Guide to the management of rubella problems.

Despite the availability of rubella vaccine the incidence of the congenital rubella syndrome has been increasing in certain regions of Canada. Perhaps this is not surprising in view of the known irregular cyclic activity of rubella virus in a community and the fact that the percentage of seropositive women of childbearing age has not changed appreciable since the vaccine was introduced. Clearly vaccine is not being administered to sufficient numbers of women at risk. Until a much higher percentage of women of childbearing age possess rubella antibody, the costly problem of congenital rubella syndrome is likely to be with us. Common rubella problems relate to four categories: the exposed pregnant woman, laboratory diagnosis, the infant with suspected congenital rubella and the vaccine. One of the most common questions about the vaccine is the following: Can recently vaccinated individuals disseminate vaccine and infect seronegative contact? The answer is No.     

Susceptibility to rubella among pregnant women and the serological evidence of congenital rubella in newborn babies at Colombo South Teaching Hospital

OBJECTIVE: To determine the susceptibility to rubella infection in early pregnancy and the incidence of seropositivity of cord blood for rubella specific IgM among the newborn babies at Colombo South Teaching Hospital. METHODS: 1000 cord blood samples and 500 maternal blood samples from pregnant women before the 16th week of gestation were taken from the labour room and the antenatal clinic of the University Unit, Colombo South Teaching Hospital during the period of February 1999 to February 2001. These samples were tested for rubella specific IgM and IgG antibodies by ELISA. A detailed questionnaire was filled during the time of sampling. RESULTS: Of the 500 antenatal blood samples 82% were positive for rubella specific IgG. 373(75%) women gave a history of vaccination against rubella before their present pregnancy. Among the vaccinated 2(0.5%) were negative for IgG antibodies by ELISA. Out of 127 unvaccinated women 12(9%) gave a history of past infection with rubella and of this 3(25%) were seronegative for rubella specific IgG. 18% of pregnant women at 16 weeks of gestation were at risk of giving birth to a baby with congenital rubella syndrome. Among the tested 1000 cord blood samples three were seropositive (0.3%) for rubella specific IgM. CONCLUSIONS: A significant proportion of pregnant women were susceptible to rubella infection in the studied population. The present strategy of selective rubella vaccination should be reconsidered if we are to get closer to eliminating rubella syndrome in Sri Lanka.     

哈尔滨市妊娠妇女风疹病毒感染的筛查及分析

目的 调查2000年哈尔滨市妊娠妇女风疹病毒感染情况，方法 收集60例妊娠8－24周孕妇血清，采用酶联免疫吸附法（ELISA）检测风脊特异性IgM抗体，对该人群的风疹病毒感染率进行调查。结果 21例正常妊娠组血清样本的阳性率为4.76%，39例异常妊娠组血清样本阳性率为17.95%，两组数值经统计学处理x^2=7.33，P＜0.05，有显著性差异。结论 风疹病毒感染是造成异常妊娠的主要原因之一，妊娠早期进行风疹病毒感染的检测，对降低先天性风疹综合征患儿的出现具有重要意义。     

风疹易感人群婚前风疹疫苗接种预防先天性风疹综合征

目的探讨婚前风疹易感人群风疹疫苗接种在提高孕妇对风疹的免疫力,预防先天性风疹综合征中的作用.方法对10 913例婚前风疹病毒抗体IgG阴性者给予国产风疹减毒活疫苗注射.3个月随防671例,比较风疹疫苗接种前后该地区孕妇近期风疹感染的发病率.结果818例风疹病毒抗体IgG阴性者接种后抗体转阳率为99.8%.风疹疫苗接种前后3年孕妇近期风疹感染率分别为0.37%及0.08%,有明显下降,有非常显著差异(P＜0.001).结论应用国产风疹减毒活疫苗对婚前易感人群作预防接种可提高育龄妇女对风疹的免疫力,降低孕期风疹感染的发生率,是预防先天性风疹综合征及风疹致畸的有效、安全措施.     

Intrauterine diagnosis of cytomegalovirus and rubella infections by amniocentesis.

