孕晚期无乳链球菌定植的筛查与管理对母婴结局的影响

Effect of screening and management of Streptococcus agalactiae colonizing in the third trimester on maternal and infantile outcomes

目的探究孕晚期无乳链球菌定植的筛查与管理对母婴结局的影响。方法筛选住院分娩的单胎孕妇3018例,于孕35～37周产前检查时或入院时取阴道下段1/3处及肛周分泌物进行无乳链球菌(group B Streptococcus,GBS)检测,其中确诊为GBS定植者89例作为观察组;选择同期外院转入我院分娩,住院后才确诊的GBS定植的单胎孕妇96例作为对照组。观察组在产前检查中确诊GBS后给予知识宣教,采取系统性管理和指导,对照组在GBS检测结果出来后给予系统性管理,比较两组孕妇母婴结局。结果 3018例孕妇中共筛查出185例GBS定植的孕妇,检出率为6.13%。观察组孕妇胎膜早破、宫内感染胎儿窘迫、早产、剖宫产的发生率明显低于对照组,分娩后出现新生儿肺炎、新生儿窒息、新生儿败血症、脑膜炎的几率低于对照组;组间比较差异均有统计学意义(P<0.05)。Logistic回归分析结果表明GBS定植阳性是胎膜早破的高危因素(OR=1.91,P<0.05)。结论加强孕晚期泌尿生殖道GBS定植的筛查与管理,可有效减少母婴并发症。

Objective To evaluate the effect of screening and management of Streptococcus agalactiae colonizing in the third trimester on maternal and infantile outcomes.Methods Firstly,3018 singleton pregnancy women admitted for hospitalization were selected as the subjects of study.Perianal and vaginal discharge were then sampled from the subjects due for prenatal checkup or hospitalization when admitted to the hospital at 35~37 weeks of pregnancy.The samples were then subjected to detection for group B Streptococcus(GBS)colonization.89 patients out of the subjects diagnosed as cases of colonization of GBS were chosen as the experimental group while 96 singleton pregnancy patients diagnosed as cases of colonization of GBS after being transferred from other hospitals and admitted for hospitalization were taken as the control.The experimental group were subjected to knowledge education,systematic management and guidance immediately after GBS colonization was detected upon prenatal checkup.Systematic management and guidance were given to the control.The maternal and infantile outcomes of the two groups were lastly analyzed and compared.Results Of the 3018 subjects,185 were diagnosed as cases of GBS colonization,the rate of detection being 6.13%.The rates of incidence of premature rupture of membranes,intrauterine infection,fetal distress,premature delivery and cesarean section of the experimental group were significantly lower than those of the control.The rates of incidence of neonatal pneumonia,neonatal asphyxia,neonatal sepsis and meningitis as observed after delivery in the experimental group were also lower than those in the control.The differences were statistically significant(P<0.05).Logistic regression analysis indicated that positive GBS colonization was a high risk factor causing premature rupture of membranes(OR=1.91,P<0.05).Conclusions Complications as maternal and infantile outcomes can be effectively reduced by strengthening the screening and management of urogenital GBS colonization in the third trimester.