本文關(guān)鍵詞：妊娠中晚期B組溶血性鏈球菌感染對(duì)妊娠結(jié)局的影響　出處：《蘇州大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 妊娠 B族溶血性鏈球菌 妊娠結(jié)局 孕婦 新生兒

【摘要】：B族溶血性鏈球菌(Group B Streptococcus,GBS)是與產(chǎn)婦及新生兒的發(fā)病率及死亡率相關(guān)的一種病原體,是新生兒早發(fā)性嚴(yán)重感染及嚴(yán)重并發(fā)癥的主要原因。對(duì)孕35-37周孕婦進(jìn)行產(chǎn)前篩查并進(jìn)行相應(yīng)的預(yù)防抗生素使用的研究很多,但對(duì)中孕期的GBS產(chǎn)前篩查與妊娠結(jié)局的相關(guān)性,報(bào)道國(guó)內(nèi)外尚不多見。GBS感染存在地區(qū)差異性,在上海地區(qū)未見類似報(bào)道。因此,本研究擬在孕中、晚期產(chǎn)前檢查時(shí)進(jìn)行宮頸分泌物B族溶血性鏈球菌(GBS)檢測(cè),并觀察其妊娠結(jié)局,為制定妊娠期GBS的防治策略提供依據(jù)。研究目標(biāo):探討不同孕周B族溶血性鏈球菌(GBS)感染與妊娠結(jié)局的相關(guān)性。研究方法:2015年9月至2016年8月于上海市浦東醫(yī)院產(chǎn)科門診定期產(chǎn)檢孕婦744人,選取宮頸分泌物GBS檢測(cè)陽(yáng)性并在本院分娩的孕婦共104例作為研究組,再按GBS檢測(cè)的孕周分為4個(gè)亞組:A組19例(孕20-24周檢測(cè)GBS);B組35例(孕24-28周檢測(cè)GBS);C組27例(孕28-34周檢測(cè)GBS);D組23例(孕周34周檢測(cè)GBS)。同期選取本院門診產(chǎn)檢、宮頸分泌物GBS檢測(cè)陰性的孕婦46例為對(duì)照組。兩組孕婦均無(wú)其他妊娠合并癥和并發(fā)癥。隨訪各組妊娠各組妊娠結(jié)局包括分娩孕周、有無(wú)胎膜早破、羊水污染、產(chǎn)后出血、新生兒窒息、新生兒體重及母嬰感染情況,分娩后送病理檢查是否存在絨毛膜羊膜炎。結(jié)果:1.研究組和對(duì)照組的一般資料無(wú)顯著性差異(P0.05)。2.本研究孕婦GBS總帶菌率為14.0%(104/744),不同孕周GBS檢測(cè)帶菌率分別為12.4%(A組)、15.6%(B組)、14.4%(C組)、13.1%(D組),各孕周GBS帶菌率基本相同,無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。3.研究組和對(duì)照組孕婦的不良妊娠結(jié)局發(fā)生率分別為47.1%和19.6%。其中,胎膜早破分別為41.4%和17.4%;絨毛膜羊膜炎分別為10.6%和4.4%;產(chǎn)前感染分別為28.9%和6.5%;早產(chǎn)分別為15.4%和6.5%,研究組明顯均高于對(duì)照組,并有統(tǒng)計(jì)學(xué)差異(P0.05)。4.GBS陽(yáng)性的研究組孕婦,各亞組胎膜早破、產(chǎn)后出血、羊水污染發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。A組和B組孕婦中產(chǎn)前感染發(fā)生率分別為(52.6%和28.6%)、新生兒感染分別(15.8%和17.1%)、死胎或流產(chǎn)(10.5%、8.6%)比較C組和D組孕婦產(chǎn)前感染發(fā)生率(18.5%和21.7%)、新生兒感染(3.7%和0%)、死胎或流產(chǎn)(3.7%和0%),均明顯升高;A組和B組在這幾種不良妊娠結(jié)局中的發(fā)生率高于C組及D組;A、B、C組中孕婦中絨毛膜羊膜炎(10.5%、17.1%、14.8%)、早產(chǎn)率(15.8%、17.1%、18.5%)的發(fā)生率高于D組發(fā)生率(分別是8.7%、8.7%)(P0.05)。結(jié)論:孕期生殖道GBS定植會(huì)導(dǎo)致不良妊娠結(jié)局,長(zhǎng)時(shí)間感染可能會(huì)增加母嬰感染率,重視產(chǎn)前篩查、及早發(fā)現(xiàn)、及時(shí)治療GBS感染,可能會(huì)改善妊娠結(jié)局。
[Abstract]:Group B hemolytic streptococcus group B Streptococcus GBSis a pathogen associated with maternal and neonatal morbidity and mortality. It is the main cause of early severe infection and serious complications of newborns. There are many studies on prenatal screening of pregnant women at 35 to 37 weeks of gestation and corresponding prevention of antibiotic use. However, for the relationship between prenatal screening and pregnancy outcome during pregnancy, it is reported that there is no regional difference in GBS infection at home and abroad, and no similar report has been found in Shanghai. Therefore, this study is intended to be in pregnancy. The cervical secretion group B hemolytic streptococcus (GBS) was detected during the late prenatal examination and its pregnancy outcome was observed. Objective: to study the prevention and treatment strategy of GBS in gestational period. Objective: to study the prevention and treatment of Group B hemolytic streptococcus in different gestational weeks. The relationship between infection and pregnancy outcome. Methods: from September 2015 to August 2016, 744 pregnant women were examined regularly in the obstetrical outpatient clinic of Shanghai Pudong Hospital. A total of 104 pregnant women with