OBJECTIVE: To establish a correlation between the presence of cytomegalovirus (CMV) or rubella virus in amniotic fluid obtained through amniocentesis and fetal infection. DESIGN: Case series. SETTING: Five hospitals in the Montreal region. Virology testing was done at the Virology Research Centre, Institut Armand-Frappier, Laval, Que. PATIENTS: Thirteen pregnant women infected with CMV, 3 with rubella, their 15 babies and 2 fetuses. Twelve of the women with CMV infection were recruited from a prospective study of CMV infection in pregnancy. Infection in the other women was detected through routine laboratory diagnostic testing. INTERVENTION: Amniotic fluid samples were cultured for CMV and rubella virus. Congenital infection of the neonates was established through isolation of either virus from pharyngeal mucus and urine specimens collected during the first 3 days of life or from fetal tissue if the pregnancy was terminated. MAIN RESULTS: CMV was cultured from the amniotic fluid of three of the CMV-infected women and from the pharyngeal mucus and urine specimens of their infants. Of the three women with rubella the amniotic fluid of one (who had a twin pregnancy) was positive for rubella virus. After the in-utero death of one fetus she underwent a therapeutic abortion of both. Examination of fetal tissue indicated that both fetuses had been infected with rubella virus. Each of the two other women with rubella gave birth to an uninfected, healthy infant. CONCLUSIONS: We found a strong correlation between the isolation of CMV or rubella virus from the amniotic fluid and the presence of congenital infection. This suggests that amniocentesis used to detect the presence of a virus is a useful method for the diagnosis of fetal infection.     

Rubella vaccination programme in Malaysia: analysis of a seroprevalence study in an antenatal clinic

In many developed countries, the incidence of rubella and congenital rubella syndrome (CRS) is considered to be negligible due to the availability of an effective vaccine. However, in Malaysia, several CRS cases are seen every year. This casts doubt on the effectiveness of the rubella vaccination programme. Very few seroprevalence studies were done over the years, making it difficult to discuss the effectiveness of the vaccination programme. The objective of this study is to determine the prevalence of rubella immunity among pregnant women attending antenatal clinics in a local teaching hospital. The hospital database on rubella immunity was assessed retrospectively from August 2001 to June 2002. A cross-sectional study of interviewed method as well as determination of rubella immunity by laboratory tests were carried out in July 2002. A total of 414 women were included, of whom 134 women were interviewed. The rubella immunity status was 92.3%. Based on this figure, rubella vaccination programme in Malaysia is a success despite the presence of CRS cases. Malaysia must ensure rubella vaccine coverage among target groups is high in order to minimise CRS cases.     

妊娠合并亚临床甲状腺功能减退对孕期并发症及妊娠结局的影响

目的：分析妊娠合并亚临床甲状腺功能减退对孕期并发症及妊娠结局的影响。方法整群选取该院2014年6月—2015年6月接收的95例妊娠合并亚临床甲减孕妇作为观察组,并选取同期95例正常妊娠孕妇作为对照组。两组孕妇入院后均常规进行产前检查和保健,定期检测血压﹑血糖水平,观察并记录两组孕期并发症情况和妊娠结局。结果观察组妊娠期高血压﹑妊娠期糖尿病发病率分别为12.63%﹑15.79%,显著高于对照组的4.21%﹑6.32%,差异有统计学意义(P<0.05)。观察组早产﹑新生儿窒息﹑低出生体重的发生率均明显高于对照组(P<0.05),流产﹑先天性甲减方面比较差异无统计学意义(P>0.05)。结论妊娠合并亚临床甲减可增加孕期并发症和不良妊娠结局的风险,临床应注意定期产检,严格防治,以期最大程度改善妊娠结局。     

Seroepidemiologic study of rubella in selected Chinese female

To have a better understanding of rubella seroepidemiology among female population in Taiwan, we report a serologic survey of 4030 examinations for 2030 school girls and 2000 pregnant women, using enzyme-linked immunosorbent assay for the detection of rubella specific IgG. RA 27/3 vaccines were given to susceptible volunteer students and postpartum women for the evaluation of vaccine efficiency and its side effects. The results showed that the rubella susceptible female among 8 to 22-year-old girl students was 44.97%, which was higher than expected, as most of them experienced the outbreak of rubella in 1977. The susceptibility rate among the pregnant women was 19.35%, which was also higher than expected for an age group having been through two outbreaks in the past. All the vaccinees showed good tolerance to the vaccine and the seroconversion rate was 100%. With such high susceptibility rate among women of child bearing age and girl students, plus the endemic property of rubella infection in Taiwan, we can expect a high risk of congenital rubella syndrome. Mass vaccination against rubella should be brought into effect immediately.     

孕妇风疹病毒IgG、IgM检测及意义

目的：了解温州地区孕妇对风疹的免疫状态,探讨风疹病毒IgG、IgM检测对评估孕妇免疫状态及判断风疹宫内感染的作用。方法：用ELISA法对1471名产前检查孕妇检测风疹病毒特异性抗体IgG、IgM,电镜检查和分子生物学法检查组织中病毒颗粒和病毒核酸。结果：76.07%（1119／1471）的孕妇具有免疫力,7.41%（109／1471）有孕妇为原发感染,14.14%的孕妇为易感,2.38%（35／1471）的孕妇IgG、IgM均呈阳性,其中1例引产胎儿心肌细胞和1例死胎的心肌、肝及脑细胞中均发现病毒颗粒。结论：同时检测孕妇风疹IgG和IgM可以正确判断孕妇的免疫状态,对IgM阳性孕妇应进行连续多次检测,IgM持续呈阳性三个月以上的孕妇可大致确定为宫内感染。     

