未足月胎膜早破孕妇阴道菌群失调状况及不同抗感染治疗时机的效果对比

Vaginal flora imbalance in preterm premature rupture of membranes and the effect of different anti infective treatment opportunities

目的研究未足月胎膜早破(PPROM)孕妇阴道菌群微生态状况及不同抗感染治疗时机对妊娠结局的影响,为改善母婴结局提供参考。方法回顾性分析2018年1月至2021年3月高州市妇幼保健院收治的94例PPROM孕妇的临床资料,并将其作为PPROM组,另选取同期收治的94例正常妊娠晚期孕妇的临床资料作为健康对照组。分析两组研究对象的阴道菌群微生态状况及感染情况,比较两组研究对象的阴道优势菌,并分析比较破膜后不同治疗时间[破膜后6 h(早期组)与破膜后18 h(晚期组)进行抗感染治疗]PPROM孕妇的白细胞计数水平、妊娠结局及新生儿体质量、住院时间的差异。结果PPROM组孕妇菌群失调、细菌性阴道病(BV)、假丝酵母菌病(VVC)发生率均显著高于健康对照组;PPROM组孕妇革兰阳性球菌、革兰阳性杆菌、革兰阴性杆菌占比均显著高于健康对照组,乳酸杆菌占比显著低于健康对照组;早期组分娩前白细胞计数水平<10×10^(9)/L的孕妇占比显著高于晚期组,白细胞计数水平>15×10^(9)/L的孕妇占比显著低于晚期组;早期组孕妇宫内感染与新生儿感染发生率均显著低于晚期组;早期组新生儿住院时间显著短于晚期组(均P<0.05);两组孕妇菌群抑制发生率和新生儿出生体质量比较,差异均无统计学意义(均P>0.05)。结论PPROM孕妇存在明显的阴道菌群微生态失衡,于破膜后6 h给予孕妇早期抗感染治疗,能够使宫内感染的发生风险降低,并缩短新生儿住院时间,对母婴预后具有明显的改善作用。

Objective To study the microecological status of vaginal flora in pregnant women with preterm premature rupture of membranes(PPROM)and the effect of different anti infection treatment timing on pregnancy outcome,so as to provide reference for improving maternal and infant outcomes.Methods The clinical data of 94 pregnant women with PPROM treated in Gaozhou Maternal and Child Health Hospital from January 2018 to March 2021 were analyzed retrospectively,and they were used as the PPROM group.In addition,the clinical data of 94 pregnant women with normal late pregnancy treated in the same period were selected as the healthy control group.The vaginal flora microecological status and infection situation of the two groups of research objects were analyzed,and the vaginal dominant bacteria of the two groups of research objects were compared,and the differences of white blood cell count,pregnancy outcome,neonatal body mass and length of hospital stay of PPROM pregnant women at different treatment time after membrane rupture[6 h after membrane rupture(the early group)and 18 h after membrane rupture(the late group)]were analyzed and compared.Results The incidence of dysbacteriosis,bacterial vaginosis(BV)and vulvovaginal candidiasis(VVC)in the PPROM group were significantly higher than those in the healthy control group;the proportion of gram-positive cocci,gram-positive bacilli and gram-negative bacilli in the PPROM group was significantly higher than that in the healthy control group,and the proportion of lactobacillus was significantly lower than that in the healthy control group;the proportion of pregnant women with prenatal white blood cell count<10×10^(9)/L in the early group was significantly higher than that in the late group,the proportion of white blood cell count>15×10^(9)/L was significantly lower than that in the late group;the incidence of intrauterine infection and neonatal infection in the early group were significantly lower than those in the late group;the hospitalization time of newborns in the early group was significantly shorter than that in the late group(all P<0.05);there was no significant difference in the incidence of bacterial flora inhibition and neonatal birth weight between the two groups(all P>0.05).Conclusion Pregnant women with PPROM have obvious microecological imbalance of vaginal flora.Early anti-infective treatment 6 hours after membrane rupture can reduce the risk of intrauterine infection,shorten the hospitalization time of newborns,and significantly improve the prognosis of mothers and infants.