分娩期GBS阳性产妇羊水、胎盘及脐带血与母婴感染的关联性分析

Analysis on the correlations between amniotic fluid,placenta,umbilical cord blood,and maternal and infantile infections in GBS-positive lying-in women during delivery

目的探讨妊娠期生殖道B族溶血性链球菌与围生期母婴感染的关联性。方法回顾性分析2017年1月-2018年6月在医院门诊常规孕检并自然分娩的妇女B族溶血性链球菌(GBS)检测及GBS感染情况。妊娠早期(8~12周)和37周取阴道下三分之一分泌物采用胶体金免疫层析法GBS鉴定卡进行GBS检测;临产后对GBS阳性孕妇预防性静滴抗生素1~2次,分娩时取羊水、胎儿脐带血及胎盘(母体面取拭子)做GBS检测,并纪录母亲产后发热、产褥感染、产后出血、新生儿带菌及新生儿感染发生率。结果共检测2 100例孕妇,早孕期GBS带菌率6. 13%;至妊娠37周时筛查1 848例(去除流产及早产病例252例),GBS阳性率6. 89%;分娩时127例GBS阳性孕妇羊水、胎盘及脐带血GBS阳性率分别为3. 94%、3. 94%及2. 36%,1721例GBS阴性孕妇的羊水、胎盘和脐带血GBS均为阴性。GBS阳性母亲产后发热、产褥感染及产后出血率与阴性者相比差异无统计学意义(P>0. 05),胎盘病理检查绒毛膜羊膜炎的发生率69. 29%明显高于阴性者的18. 94%。GBS阳性母亲的新生儿带菌率为3. 94%,感染率为2. 36%;GBS阴性母亲的新生儿GBS均阴性。结论妊娠期产道GBS阳性母亲,羊水、胎盘及脐带血的阳性率高于阴性者。羊水、胎盘及脐带血阳性者新生儿有一定的带菌率和感染率,应引起产科医师重视。

Objective To explore the correlation between group B hemolytic streptococcus( GBS) in reproductive tract during pregnancy and perinatal maternal and infantile infections. Methods GBS detection and infection in the women receiving routine pregnancy test and spontaneous labor in Maternal and Child Health Care Hospital of Futian District,Shenzhen from January 2017 to June 2018 were analyzed retrospectively,vaginal secretion samples were obtained during 8-12 weeks and 37 week,GBS detection was performed using colloidal gold immunochromatography GBS identification card. During delivery,GBS-positive women were given preventive intravenous drip of antibiotic once or twice,amniotic fluid,umbilical cord blood,and placental samples were obtained for GBS detection. The incidence rates of maternal postpartum fever,puerperal infection,postpartum hemorrhage,neonatal carrying rate of GBS,neonatal infection rate were recorded.Results A total of 2 100 pregnant women were detected,the carrying rate of GBS in early pregnancy was 6. 13%;1 848 pregnant women were detected in 37 gestational week( excluding 252 cases of abortion and premature delivery),GBS positive rate was 6. 89%;during delivery,among 127 GBS-positive women,the positive rates of GBS in amniotic fluid,placenta,and umbilical cord blood were 3. 94%,3. 94%,and 2. 36%,respectively;among 1 721 GBS-negative women,the positive rates of GBS in amniotic fluid,placenta,and umbilical cord blood were 0. There was no statistically significant difference in incidence rates of maternal postpartum fever,puerperal infection,postpartum hemorrhage between GBS-positive women and GBS-negative women( P > 0. 05). The incidence rate of chorioamnionitis after placental pathological examination was 69. 29% in GBS-positive women,which was significantly higher than that in GBS-negative women( 18. 94%). The carrying rate and infection rate of GBS in neonates born by GBS-positive women were 3. 94% and 2. 36%,respectively;the carrying rate and infection rate of GBS in neonates born by GBS-negative women were 0. Conclusion The positive rates of amniotic fluid,placenta,and umbilical cord blood in GBS-positive mothers during pregnancy are higher than those in GBS-negative mothers. The neonates with positive amniotic fluid,placenta,and umbilical cord blood have certain carrying rate and infection rate of GBS,which should be paid attention to by obstetricians.