Effect of selective vaccination on rubella susceptibility and infection in pregnancy

The effect of school and adult vaccination on susceptibility to rubella in women of childbearing age was assessed in the Manchester area, where the population attending antenatal clinics is over 40 000 a year. Between 1979 and 1984 the proportion susceptible fell from 6.4% to 2.7%. In 1984, 4.2% of nulliparous women were susceptible compared with 1.4% of women in their second or subsequent pregnancy. Eighty five per cent of pregnant women screened and found to be non-immune were vaccinated post partum before leaving hospital. Requests for prevaccination screening of non-pregnant women increased in response to a national campaign and at the time of local outbreaks of rubella but only two thirds of those found to be nonimmune were subsequently vaccinated. During 1983 and 1984 infection was confirmed in 57 pregnant women--2% of those non-immune. Selective vaccination has reduced susceptibility to rubella in the childbearing population, but it is suggested that mass vaccination of children of both sexes should be added to the existing policy to control circulation of wild rubella virus and reduce the risk of infection to pregnant women who remain susceptible.     

妊娠合并先天性子宫畸形对母婴结局的影响

目的探讨先天性子宫畸形妊娠对于母婴结局的影响。方法回顾性分析2008年1月至2011年6月进入围生期的子宫畸形合并妊娠患者54例（畸形组）和同期正常子宫妊娠者60例（对照组）的临床资料,比较2组的母婴结局。结果畸形组胎位异常发生率（46.3%）、胎膜早破发生率（27.8%）、剖宫产率（77.8%）、早产率（25.9%）及足月低体重儿发生率（11.1%）均显著高于对照组;平均孕周（37.1周）、新生儿平均出生体重（2728g）显著低于对照组;而胎儿宫内窘迫、新生儿窒息发生率2组差异无统计学意义（11.1%vs 8.3%,7.4%vs6.7%）。结论子宫畸形合并妊娠可对母婴结局产生不良影响,应引起临床医生足够重视,加强育龄妇女孕前检查及孕期保健。     

潜伏期妊娠梅毒168例临床及母婴传播干预分析

目的:探讨潜伏期妊娠梅毒的临床预后及不同驱梅治疗时机胎传梅毒的发生.方法:总结168例潜伏期妊娠的梅毒妊娠不良结局,根据驱梅治疗时机分为早、中孕治疗组和晚孕、未治疗组,比较两组先天梅毒的发生.结果:168例患者中,宫外孕20例(11.9%),自然流产10例(5.95%),死胎死产5例(2.98%),人工流产或引产13例...     

TORCH系列病原体感染对中、晚期孕妇妊娠结局的影响

目的探讨TORCH系列病原体感染对中、晚期孕妇妊娠结局的影响。方法选取本院2006年1月~2010年6月收治的中、晚期孕妇846例,分别进行弓形虫（TOX）、风疹病毒（RV）、巨细胞（CMW）、单纯疱疹病毒（HSV-Ⅱ）检测,并将所有孕妇进行分组,其中,将TORCH系列病原体呈阴性孕妇678例作为对照组,将TORCH系列病原体呈阳性孕妇168例作为观察组,分别比较各组间妊娠结局情况。结果观察组在胎膜早破、产褥病、死胎、胎儿宫内窘迫、死产、新生儿窒息、先天性畸形儿、不良妊娠等方面比率均明显高于对照组（P〈0.05）;混合感染组在胎膜早破、产褥病、死胎、胎儿宫内窘迫、死产、新生儿窒息、先天性畸形儿、不良妊娠等方面比率均明显高于单一感染组,差异有统计学意义（P〈0.05）。结论 TORCH系列病原体感染对中、晚期孕妇妊娠会产生一定程度的不良影响,对中、晚期孕妇进行必要的TORCH系列病原体感染检测可以有效预防和控制胎儿宫内感染的发生,大幅降低不良妊娠的发生率,值得临床推广使用。     

孕前BMI对产科并发症及妊娠结局的影响

目的 研究孕前体质量指数(body mass index, BMI)对孕妇产科并发症发生率以及妊娠结局的影响。方法 以2014年06月至2015年12月同济大学附属第十人民医院收治的1000名正规产检并住院分娩孕妇作为研究对象,分析孕前和孕期体质量对产科并发症和妊娠结局的影响。结果 BMI越高,发生子痫前期、妊娠期糖尿病、早产、胎膜早破、巨大儿的风险越高,剖宫产率增加。BMI越低,妊娠期贫血发病率增高。ICP、妊娠期甲状腺功能减退及羊水过少发生率与BMI无明显相关性。结论 孕前BMI对孕妇产科并发症发生率以及妊娠结局具有较大影响。     

