不同时机治疗对妊娠合并梅毒患者妊娠结局及胎儿预后的影响

Effects of different timing of treatment on pregnancy outcome and fetal prognosis in pregnant women with syphilis

目的分析对妊娠合并梅毒患者采用不同时机治疗对妊娠结局及胎儿预后的影响。方法对2016年1月至2018年1月本院妇产科收治的90例妊娠合并梅毒患者进行观察,根据不同治疗时机将患者分为早期组、中期组、晚期组3组,各30例。早期组在孕早期(孕周低于12周)给予抗梅毒治疗,中期组在孕中期(妊娠13~28周)给予抗梅毒治疗,晚期组在孕晚期(孕周超过29周)给予抗梅毒治疗。比较3组母婴RPR滴度、妊娠结局、胎儿预后(新生儿Apgar评分、先天梅毒发生率)情况。结果早期组足月分娩率、母婴RPR滴度<1∶8、早期组新生儿Apgar评分>中期组>晚期组,差异有统计学意义(P<0.05);早期组先天梅毒发生率<中期组、晚期组,差异有统计学意义(P<0.05);3组早产率、流产率、低体质量儿、死胎比较差异无统计学意义。结论对妊娠合并梅毒患者在孕早期尽早给予抗梅毒治疗可以有效降低早产、流产等不良妊娠结局及新生儿先天性梅毒发生率,改善胎儿预后。

Objective To analyze the effect of different timing of treatment on pregnancy outcome and fetal prognosis in pregnant women with syphilis.Methods From January 2016 to January 2018,90 pregnant women with syphilis were observed.According to different treatment opportunities,the patients were divided into three groups:early group,mid-term group and late group,30 cases in each group.The early group was given antisyphilis treatment in early pregnancy(less than 12 weeks of gestation),the middle group was given anti-syphilis treatment in mid-pregnancy(13-28 weeks of gestation),and the late group was given anti-syphilis treatment in late pregnancy(more than 29 weeks of gestation).The RPR titers,pregnancy outcomes,fetal prognosis(Apgar score of newborns,incidence of congenital syphilis)of the three groups were compared.Results There was significant difference in term delivery rate,maternal and infant RPR titer<1:8 ratio,neonatal Apgar score of early group>mid-term group>late pregnancy(P<0.05);incidence of congenital syphilis in early group<mid-term group,late pregnancy(P<0.05);premature delivery rate,abortion rate,low birth weight infant,death rate in three groups(P<0.05).There was no significant difference in fetal size.Conclusion Anti-syphilis treatment in early pregnancy and early pregnancy can effectively reduce adverse adverse pregnancy outcomes such as premature delivery and abortion,and the incidence of congenital syphilis in newborns,and improve fetal prognosis.