妊娠期梅毒血清学阳性患者的处理与妊娠结局

The disposal for syphilis-positive pregnant women by serological test and final results of pregnancy

目的探讨妊娠期梅毒血清学阳性患者的诊治及妊娠结局,降低先天性梅毒发生率。方法回顾性分析我院妇产科2004年1月至2005年9月引产和分娩的3105例孕妇的检查结果。结果在3105例孕妇中,TP(treponemapallidum)阳性者21例,TP阳性率为6.76‰,其中TRUST(梅毒甲苯胺红不加热血清试验)同时阳性者7例(33.33%),TRUST阴性者6例(28.57%),仅2例为Ⅰ期梅毒,出现皮损、溃疡、软下疳等;在孕期发现的18例中,11例(61.11%)TRUST阳性经过驱梅治疗;21例TP阳性孕妇中,引产5例,继续妊娠并分娩的16例中,剖宫产13例,自然分娩3例,平均孕龄(267.44±11.00)d,所有新生儿出生时Apgar评分均为10分;脐血查TP阳性3例和TRUST阳性者2例,均未出现先天性梅毒临床表现,有5例新生儿转儿科诊治(其中2例驱梅治疗,2例早产、1例发绀)均健康出院。结论在妊娠早、中期发现TP阳性患者,如经过正规检查和驱梅治疗,可获得良好的妊娠结局。

Objective To report the diagnosis and treatment of the pregnant women, who were positive for syphilis in serological test, as well as their final pregnant results. Methods we conducted a retrospective analysis of the serological test results of 3 105 pregnant women subjected to childbirth or induced labor in the department of gynaecology and obstetrics at our hospital since January of 2004. Results Of the 3105 pregnant women, 21 （6.76） were positive for treponema pallidum （TP）. Additionally, 7 （33.33%） cases were positive for TRUST, and 6 （28.57%） negative. Only 2 cases showed skin lesion, canker and soft chancre. Of the 18 cases, who were found to get infection during pregnancy, 11 （61. 11% ） had taken the treatment against syphilis. Of the 21 women positive for TP, 5 were subjected to induced labor, 13 to cesarean section, and 3 to spontaneous parturition. The average time of pregnancy was （267.44 ± 11.00） d. The Apgar score of all 16 newborns was 10 at birth. The umbilical blood of 5 infants was tested by TP and TRUST, among which 3 were positive by TP, 2 were positive for TRUST. All infants did not have any clinical manifestation of congenital syphilis after birth. There were 5 cases transferred to the ward of pediatrics, among which 2 undertook the treatment against syphilis, 2 against premature delivery, and 1 against asphyxia, and finally all had been cured. Conclusion The patients, who were found positive for TP during the early and middle period of pregnancy, can obtain a fine pregnant result, if undertaking regular examination and treatment against syphilis.