妊娠合并梅毒、乙型肝炎、艾滋病临床状况分析

目的：探讨妊娠合并梅毒螺旋体、乙型肝炎病毒（HBV）、人类免疫缺陷病毒（HIV）感染的母婴阻断方法及随诊管理流程。方法：对东南大学附属第二医院妇产科2001年1月至2012年12月妊娠合并梅毒螺旋体、HBV、HIV感染的住院分娩病例数、母婴阻断方法及成功率以及随诊管理方法进行回顾性分析。结果：12年间共收治妊娠合并感染性疾病孕妇住院分娩8 127例,其中梅毒螺旋体感染孕妇365例,占4.49%;HBV感染孕妇7 252例,占89.23%;HIV感染孕妇住院分娩治疗27例,占0.33%。近5年妊娠期感染梅毒螺旋体者早产发生率为12.02%（41/341）,死胎、死产率为4.40%（15/341）,胎儿畸形发生率为2.35%（8/341）。HBV宫内感染率为0.97%（42/4 310）,分娩前HBV DNA〈106copies·ml-1的患者宫内感染发生率为0%,HBV DNA≥106copies·ml-1的患者宫内感染率为3.18%~10.34%。27例妊娠合并HIV感染孕妇有13例放弃继续妊娠,选择流产或引产终止妊娠,有1例孕36周早产顺产,其余13例均孕38周以上行选择性剖宫产术。结论：制定合理的梅毒螺旋体、HBV、HIV感染孕妇的阻断随诊流程可减少婴儿的宫内感染,改善患者预后。HBV的宫内感染发生在分娩前病毒高载量者。

Clinical analysis of pregnancy with syphilis,hepatitis B,HIV/AIDS

Objective： To discuss PMTCT treatment and follow-up management processes in pregnant women with syphilis, hepatitis B virus （HBV）, human immunodefieiency virus （HIV） infection. Methods： Pregnant women with syphilis, HBV, HIV infection admitted by Obstetrics and Gynecology of the Second Affiliated Hospital of Southeast University from Jan. 2001 to Dec. 2012 were retrospectively analyzed to access successful rate of different interdiction methods and follow＇up management. Results： A total of 8 127 cases of pregnancies combined with the infection were admitted during the 12-year period, 365 of them were infected by Treponema pallidum （4. 49% ） , 7 252 by HBV （89.23%）, and 27 by HIV（0.33% ）. In the last five years, preterm-birth rate of pregnancies with syphilis was 12. 02% （41/341）, stillbirth rate was 4. 40% （15/341）, and fetal malformation rate was 2.35% （8/341）. Rate of intrauterine infection of pregnancies with HBV was 0. 97% （42/4310）, intrauterine infection rate was 0 in pregnancies with HBV DNA 〈 10^6 copies · ml^ -1, and was 3.18% - 10. 34% in those HBV DNA 〉 10^6 copies · ml^ -1 Thirteen of the 27 patients with HIV terminated the pregnancy by abortion, 1 of the patients delivered a preterm infant spontaneously, and the other 13 case carried the baby for over 38 weeks and delivered by elective cesarean section. Conclusion： A reasonable blocking and follow-up process of syphilis, HBV, HIV in pregnant women can reduce the baby＇s intrauterine infection and improve the prognosis of patients. Intrauterine infection of HBV occurs only in patients with high viral load upon delivery.