阴道微生态变化对胎膜早破及母儿结局的影响

Effect of vaginal microecology changes on premature rupture of membranes and maternal and fetal outcomes

目的探讨阴道微生态变化对胎膜早破(PROM)及对母儿结局的影响。方法选取2019年9月—2020年2月徐州医科大学淮安妇幼临床学院(以下简称“我院”)的PROM孕妇作为研究对象,按照PROM的不同时期分为足月PROM(tPROM)32例和未足月PROM(PPROM)组48例,选取同期于我院体检的健康孕妇32名作为对照组。比较三组阴道分泌物、阴道菌群检测情况;比较三组病理性黄疸发生率、产褥感染率,新生儿血气pH值和Apgar 1 min评分。结果PPROM组乙酰胺基葡萄糖苷酶、过氧化氢酶、β-葡萄糖醛酸酶、白细胞脂酶阳性率和pH>4.5占比高于对照组,差异有统计学意义(P<0.017)。tPROM组乙酰胺基葡萄糖苷酶、过氧化氢酶、唾液酸苷酶、白细胞脂酶阳性率和pH>4.5占比高于对照组,差异有统计学意义(P<0.017)。PPROM组细菌性阴道病、沙眼衣原体感染率高于tPROM组及对照组;阴道分泌物异常率、生殖道假丝酵母菌感染率高于对照组,差异有统计学意义(P<0.017)。tPROM组阴道分泌物异常率及支原体感染率高于对照组,差异有统计学意义(P<0.017)。PPROM组剖宫产率、病理性黄疸发生率及新生儿血气pH高于tPROM组、对照组,Apgar 1 min低于tPROM组、对照组,差异有统计学意义(P<0.017或P<0.05)。结论孕期阴道微环境改变及生殖道感染是PROM的致病因素,且阴道微环境的改变对母儿结局均有影响。

Objective To investigate the effect of vaginal microecology changes on premature rupture of membranes(PROM)and maternal and fetal outcomes.Methods Pregnant women with PROM who delivered in Huai’an College of Women and Children Clinical,Xuzhou Medical University(hereinafter referred to as“our hospital”)from September 2019 to February 2020 were selected as research objects.According to the different periods of PROM,they were divided into term PROM(tPROM)32 cases and preterm PROM(PPROM)48 cases,32 healthy pregnant women in our hospital during the same period were selected as control group.The detection of vaginal secretions and vaginal microflora among three groups were compared;the incidence of pathological jaundice,puerperal infection rate,neonatal blood gas pH value and Apgar 1 min score were compared among three groups.Results The positive rates of acetylglucosaminidase,catalase,β-glucuronidase,leucocyte lipase and the ratio of pH>4.5 in PPROM group were higher than those in control group,and the differences were statistically significant(P<0.017).The positive rates of acetylglucosaminidase,catalase,sialidase,leucocyte lipase and the ratio of pH>4.5 in tPROM group were higher than those in control group,and the differences were statistically significant(P<0.017).The infection rates of bacterial vaginitis and chlamydia trachomatis in PPROM group were higher than those in tPROM group and control group;the abnormal rate of vaginal secretions and the infection rate of vulvovaginal candidiasis were higher than those in control group,and the differences were statistically significant(P<0.017).The abnormal rate of vaginal secretions and ureaplasma urealyticum infection in tPROM group were higher than those in control group,and the differences were statistically significant(P<0.017).The rate of cesarean section,incidence of pathological jaundice and neonatal blood gas pH in PPROM group were higher than those in tPROM group and control group,and Apgar 1 min was lower than that in tPROM group and control group,and the differences were statistically significant(P<0.017 or P<0.05).Conclusion Changes in vaginal microenvironment during pregnancy and reproductive tract infection are the pathogenic factors of PROM,and changes in vaginal microenvironment affect maternal and fetal outcomes.