HBsAg阳性患者中产钳助产对乙型肝炎病毒母婴传播的影响

Risk of transmission of hepatitis B after foceps delivery in HBs antigen-positive mothers

目的评估阴道产钳助产是否增加乙肝病毒母婴传播的风险。方法本研究回顾性研究2015年1月1日至2020年6月1日首都医科大学附属北京佑安医院分娩的足月单胎妊娠患者,试验组为产钳助产分娩且HBsAg阳性的产妇,对照组选取同时段阴道顺产HBsAg阳性的产妇,两组患者新生儿均完成乙肝免疫球蛋白及乙肝疫苗的联合免疫,随访12个月。比较两组患者出生时新生儿及7月龄婴儿乙肝表面抗原阳性率,同时对比两组产妇的产后出血量,会阴裂伤,新生儿黄疸及新生儿产伤的比率。结果共纳入183例,产钳助产组61例,阴道顺产组122例。其中0月龄新生儿HBsAg阳性率,产钳组(16/61)高于顺产组(27/122),P>0.05,差异无统计学意义;两组患者7月龄婴儿HBsAg阳性率皆为0;产钳组产后出血量[(191.29±115.36) mL]高于阴道顺产组[(121.73±73.45) mL],P<0.0001;会阴侧切或Ⅱ度裂伤比率(61/61)高于顺产组(56/122),P<0.05,但两组患者均无会阴Ⅲ/Ⅳ度裂伤;两组患者新生儿黄疸率无差别(产钳组:15/61,顺产组:32/122,P>0.05);产钳组新生儿皮肤轻度擦伤比率较高,无严重产伤发生。结论HBsAg阳性产妇行产钳助娩不增加HBV母婴感染的风险,产妇产后出血量及会阴Ⅱ度裂伤、新生儿皮肤擦伤比率高于阴道顺产组,但会阴重度裂伤、新生儿黄疸、新生儿严重产伤的发生与顺产组无明显统计学差异。

Objective Evaluate whether forceps delivery increases the risk of transmission of hepatitis B virus in HBsAg positive patients. Methods This reprospective study enrolled patients whose Infants through forceps delivery with HBsAg positive from 2015-01-01 to 2020-06-01. Patients who delivered without forceps were selected as control. The primary outcome was defined by the percentage of infants with HBsAg positive when they were 7 months old. All of the newborns received the active-passive immunization therapy with hepatitis B immunoglobulin and HBVac intramuscular, and they were followed for 12 months. And the amount of postpartum hemorrhage, and the rates of perineal laceration, neonatal jaundice and neonatal birth injury were compared at the same time. Results Of the all the 183 patients enrolled, 61 infants born through forceps delivery, 122 matched infants delivered without the help of forceps. The positive rate of HBsAg in forceps delivery group was higher than the vaginal delivery group at the time of delivering(16/61 vs. 27/122, P>0.05) and there was no statistical significance. Also, the positive rates of HBsAg were zero in both group during the 7 months follow-up. The postpartum hemorrhage of forceps delivery group was higher than vaginal delivery group [(191.29±115.36) mL vs.(121.73±73.45) mL, P<0.0001]. At the same time, the occurrence rate of episiotomy and grade II perineal laceration was higher in forceps delivery group than in vaginal delivery group(61/61 vs. 56/122, P<0.05). However, there was no grade III/IV perineal laceration in both groups. There was no difference of neonatal jaundice between two groups(15/61 vs.32/122, P>0.05). Compared to vaginal delivery group, more neonatal scraping of skin was noticed in forceps delivery group, but no severe birth injury was found. Conclusion Forceps delivery doesn’t increase the frequency of HBV transmission. The amount of postpartum hemorrhage and the rates of II grade perineal laceration and neonatal skin scraping were higher in forceps delivery group than vaginal delivery group. However, the difference between the severe perineal laceration and neonatal birth injury and neonatal jaudice was no statistical difference in two groups. Further prospective studies are warranted to verify our findings.