妊娠晚期孕妇阴道微生态对妊娠结局的影响

The influence of vaginal microecosystem on the pregnancy outcomes at late pregnancy

目的观察妊娠晚期孕妇阴道微生态状况,分析不同微生态状况对妊娠结局的影响。方法选取全南县200例妊娠晚期孕妇为研究对象,通过产前检查,取阴道分泌物做假丝酵母菌、支原体、衣原体等检查,观察阴道菌群密集度、优势菌、多样性、炎症反应。根据阴道微生态状况和症状分为正常、异常无症状和异常有症状孕妇,分别纳入正常组(146例),无症状组(21例)和有症状组(33例),比较3组孕妇阴道菌群特征及妊娠结局。结果 54例阴道菌群异常孕妇共检出外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)19例,支原体感染17例,细菌性阴道病(bacterial vaginosis,BV)8例,滴虫性阴道炎(trichomonas vaginitis,TV)5例,衣原体感染4例,淋菌1例。症状组孕妇以VVC感染最多见,占42.4%;无症状组孕妇以支原体感染最多见,占42.9%;两组孕妇菌群异常检出情况差异有统计学意义(P<0.05)。胎膜早破、产褥感染发生率症状组高于无症状组和对照组(P<0.05),无症状组高于正常组(P<0.05);症状组新生儿感染、新生儿黄疸发生率高于无症状组和正常组(P<0.05)。结论妊娠晚期阴道微生态环境可影响妊娠结局,有自觉症状孕妇应积极治疗,无症状孕妇应定期检查并恢复阴道微生态平衡,从而降低不良妊娠结局的风险。

Objective To investigate the influence of vaginal microecosystem on the pregnancy outcomes at late pregnancy.Methods 200 women at late pregnany in Quannan county were selected. The vaginal candida,mycoplasma,chlamydia,et al were examined through prenatal examination. The vaginal microecosystem including vagina flora density,dominant bacteria,diversity,inflammatory reactions were observed. Based on the vaginal microecosystem and subjective symptoms,all cases were divided into normal group（ 146 healthy cases）,asymptomatic group（ 21 cases had pathogens without clinical symptom） and symptomatic group（ 33 cases had pathogens and clinical symptoms）. The vaginal flora characteristics and pregnancy outcomes of three groups were compared.Results 19 cases with vulvovaginal candidiasis（ VVC）,17 cases with mycoplasma,8 cases with bacterial vaginosis（ BV）,5 cases with trichomonas vaginitis（ TV）,4 cases with chlamydia and 1 cases with gonococcus were detected in 54 women of abnormal vaginal flora. The VVC was the most common in symptomatic group（ 42. 4%） while the mycoplasma was the most common in asymptomatic group（ 42. 9%）. The difference in vaginal flora between symptomatic group and asymptomatic group had statistical significance（ P〈0. 05）. The ratio of premature rupture of membrane and puerperal infection in symptomatic group was higher than asymptomatic group and normal group（ P〈0. 05）,while symptomatic group was higher than normal group（ P〈0. 05）. The ratio of neonatal infection and neonatal jaundice in symptomatic group was higher than asymptomatic group and normal group（ P〈0. 05）. Conclusions Abnormal vaginal microecosystem at late pregnancy is closely associated with adverse pregnancy outcomes,thus symptomatic pregnant women should receive aggressive treatment, asymptomatic pregnant women should receive regular checking and rebalance vaginal microecosystem,which can reduce the risk of adverse pregnancy outcomes.