GBS positive cervical secretion and delivered in our hospital were selected as the study group. According to the gestational weeks detected by GBS, 19 cases were divided into 4 subgroups: group A (20-24 weeks gestation); Group B 35 cases (24-28 weeks of gestation); Group C 27 cases (28-34 weeks gestation); Group D 23 cases (34 weeks of gestational age) were tested for GBSN. At the same time, the outpatient department of our hospital was selected for birth examination. There were 46 pregnant women with negative GBS detection of cervical secretion as control group. There were no other pregnancy complications and complications in both groups. The pregnancy outcomes of each group were followed up including delivery gestational weeks, premature rupture of membranes. Amniotic fluid contamination, postpartum hemorrhage, neonatal asphyxia, neonatal weight and maternal and infant infection. Results: 1. There was no significant difference in general data between the study group and the control group (P0.05). 2.The total bacterial rate of pregnant women with GBS was 14.010 / 744). The rate of carrying bacteria detected by GBS in different gestational weeks was 12.4B and 15.6B, respectively. The rate of GBS carrying in group B was the same as that in group C (13.1g / D). There was no significant difference between the two groups. The incidence of adverse pregnancy outcomes in the study group and the control group was 47.1% and 19.6respectively. Premature rupture of membranes was 41.4% and 17.4 respectively. The chorioamnionitis was 10.6% and 4.4 respectively. Antepartum infection was 28.9% and 6.5, respectively. The number of premature delivery was 15.4% and 6.5 respectively, the study group was significantly higher than the control group, and there was statistical difference in the study group with positive P0.050.4.The premature rupture of membranes and postpartum hemorrhage were observed in each subgroup. There was no statistical difference in the incidence of amniotic fluid contamination. The incidence of prenatal infection in pregnant women in group A and group B was 52.6% and 28.6%, respectively. The incidence of antenatal infection in group C and group D was 18.5% and 21.7g respectively, compared with that of group C and D (15.8% and 17.1%, respectively). The neonatal infection rate of 3.7% and 0%, stillbirth or abortion 3.7% and 0% were significantly increased. The incidence of adverse pregnancy outcomes in group A and group B was higher than that in group C and group D. In group A BU C, 10.5% of the pregnant women had chorioamnionitis and 17.1% were involved in 14.8.The rate of premature delivery was 15.810% or 17.1%. The incidence of GBS implantation in pregnancy was higher than that in group D (8.7%). Conclusion: GBS colonization of reproductive tract during pregnancy may lead to adverse pregnancy outcome. Long-term infection may increase the infection rate of mother and child, pay attention to prenatal screening, early detection, timely treatment of GBS infection, may improve the outcome of pregnancy.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R714.251

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