % ) , 75 ( 9.55 % ) , 174 ( 22.17 % ) , 27 ( 3.44 % ) , 95 ( 12.10 % ) respectively .

2 . Distribution characteristics of reproductive tract infection in different pregnancy stages

297 cases were infected with early pregnancy , accounting for 37.83 % ;
In the mid trimester of pregnancy , 250 cases were infected , accounting for 31.85 % ;
238 cases in the late pregnancy ( 30.32 % ) were infected with bacterial vaginopathy , Candida albicans and mycoplasma infection .
The infection rate of bacterial vaginopathy is the highest in each pregnancy infection .
The infection of 尾 - hemolytic streptococcus is mainly in the late pregnancy .

3 . Intervention measures and efficacy

Among the 785 cases in the study , 439 cases ( treatment group ) were treated , 346 cases were not treated ( non - treatment group ) . In the treatment group , 151 cases were early pregnancy , accounting for 19.24 % of the infected persons ;
There were 146 cases in the middle of pregnancy , accounting for 18.60 % ;
There were 142 cases ( 18.09 % ) in the late pregnancy , 146 in the non - treatment group ( 18.60 % ) .
104 cases ( 13.25 % ) were pregnant .
In the treatment group , there were 112 cases of bacterial infection , 25 cases of trichomonas vaginitis , 85 cases of mycoplasma infection , 29 cases of chlamydia infection , 166 cases of vulvovaginal candida , and 22 cases of gonococcus .

4 . perinatal outcome

The incidence of adverse outcomes was 24.21 % ( 261 / 1078 ) , 301 in the infection group and 38.34 % ( 301 / 785 ) in the infection group . The incidence of adverse outcomes was significantly higher in the infection group than in the uninfected group ( X2 = 43.65 , P0.05 ) .
The incidence of adverse perinatal outcome in 132 cases of treatment group was 30.07 % ( 132 / 439 ) . The incidence of adverse perinatal outcome was 48.84 % ( 169 / 346 ) . The incidence of adverse perinatal outcome in treatment group was significantly lower than that in non - treatment group ( X2 = 28.853 , P0.05 ) .

Conclusion :

1 . The infection rate of reproductive tract infectious diseases during pregnancy was 42.14 % , among which the incidence of bacterial infection was the highest , reaching 26.11 % .

2 . There was no significant difference between the infection group and the non - infected group in the age , pregnancy and the number of abortions .

3 . During pregnancy , reproductive tract infection can take place during pregnancy . There is no difference in the overall infection rate during pregnancy , but the type of genital tract infection is different . The infection with bacterial vaginopathy , Candida albicans infection and mycoplasma infection is the main infection in the early pregnancy , and the infection of bacterial vaginopathy is the highest in each pregnancy infection , and the infection of 尾 - hemolytic streptococcus is mainly in the late pregnancy .

4 . During pregnancy , reproductive tract infection can get a good therapeutic effect , and the total effective rate is 83.37 % .

5 . The incidence of adverse outcome in pregnancy was 30.17 % .

6 . The probability of adverse outcomes ( 38.34 % ) of patients with reproductive tract infection during pregnancy was significantly higher than that of non - infected persons ( 24.21 % ) .

7 . The probability of adverse outcomes ( 30.07 % ) in patients with reproductive tract infections during pregnancy was significantly lower than those without intervention ( 48.84 % ) .
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.7

【参考文献】