死胎与宫内感染的关系探讨  

Relationship of Fetal Death and Intrauterine Infection

作　　者：应红军[1] 江元[1] 范琦慧[1] 卢寨娥[1] 

机构地区：[1]浙江省宁波市妇女儿童医院,浙江宁波315012

出　　处：《实用妇产科杂志》2012年第10期882-885,共4页Journal of Practical Obstetrics and Gynecology

基　　金：宁波科技项目(编号:2007C10044)

摘　　要：目的:探讨死胎发生时宫颈分泌物和胎盘拭子病原微生物培养情况与宫内感染的关系。方法:选择2010年6月至2011年12月,于宁波市妇女儿童医院确诊为死胎住院分娩的54例患者的临床资料,分析其孕妇的宫颈分泌物及胎盘拭子的一般细菌、支原体、衣原体及淋菌培养结果,并结合胎盘病理检查,对不同病变程度绒毛膜羊膜炎与其病原微生物检查阳性之间的情况和不同孕周死胎胎盘绒毛膜羊膜炎的情况进行比较。结果:①54例死胎孕妇宫颈分泌物培养阳性情况:支原体28例(65.12%),真菌10例(23.26%),革兰阳性球菌8例(18.60%),革兰阴性杆菌6例(13.95%),革兰阳性杆菌3例(6.98%),衣原体2例(4.65%);胎盘拭子培养出支原体9例,真菌4例,细菌3例;②胎盘病理检查轻度、中度和重度绒毛膜羊膜炎中宫颈分泌物培养阳性率有逐渐增高趋势,分别为57.14%、84.62%和100.00%,差异有统计学意义(χ2=8.790,P=0.012);轻度、中度和重度绒毛膜羊膜炎中胎盘拭子培养阳性率也有增高趋势,分别为14.29%、30.77%和66.67%,差异有统计学意义(χ2=8.854,P=0.012);③孕20～27+6周死胎胎盘绒毛膜羊膜炎发生率(100.00%)分别与孕28～33+6周(70.59%)、孕34～36+6周(66.67%)和≥孕37周(66.67%)比较,差异均有统计学意义(χ2=5.546,P=0.019;χ2=6.222,P=0.013;χ2=6.061,P=0.014)。结论:妊娠过程中死胎的发生与宫颈感染病原微生物有较密切的关系,死胎胎盘绒毛膜羊膜炎的严重程度也与病原微生物感染有关;应加强对孕妇孕28周前的宫颈分泌物检查,及早干预,以改善妊娠结局。Objective：To study the relationship of pathogenic microorganism culture results from cervical secretions and placental swab from fetal death and intrauterine infection. Methods： From June 2010 to December 2011, the clinical data of 54 cases of fetal death among pregnant women who delivered in Ningbo Women and Children＇s Hospital were analyzed retrospectively. In these cases, cultivation of cervical secre- tions and from placenta swab for general bacteria, mycoplasma, gonorrhea, and chlamydia were done,and all placentas received the pathological examination. The different degrees of placental chorioamnionitis with positive results of Pathogenic microorganism culture, and the rates of placental chorioamnionitis of different weeks were compared. Results：①Among 54 cases, the cervical secretions culture positive rates were 65. 12% （mycoplasma） ,23.26% （fungus）, 18.60%（ G ＋cocci ）, 13.95%（ G- bacilli ）, 6.98%（ G ＋ ba- cilli ）, and 4.65% （ Chlamydia）, respectively; placental swab culture results showed mycoplasma in 9 cases, fungus in 4 cases, bacteria in 3 cases. ② The positive rates of pathogenic microorganism culture had significant differences among mild, moderate and severe placental chorioamnionitis, respectively which were 57.14% ,84.62% and 100% （χ2= 8.790, P = 0.012）. The positive rates of placental swab culture respectively which were 14.29% ,30.77% and 66.67% （χ2= 8.854, P =0. 012）. ③The rate of placental chorioamnionitis was 100.00% in fetal death of 20 ～27 ＋6 weeks and was significant different from the total rate of 28 ～33 ＋6weeks （ 70.59% ）, 34 ～ 36 ＋6 weeks （ 66.67% ） and 37 weeks later （ 66.67% ） （ χ2 = 5. 545, P =0.019 ;χ2= 6. 222, P = 0.013 ;χ2 = 6.061, P = 0.014 ）. Conclusions： The yeast infection of pathogenic microor- ganism may be closely related to the increasing incidence of fetal death. The degree of placental chorioamnionitis may be related to pathogenic microorganism infection. Thinking highly of cervical sec

关 键 词：死胎 宫内感染 病原微生物 绒毛膜羊膜炎 宫颈分泌物 胎盘拭子 

分 类 号：R714.5[医药卫生—妇产科学]