妊娠期外阴阴道假丝酵母菌病与垂直传播

Vulvovaginal candidiasis during pregnancy and its vertical transmission

目的了解妊娠期外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)的发生率,母婴垂直传播及对孕产妇的影响。方法2002年11月至2003年5月对北京妇产医院定期产检的513例孕妇行阴道假丝酵母菌涂片、培养及菌种鉴定,并进行随诊;其间对252例孕妇分娩的新生儿、胎盘行假丝酵母菌培养及菌种鉴定,31个胎盘送病理检查。结果妊娠期VVC的发病率18.71%(96/513)。孕期VVC者与携带者不增加胎膜早破发生,亦不引起产褥感染的发生。分娩的252例孕妇阴道假丝酵母菌涂片和(或)培养阳性109例,剖宫产组新生儿、胎盘该菌携带率分别为20.76%(11/53)、13.21%(7/53);阴道分娩组分别为35.71%(20/56)、23.21%(13/56),P>0.05;孕期诊断VVC者新生儿、胎盘假丝酵母菌携带率分别为16.67%(8/48)、8.33%(4/48),携带者分别为37.71%(23/61)、26.23%(16/61),P<0.05;孕期接受治疗48例新生儿、胎盘无假丝酵母菌携带;未治疗61例新生儿、胎盘假丝酵母菌携带率为50.82%(31/61)、32.79%(20/61)。胎盘假丝酵母菌携带者病理表现为急性炎症。结论孕期存在假丝酵母菌垂直传播。孕期治疗VVC与携带者可明显减少垂直传播的发生。

Objective To investigate the incidence of vulvovaginal candidiasis （VVC） during pregnancy, possibility of vertical transmission and impact on the mothers . Methods Vaginal discharge samples of 513 gravida were examined in the Obstetrics and Gynecology Hospital from 2002,11 to 2003,5 by smeared and cultured for fungus. Placental surface of 252 pregnant women and skins of their newborns were also cultured for fungus. Placenta pathological examination was performed in 31 cases. The puerperants were followed up. Results The incidence of VVC was 18.71%. The rates of premature rupture of membrane and puerperal infection were not higher in VVC and fungus-carrier groups. The fungus positive of smearing and（or） culturing in 252 gravida was 109. Among 109 cases, fungus-carrier rate of newborn skin and placenta were 20. 76% and 13.21% in cesarean delivery group, and 35.71% and 23.21% in vaginal delivery group, P 〉0. 05. Fungus-carrier rate of newborn skin and placenta were 16.67% and 8.33% in VVC group（48 cases） , and 37. 71% and 26. 23% in fungus-carrier group（61cases）, P 〈0. 05 ; fungus-carrier rate of newborn skin and placenta were zero in the group who had received treatment during preguancy,and 50. 82% and 32. 79% in the group who hadn＇ t been treated. Pathological examination of the placenta of the fungus-carrier confirmed it to be acute infection. Conclu- sion VVC can be transmitted vertically from mother to fetus. During pregnancy, fungus smearing and（or） culturing of vaginal samples and treatment VVC are beneficial strategy for both mothers and their babies.