妊娠合并梅毒治疗对妊娠结局及新生儿感染的影响

Effect of treatment to pregnancy outcome and neonatal infections of the pregnancy with syphilis

目的探讨梅毒对妊娠结局的影响,探索驱梅治疗是否为降低孕产妇合并症及先天梅毒发生率的有效措施。方法回顾性分析首都医科大学附属北京地坛医院2008年1月至2014年12月收治的1 064例经梅毒血清学监测确诊的妊娠梅毒患者,经过驱梅治疗后监测妊娠结局、围产儿预后及先天性梅毒的情况。结果未进行驱梅治疗或社会因素主动放弃的妊娠患者共193例(18.08%);异位妊娠69例(6.47%)。新生儿早产41例(占3.84%),孕周>13周发生胎死宫内的58例(5.4496),其中6例为孕晚期(>28周)胎死宫内。新生儿血清梅毒检测共有115例(1 5.48%)为阳性,但均低于母亲滴度,给予积极预防治疗,其中20139前所分娩的89例新生儿中,经过两年的随访,未发现1例先天梅毒患儿。结论从孕前保健,孕期管理及抗梅治疗都是围产科学的重点,在孕前及孕期给予规范的抗梅毒治疗,可以有效减少不良的妊娠结局,有效降低先天梅毒儿的发生率,降低围产儿的患病率和病死率。

Objecive To investigate the influences of syphilis to pregnancy,and to explore the effective of reduce the maternal complications and congenital syphilis.Methods The clinical data of 1 064 pregnancy cases combined with syphilis serology from January 2008 to December 2014 were analyzed.After the treatment with perinatal prognosis and congenital syphili,the pregnancy outcome were monitered.Results There were 193（18.08%） abortion cases,69（6.47%） ectopic pregnancy cases,41（3.84%） neonatal premature birth cases,58（5.44%） fetal intrauterine death over 13 weeks gestational age;6（0.56%） fetal intrauterine death occurred during over 28 weeks late pregnancy.The results of 115（15.48%） neonatal RPR tests were positive in the newborn,but the concentration of RPR tests were lower than mother＇s drop degree,all of them were given a positive preventive treatment.In neonatal birth before 2013,after two years of monitrting,no congenital syphilis case were found.Conclusions From pregnancy care,management and resistance to syphilis during pregnancy are the focus of the obstetric science.The treatment of syphilis during pregnancy could effectively reduce the adverse pregnancy outcomes,effectively reduce the incidence of congenital syphilis,also perinatal morbidity and mortality.