生殖道微生物感染与胎膜早破孕妇妊娠结局的关系探究

Relationship between reproductive tract microbial infections and pregnancy outcomes in pregnant women with premature rupture of membranes

目的调查胎膜早破孕妇生殖道微生物感染发生情况及其对妊娠结局的影响。方法选取2019年1月至2021年12月于宁德师范学院附属宁德市医院就诊的200例胎膜早破孕妇作为观察组,选取同期200例正常孕妇作为对照组;根据是否发生生殖道感染,将观察组分为感染组(n=130)和未感染组(n=70)。入组后24h内采集所有孕妇的宫颈及阴道分泌物进行病原学分析,统计并比较两组生殖道微生物感染发生情况及妊娠结局。结果观察组生殖道微生物感染总发生率65.00%,高于对照组的17.00%(P<0.05)。感染组胎膜早破孕周、分娩孕周均小于未感染组,妊娠延长天数少于未感染组(P<0.05);感染组绒毛膜羊膜炎发生率为14.62%、剖宫产率为39.23%、产后出血率为13.08%、产褥病率为13.85%,高于未感染组的1.43%、20.00%、2.86%、2.86%(P<0.05);感染组早产儿发生率为70.77%、新生儿窒息为30.00%、新生儿感染率为17.69%,高于未感染组的48.57%、11.43%、2.86%(P<0.05)。多因素Logistic分析显示,合并生殖道感染是影响胎膜早破孕妇不良结局的危险因素(P<0.05),未足月、合并生殖道感染均是影响胎膜早破孕妇新生儿不良结局的危险因素(P<0.05)。结论胎膜早破孕妇生殖道微生物感染率较正常孕妇高,且感染的发生可进一步影响妊娠进程,增加孕妇及新生儿不良结局的发生风险。

Objective To investigate the incidence of reproductive tract microbial infection in pregnant women with premature rupture of membranes and its effect on pregnancy outcome.Methods 200 pregnant women with premature rupture of membranes who were treated in Ningde Municipal Hospital of Ningde Normal University between January 2019 and December 2021 were selected as observation group,and another 200 normal pregnant women during the same period were selected as control group.According to the occurrence of reproductive tract infections,the pregnant women in observation group were divided into infected group(n=130)and uninfected group(n=70).Cervical and vaginal secretions were collected within 24 h after enrollment for pathogenic analysis,and the occurrence of reproductive tract microbial infections and pregnancy outcomes were counted and compared between the two groups.Results The total incidence rate of reproductive tract microbial infections in observation group was higher than that in control group(65.00%vs.17.00%,P<0.05).The gestational week of premature rupture of membranes and gestational week of delivery in infected group were smaller than those in uninfected group,and the prolonged pregnancy time was shorter than that in uninfected group(P<0.05).The incidence rate of chorioamnionitis,cesarean section rate,postpartum hemorrhage rate and puerperalism rate in infected group were higher than those in uninfected group(14.62%vs.1.43%,39.23%vs.20.00%,13.08%vs.2.86%,13.85%vs.2.86%,P<0.05).The incidence rates of premature infants,neonatal asphyxia and neonatal infection in infected group were higher than those in uninfected group(70.77%vs.48.57%,30.00%vs.11.43%,17.69%vs.2.86%,P<0.05).Multivariate Logistic analysis showed that combination of reproductive tract infections was a risk factor for adverse outcomes of pregnant women with premature rupture of membranes(P<0.05),and premature delivery and combination of reproductive tract infections were the risk factors for adverse outcomes in neonates(P<0.05).Conclusions Pregnant women with premature rupture of membranes have higher rate of reproductive tract microbial infection than normal pregnant women,and the occurrence of infection can further affect the pregnancy process and increase the risk of adverse outcomes of pregnant women and neonates.