晚期妊娠宫内感染对母婴的影响

Effects of late pregnancy intrauterine infection on mothers and babies

目的探讨晚期妊娠宫内感染的发病原因与病原菌,同时观察其对母婴健康的影响,并提出相应护理防范对策。方法选取2015年6月-2017年6月医院晚期妊娠者500例为研究对象,其中诊断为晚期妊娠宫内感染者50例,根据患者分娩孕周情况将其分组为试验组20例与对照组30例,试验组胎儿早产,对照组胎儿足月。比较两组晚期妊娠宫内感染者感染诊断时间、分娩方式、胎膜早破情况。统计两组晚期妊娠宫内感染者产褥期感染和围产儿预后情况;进行宫腔细菌培养和胎盘病理检查,观察细菌培养结果与病理检查结果。统计晚期妊娠宫内感染者产程并发症和阴道检查及羊水胎粪污染情况。结果晚期宫内感染率为10.00%(50/500);试验组患者于入院时和保胎治疗时确诊为主,对照组患者于引产和产程中确诊为主。试验组胎膜早破发生率为70.00%(14/20)高于对照组13.33%(4/30)(P<0.001);试验组患者产褥期感染、围产儿死亡及新生儿感染发生率分别为35.00%、25.00%、40.00%高于对照组(P均<0.05)。50例晚期妊娠宫内感染者细菌感染主要以B族链球菌和大肠埃希菌及粪肠球菌为主。试验组绒毛膜羊膜炎II级发生率为25.00%(5/20),病理结果阴性占45.00%(9/20)与对照组比较,差异有统计学意义(P<0.05)。结论晚期妊娠宫内感染对母婴健康有一定威胁,尤其是早产宫内感染者;加强对晚期妊娠者孕期保健和保胎期的治疗和产程管理,同时积极预防和治疗宫内感染以改善母婴预后。

OBJECTIVE To investigate the pathogenesis of late pregnancy intrauterine infection and the main pathogens,and meanwhile observe its impact on maternal and child health,and propose appropriate preventive measures.METHODS 500 cases of late pregnancy in our hospital from Jun.2015 to Jun.2017 were selected,of whom50 were diagnosed as late pregnancy intrauterine infection.According to the gestational week of patients,they were grouped into observation group(premature,20 cases)and control group(full-term,30 cases).The infection diagnosis time,mode of delivery,and premature rupture of membranes were compared between the two groups of patients with late pregnancy intrauterine infection.The incidence of puerperal infection and perinatal outcome in the two groups of pregnant women with late pregnancy intrauterine infection were analyzed.The intrauterine bacteria culture and placental pathology examination were performed to observe the results of bacterial culture and pathological examination.Complications during labor,vaginal examination and contamination of amniotic fluid by meconium in patients with late pregnancy intrauterine pregnancy were analyzed.RESULTS The late intrauterine infection rate was 10.00%(50/500).The patients in the experimental group were mainly diagnosed at the time of admission and during the treatment of the fetus,and the patients in the control group were mainly diagnosed during labor induction and labor.The incidence of premature rupture of membranes in the experimental group was70.00%(14/20),significantly higher than that in the control group which was 13.33%(4/30)(P<0.001).The incidence of puerperal infection,perinatal death and neonatal infection in the experimental group were 35.00%,25.00%,and 40.00%,significantly higher than those of the control group(P<0.05).The bacterial infection in the 50 cases of intrauterine infection in late pregnancy was mainly caused by group B Streptococcus,Escherichia coli and Enterococcus faecalis.The incidence of grade II chorioamnionitis in the experimental group was 25.00%(5/20),and the negative pathological results accounted for 45.00%(9/20),with significant difference from those of the control group(P<0.05).CONCLUSIONLate pregnancy intrauterine infection has a certain threat to maternal and child health,especially in patients with preterm intrauterine infection.Enhancement of the late pregnancy care,labor protection and labor management,together with active prevention and treatment of intrauterine infection,could improve the prognosis of mother and child.