产时体温异常孕妇中组织学绒毛膜羊膜炎的相关因素及产后母婴感染风险分析  

Related factors of histologic chorioamnionitis in women with abnormal intrapartum temperature and the risk analysis of postpartum maternal and neonatal infection

作　　者：葛瀛洲 张晨[1] 刘欣梅 黄荷凤[1] GE Ying-zhou;ZHANG Chen;LIU Xin-mei;HUANG He-feng(International Peace Maternity and Child Health Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院,上海胚胎源性疾病重点实验室,上海200030

出　　处：《中国实用妇科与产科杂志》2021年第3期342-347,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划(2017YFC1001300);国家自然科学基金(81661128010);中国医学科学院医学与健康科技创新工程(2019-I2M-5-064);申康三年行动计划(16CR3003A)。

摘　　要：目的探讨产时体温异常的孕妇中组织学绒毛膜羊膜炎(HCA)的相关因素及HCA对产后母婴感染性疾病的影响。方法选取2017年1月至2019年1月在上海交通大学医学院附属国际和平妇幼保健院分娩且产时体温≥37.5℃的孕妇,根据胎盘病理结果将其分为HCA组和对照组。比较两组间临床特征及实验室检查的差异,采用多变量logistic回归分析评估与HCA相关的因素,并比较两组间产后母婴感染风险差异。结果妊娠期糖尿病(GDM)(OR=1.57,95%CI 1.082.28)、胎膜早破(PROM)(OR=1.41,95%CI 1.091.82)、胎膜破裂持续时间≥24 h(OR=1.61,95%CI 1.032.51)、产程中最高体温≥38℃(OR=1.37,95%CI 1.071.76)、解脲支原体感染(OR=1.54,95%CI 1.072.22)及C-反应蛋白(CRP)≥12mg/L(OR=2.05,95%CI 1.622.59)是HCA的相关因素,且上述因素数量越多,该孕妇其存在HCA的可能性越大。同时,HCA会导致产褥感染及新生儿败血症风险增加。结论在产时体温异常的孕妇中,GDM、PROM、胎膜破裂持续时间≥24 h、产程中最高体温≥38℃、解脲支原体感染、CRP≥12mg/L等因素与HCA密切相关,且HCA的存在会增加产后母婴感染风险。对于此类高度怀疑存在HCA的孕妇,建议采取更积极的产科干预措施,并在产后加强预防性抗感染治疗,以改善孕妇和新生儿的预后。ObjectiveTo explore the related factors of histologic chorioamnionitis(HCA)in women with abnormalintrapartum temperature and the effect of HCA on postpartum maternal and neonatal infection.MethodsThis case-control study was conducted at the International Peace Maternity and Child Health Hospital(IPMCH)from Jan. 2017 toJan 2019. Women with intrapartum temperature ≥ 37.5℃ were included in this study and were divided into HCA groupor control group based on the results of placental pathology. The differences in clinical characteristics and laboratorytests between the two groups were compared,and multivariable Logistic regression analysis was used to evaluate therelated factors of HCA. The difference in the risk of postpartum maternal and neonatal infection was also compared.ResultsGestational diabetes mellitus(GDM)(OR=1.57,95% CI 1.08-2.28),premature rupture of membranes(PROM)(OR=1.41,95%CI 1.09-1.82),rupture of membranes ≥ 24 hours(OR=1.61,95%CI 1.03-2.51),maximumintrapartum temperature ≥ 38℃(OR=1.37,95%CI 1.07-1.76),ureaplasma infection(OR=1.54,95%CI 1.07-2.22),andC-reactive protein(CRP)≥ 12 mg/L(OR=2.05,95%CI 1.62-2.59)were the related factors of HCA,and the more relatedfactors a woman had,the more likely she was to have HCA. At the same time,HCA could increase the risk of puerperalinfection and neonatal sepsis.ConclusionIn women with abnormal intrapartum temperature,the factors such as GDM,PROM,prolonged rupture of membranes(≥ 24 hours),maximum intrapartum temperature ≥ 38℃,ureaplasmainfection,and CRP ≥ 12 mg/L are all closely related toHCA,and the presence of HCA will increase the risk ofpostpartum maternal and neonatal infection. Thus,forsuch pregnant women who are highly suspected of havingHCA,it is recommended to take more active obstetric interventions and strengthen preventive antibiotic use atpostpartum period,so as to improve the prognosis of mothers and neonates.

关 键 词：组织学绒毛膜羊膜炎 妊娠期糖尿病 胎膜早破 解脲支原体 C-反应蛋白 

分 类 号：R714.7[医药卫生—妇产科学]