早孕期胚胎绒毛膜下血肿与下生殖道感染的关系

The relationship between embryonic subchorionic hematoma and lower genital tract infections during early pregnancy

目的 探讨孕早期绒毛膜下血肿与下生殖道感染及胚胎停育的关系。方法 采用前瞻性随机试验方法,选择早孕5~9周合并绒毛膜下血肿的女性180例作研究对象,依据阴道分泌物培养结果,分为下生殖道感染组(54例)与下生殖道无感染组(126例),分析下生殖道感染及绒毛膜下血肿面积与妊娠结局的关系。结果 下生殖道感染组与下生殖道无感染组在孕妇平均年龄、孕天数、孕次及体质指数上,均差异无统计学意义(P> 0.05)。在阴道出血持续的天数、下腹痛持续天数等症状上也差异无统计学意义(P> 0.05)。经过病因分析,发现下生殖道感染、绒毛膜下血肿出现的孕周<6周,及血肿与孕囊面积占比≥50%及25%~50%之间,均为早孕胚胎停育的独立危险因素。结论 孕早期胚胎停育,与女性下生殖道感染、绒毛膜下血肿出现的孕周<6周,及血肿与孕囊面积占比≥50%及25%~50%,均相关。早孕期应该及时重视调整阴道菌群微生态平衡,早期B超检查发现并处理绒毛膜下血肿,以获得更好结局。

Objective This study aims to investigate the relationship between subchorionic hematoma in the first trimester and lower genital tract infection and embryonic arrest.Methods The method of prospective randomized trials was used to select 180 women with pregnancy 5 ~ 9 weeks following subchorionic hematoma.and then divide them into the lower genital tract infection group(n = 54)and normal group(n = 126)according to the results of vaginal secretion culture.The relationships of the lower genital tract infections and chorionic hematoma area with the pregnancy outcomes were analyzed.Results There were no significant differences in the average age,gestational days,gestational times and body mass index between the two groups.There was no significant difference in the duration of vaginal bleeding and the duration of lower abdominal pain(P<0.05).Etiological analysis showed that the abnormal vaginal flora,the gestational age of subchorionic hematoma 6 weeks,and the ratio of hematoma to gestational sac area ≥ 50% and between 25% ~ 50% were all the independent risk factors for embryo suspension in early pregnancy.Conclusion Embryo termination in early pregnancy is related to the imbalance between vaginal microbiota and vaginal microbiota,the gestational age of subchorionic hematoma 6 weeks,and the proportion of hematoma to gestational sac area ≥ 50% and between 25% ~ 50%.In early pregnancy,attention should be paid to the balance of vaginal microflora,timely adjustment of the microecological balance of vaginal microflora,early B-ultrasound examination for detecting and treating subchorionic hematoma,in order to obtain a better outcome.