妊娠期梅毒患者发生围产儿死亡20例临床分析

Investigation on perinatal death in pregnant women with syphilis and its prevention measures:a clinical analysis of 20 cases

目的:研究20例感染梅毒的孕妇发生围产儿死亡的临床特点及探讨防治措施。方法:对2009年1月至2015年6月在东南大学附属第二医院收治的发生围产儿死亡的20例梅毒孕妇的临床资料进行回顾性分析。结果:发生围产儿死亡的梅毒孕产妇20例,12例(60%)孕产妇孕期未建卡,8例建卡的孕妇中仅5例(20%)正常产检,且均行驱梅治疗。20例孕妇中16例(80%)无业,仅2例为大专以上学历。分娩前梅毒血清学高滴度(RPR≥1∶8)的孕妇有15例,其中11例(73.3%)死婴为梅毒儿;低滴度(<1∶8)的孕妇有5例,仅有1例(20%)为梅毒儿。20例中有14例为死胎,其中有9例(64.3%)考虑胎传梅毒;6例新生儿死亡中3例(33.3%)具有梅毒儿的特征。结论:开展围产期产检非常重要,应加强人群健康教育和孕前孕期梅毒血清筛检管理,及时行驱梅治疗,努力将梅毒对妊娠的危害降至最低限度。

Objectives：To investigate the clinical features and preventive measures of perinatal fetal death in 20 pregnant women with syphilis.Methods：All the data of 20 pregnant women infected with syphilis from January 2009 and June 2015 in the Second Affiliated Hospital of the Southeast University were collected and the clinical characteristics were analyzed retrospectively.Results：Among the 20 pregnant women,12 cases（60%） did not build formal pregnant archive in the hospital and only 5 cases（20%） among the 8 cases who had formal pregnant archive underwent regular pregnancy examination and anti-syphilitic treatment.16 cases（80%） of the 20 pregnant women was unemployed,and only 2 cases were graduated from junior college or above.There were 15 pregnant women with syphilis serology high titers before delivery（RPR≥1 ∶ 8）,where 11 cases（73.3%） had still-born child infected with syphilis.There were 5 pregnant women with syphilis serology low titers before delivery（〈 1∶ 8）,where only one case（20%） had still-born child infected with syphilis.There were 14 cases of stillbirth including9 cases（64.3%） of congenital syphilis and 6 cases of neonatal deaths including 3 cases（33.3%） with characteristics of syphilis infection.Conclusion：Health education and screening for syphilis management before and during pregnancy should be strengthened for timely anti-syphilitic treatment,which could reduce the harm of syphilis to the lowest degree.