摘要
目的研究孕妇B族链球菌(GBS)感染的高危因素及预防性使用抗生素对母婴结局的影响。方法选取2016年1月至2017年10月孕35周后产检并分娩的孕妇2 449例,采用细菌培养法进行GBS筛查,将2017年1至10月孕35周后筛查GBS阳性,并在临产或破膜后预防性使用抗生素的孕妇设为试验组(107例),同期有1 027例孕妇GBS筛查阴性,分析影响GBS感染的高危因素;另将2016年3至12月GBS筛查阳性,在临产或破膜后未预防性使用抗生素的孕妇设为对照组,观察预防性使用抗生素的临床意义。结果孕早期BMI≥24kg/m^2、经产妇、妊娠期糖耐量异常、合并阴道炎者的GBS阳性率均高于孕早期BMI<24kg/m^2、妊娠期糖耐量正常、初产妇和无阴道炎者,差异均有统计学意义(均P<0.05)。经多因素logistic回归分析显示孕早期BMI≥24kg/m^2、经产妇、妊娠期糖耐量异常、合并阴道炎为影响GBS感染的高危因素(均P<0.05)。预防性使用抗生素后,试验组产后出血、产褥感染、胎儿窘迫、新生儿上呼吸道感染发生率较对照组明显降低,差异均有统计学意义(均P<0.05);两组胎膜早破、早产、低出生体重儿、新生儿肺炎、新生儿败血症发生率比较差异均无统计学意义(均P>0.05)。结论肥胖、经产妇、妊娠期糖耐量异常、阴道炎为妊娠晚期孕妇GBS感染的可能高危因素,经预防性使用抗生素后,产妇自身的不良妊娠结局有较多改变,但新生儿感染、早产、胎膜早破、低出生体重儿等严重不良预后的结局改善不明显。
Objective To investigate the effect of group B streptococcus （GBS） infection during pregnancy on the maternal- infant outcomes. Methods A total 2 449 pregnant women with antenatal care and delivery in our hospital from March 2016 to October 2017 were enrolled in the study. GBS was screened by bacterial culture after 35 weeks of the pregnancy, positive GBS was detected in 107 cases in whom the preventive antibiotics were used after birth or rupture （study group）from January to October 2017, and 1 027 GBS negative cases served as negative control group, meanwhile 125 pregnant women with detected positive GBS from March to December 2016, in whom the preventive antibiotics were not used, served as positive control group.The risk factors for GBS infection during pregnancy were analyzed; and the clinical efficacy of the preventive antibiotics use was also studied. Results The positive rate of GBS was higher in multipara, pregnant women with BMI≥24kg/m2, abnormal glucose tolerance and vaginitis than that in those without these factors （all P〈0.05）. Multivariate logistic regression analysis showed that BMI≥24kg/m2 in early pregnancy, multipara, abnormal glucose tolerance, vaginitis in pregnancy were the risk factors for GBS infection （all P〈0.05）. The incidence of postpartum hemorrhage, puerperal infection, fetal distress, neonatal upper respiratory tract infection in the study group were significantly lower than those in the negative control group （all P〈0.05）. There were no significant differences in the incidence of premature rupture of membranes, preterm birth, low birth weight and neonatal pneumonia, neonatal septicemia between two groups （all P 〉0.05）. Conclusion Obesity, multipara, abnormal glucose tolerance and vaginitis are risk factors for GBS infection in the late pregnancy. The preventive use of antibiotics can significantly change the outcomes of maternal adverse pregnancy, but has little effect on the newborn infection, premature delivery, premature rupture of membranes, and low birth weight.
作者
杨振莉
姜贻乾
来汉江
YANG Zhenli;JIANG Yiqian;LAI Hanjiang(Department of Obstetrics and Gynecology,the First People’ s Hospital of Xiaoshan District,Hangzhou 311200,China)
出处
《浙江医学》
CAS
2018年第7期709-711,716,共4页
Zhejiang Medical Journal
关键词
B族链球菌
母婴结局
高危因素
Group B streptococcus
Maternal-infant outcomes
High risk factors
