梅毒与妊娠

Syphilis and Pregnancy

妊娠期感染梅毒或梅毒患者合并妊娠称为妊娠梅毒。其发病率呈上升趋势,妊娠梅毒流行与孕妇经济收入水平、文化层次、年龄有关。梅毒螺旋体可感染胎盘而发生流产﹑死胎﹑早产﹑死产等各种妊娠不良结局,并可通过母婴垂直传播给胎儿,发生胎传梅毒。通过产前检查和梅毒筛查、积极治疗等综合干预,可使妊娠梅毒母婴传播阻断的成功率达到99.1%。妊娠梅毒越早治疗,不良妊娠结局及新生儿先天梅毒发生率越低;确诊时血清抗体滴度与妊娠不良结局的发生率及先天梅毒发病率均有较显著的相关性;梅毒孕妇是否终止妊娠,需对血清滴度、孕周、病期、规范治疗多项指标综合评估后决定。胎儿及新生儿应有恰当的评估和足够的随访,有胎传梅毒风险的新生儿需治疗。

Pregnancy syphilis refers to the pregnant women infected by Treponema pallidum （TP） or syphilis patients associated with pregnancy. The incidence of pregnancy syphilis has increased over the past decades and the prevalence of this disease has a clear link with economy-income level, degree of education and age of the pregnant woman. The TP can infect the fetus across the placenta, resulting in some adverse outcomes such as abortion,preterm delivery, stillbirth and the fetus can also be infected with syphilis through mother-to-child vertical transmission ,99.1% of which can be avoided by early antenatal examination, syphilis screening and active treatment. Early treatment and low serum antibody titers are associated with a lower incidence of adverse pregnancy outcomes and congenital syphilis. Whether the pregnant women with syphilis should terminate the pregnancy depends on a comprehensive evaluation of serum antibody ti- ters,gestational weeks, the stage of disease, standard treatment and many other factors. Fetus and neonates should be evaluated and followed appropriately and neonates with high risk of developing congenital syphilis should receive treatment.