妊娠期梅毒早期母婴阻断效果分析

目的探讨妊娠期梅毒早期规范化治疗对围产儿预后的影响。方法对浙江省天台县人民医院5l例产前筛查确诊并经规范抗梅毒治疗的妊娠梅毒孕妇的妊娠结局进行回顾性分析，选择同期住院分娩的11例未规范化治疗的妊娠期梅毒病例进行对照。结果妊娠期梅毒早期规范化治疗孕妇共分娩新生儿51例，其中足月产50例，早产1例，无流产、死胎发生。新生儿血清梅毒螺旋体颗粒凝集试验（TPPA）阳性、快速血浆反应素环状卡片试验（RPR）阴性21例，TPPA、RPR均阳性（滴度≤1：8）11例，经1-6个月随访均自行转阴。妊娠期梅毒未规范化治疗的孕妇发生死胎、新生儿死亡和足月梅毒儿共9例（81．82％）。外地孕妇不良妊娠发生率为30．43％（7／23），明显高于本地孕妇的7．69％（3／39）；无固定职业孕妇不良结局发生率为24．32％（9／37），高于有固定职业孕妇的4．00％（1，25），两组差异均有统计学意义（矿=5．53、4．55，P〈0．05）。结论妊娠梅毒早期规范化治疗能够有效改善妊娠结局，提高流动人口、无固定职业孕妇的建卡率，能有效避免妊娠梅毒不良结局的发生。

Effect of early intervention on maternal-fetal transmission of syphilis in pregnancy

Objective To explore the impact of standardized treatment of syphilis in early pregnancy on perina- tal infantile outcome. Methods The clinical data of 51 patients with pregnancy complicated by syphilis who re- ceived standardized protocol for treatment of syphilis were retrospectively analyzed. They were diagnosed as having syphilis when they had routine prenatal examination at 12 weeks of pregnancy and received the corresponding treatment immediately. Eleven pregnant patients with syphilis who did not receive any intervention were selected as controls. Results Fifty-one patients with early intervention gave birth to 51 neonates, among which 50 were full- term births and the rest one was preterm infant; no abortion and dead fetus occurred. Serum treponema palidum particle agglutination test （TPPA） was detected positive and rapid plasma regain test （RPR） was detected negative in 21 neonates; both of TPPA and RPR were detected positive （titers~〈l：8） in 11 neonates; the positive index were all found conversion to negative after 1-6 month follow-up. Of 11 controls, 9 （81.82%） had stillbirth, neonatal death, or congenital syphilis. The incidence of adverse pregnant outcomes in floating pregnancy was 30.43% （7/ 23）, which was significantly higher than that of local pregnant women 7.69% （3/39）,）（2=5.53, P〈0.05]; the rate in eases who did not have any regular job was 24.32% （9/37）, which was significantly higher than that in cases who had regular ones 4.00%（1/25）, Xa=4.55, P〈0.05]. Conclusions The treatment of syphilis in early pregnancy can improve the outcome of pregnancy. To strengthen the follow-up of pregnant women, especially those in floating population, can avoid adverse outcomes of pregnancy complicated by syphilis.