B族链球菌感染及阴道微生态变化与不良妊娠结局的关系

Relationship between GBS infection,vaginal microecological changes and adverse pregnancy outcomes of pregnant women

目的分析B族链球菌(GBS)感染及阴道微生态变化与不良妊娠结局的关系。方法收集202例孕晚期检出GBS感染(阳性组)及202例未感染GBS孕妇(阴性组)资料,比较2组一般资料、阴道微生态及不良妊娠结局。根据阴道微生态检查结果,将2组细分为阳性正常组(76例)、阳性失衡组(126例)、阴性正常组(154例)及阴性失衡组(48例)。阳性组发生胎膜早破后立即给患者使用抗生素治疗,无胎膜早破的孕妇在临产后行抗生素治疗;滴虫性阴道炎、霉菌性阴道炎或细菌性阴道病,给予硝呋太尔制霉素阴道软胶囊治疗。比较4组不良妊娠结局。结果与阴性组比较,阳性组妊娠期糖尿病占比、pH值>4.5占比、霉菌性阴道炎、细菌性阴道病检出率、早产率、胎膜早破率、产后出血率、胎儿宫内窘迫率高(P<0.05);与阴性正常组比较,阴性失衡组早产率、胎膜早破率、产褥感染率、胎儿宫内窘迫率高(P<0.05),阳性失衡组早产率、胎膜早破率、产后出血率、产褥感染率、胎儿宫内窘迫率、宫内感染率、新生儿感染率高(P<0.05);与阴性失衡组比较,早产率、胎膜早破率、胎儿宫内窘迫率在阳性正常组中低,在阳性失衡组中高(P<0.05);与阳性正常组比较,阳性失衡组早产率、胎膜早破率、胎儿宫内窘迫率高(P<0.05)。结论孕晚期GBS感染增加了不良妊娠结局发生率,阴道微生态失衡与其协同促进不良妊娠结局。

Objective To analyze the relationship between group B streptococcus(GBS)infection,vaginal microecological changes and adverse pregnancy outcomes of pregnant women.Methods The data of 202 pregnant women with GBS infection(the positive group)and 202 pregnant women without GBS infection(the negative group)in the third trimester of pregnancy were collected.The general data,vaginal microecology and adverse pregnancy outcomes were compared between the two groups.According to the results of vaginal microecological examination,patients in the two groups were divided into the positive normal group(76 cases),the positive imbalance group(126 cases),the negative normal group(154 cases)and the negative imbalance group(48 cases).Pregnant women in the positive group were treated with antibiotics immediately after premature rupture of membranes,and pregnant women without premature rupture of membranes were treated with antibiotics after labor.Pregnant women with trichomonas vaginitis or fungal vaginitis or bacterial vaginosis were given nifuratel nystatin vaginal soft capsules for treatment.The adverse pregnancy outcomes were compared between the four groups.Results Compared with the negative group,the proportion of gestational diabetes mellitus,proportion of pH value>4.5,detection rates of mycotic vaginitis and bacterial vaginosis,premature delivery rate,premature membrane rupture rate,postpartum hemorrhage rate and fetal intrauterine distress rate were higher in the positive group(P<0.05).The premature delivery rate,premature membrane rupture rate,puerperal infection rate and fetal intrauterine distress rate were higher in the negative imbalance group than those in the negative normal group(P<0.05),and the positive imbalance group had higher premature delivery rate,premature membrane rupture rate,postpartum hemorrhage rate,puerperal infection rate,fetal intrauterine distress rate,intrauterine infection rate and neonatal infection rate(P<0.05).Compared with the negative imbalance group,the premature delivery rate,premature membrane rupture rate and fetal intrauterine distress rate were lower in the positive normal group,and those were higher in the positive imbalance group(P<0.05).The positive imbalance group had higher rates of premature delivery,premature membrane rupture and fetal intrauterine distress compared to the positive normal group(P<0.05).Conclusion GBS infection in the third trimester of pregnancy increases the incidence of adverse pregnancy outcomes,and vaginal microecological imbalance its synergies promote of adverse pregnancy outcomes.