妊娠合并心脏病49例分析

目的探讨妊娠合并心脏病的类型及不同心功能状态对母婴的影响。方法对我院2003年1月至2005年12月妊娠合并心脏病49例的临床资料进行回顾性分析。结果妊娠合并心脏病发病率以先天性心脏病最高,占51%;其次为风湿性心脏病,占30.6%;第三为心律失常,占10.2%。剖宫产率占80.6%;低体重儿发生率随心功能分级增高而增加,新生儿平均体重随心功能分级增高而减少。结论在妊娠合并心脏病中,先天性心脏病发病率升至最高,风心病发病率已明显下降。心功能Ⅲ￣Ⅳ级低体重儿发生率高。剖宫产适时终止妊娠可减少心衰发生。     

宁夏地区先天性心脏病患儿发病情况与孕妇孕中期超声检查的相关性研究

目的 探讨宁夏地区先天性心脏病（CHD）发病情况与孕妇孕中期超声检查的相关性。方法 选取2015 年10 月至2018 年10 月宁夏医科大学总医院收住的年龄在0～14 周岁经心脏超声和（或）手术确诊的CHD 患儿为研究对象，进行回顾性分析；通过电话/短信等方式咨询孕妇孕中期超声检查资料。结果 孕妇孕中期CHD 超声检查的孕检率为90.822%，检出率为13.780%，检出准确率为66.667%；宁夏地区三级医院的CHD 超声筛查检出率高于二级和其他医院（P<0.05）；动脉导管未闭、房间隔缺损、室间隔缺损和肺动脉高压是患儿主要的CHD 病理类型；而患儿单一类型CHD 与两种及以上CHD 的发病率基本一致。结论 宁夏地区各级医院孕妇孕中期CHD 超声筛查水平与国内先进水平还有一定的距离，且其具有明显的医院级别差异性，应大力加强基层医疗机构孕妇孕中期CHD 的筛查水平。     

中山市某医院2005～2010年41例妊娠合并梅毒临床分析

目的改善妊娠合并梅毒的妊娠结局并探讨恰当的治疗时间,降低先天性梅毒的发病率。方法将我院41例妊娠合并梅毒孕产妇分为两组,治疗组25例,非治疗组16例,比较两组妊娠结局、新生儿预后及先天梅毒患儿发生情况。结果足月分娩率治疗组为84.00%(21/25),未治疗组仅为56.25%(9/16),治疗组孕妇妊娠结局明显好于未治疗组,差异有统计学意义(P<0.05);治疗组新生儿预后明显好于非治疗组(P<0.05);治疗孕周与非正常儿的发生率成正比,即开始治疗的时间越早,非正常儿的发生率越低(P<0.05)。结论妊娠合并梅毒患者可能发生不良妊娠结局,但在孕早期行规范的抗梅毒治疗,能有效改善妊娠结局及新生儿的预后,降低围生儿的死亡率。     

济宁市某县麻疹爆发实验室早期诊断结果分析

目的摸清麻疹爆发的原因及发病特点，为控制麻疹提供科学的实验室依据。方法采用酶联免疫捕获法，对疑似病例血清标本进行麻疹IgM抗体，风疹IgM抗体检测，同时，对孕妇血清标本进行IgG抗体检测。结果408例麻疹疑似病例IgM抗体阳性率为91．18％，风疹IgM抗体全部阴性，0—10、20—30岁年龄组发病较高，分别占45．71％（170／372）、30，38％（113／372）。性别上总体无显著性差异，但20—25岁年龄组，女性发病较高，其发病比例，男女之比为1：2．9（14／41），同时，在疫区采集的未发病的孕妇血清标本，麻疹IgG抗体阳性率仅为25％（7／28）。结论应加强0—10、20—30岁年龄组、尤其2岁以下幼儿和育龄妇女的麻疹疫苗免疫接种。其次，应加强基层人员的专业技术培训，确保麻疹疫苗的接种质量。同时也要加大麻疹保护性抗体的监测力度，随时掌握全市不同年龄组人群的麻疹免疫水平，为制定全市的麻疹免疫规划提供科学的依据。     

2015-2019年温州市高龄产妇特征及妊娠结局变化趋势

目的：分析高龄产妇的妊娠特征以及不良妊娠结局的变化特点,为进一步改进母婴保健工作方法和管理模式、保障母婴安全提供科学依据。方法：采用回顾性调查分析法,依托温州市妇幼保健信息管理平台中孕产妇保健信息系统,收集2015-2019年在温州市助产机构分娩的年龄≥20岁的产妇资料,分高龄组（年龄≥35岁）和适龄组（20～34岁）。采用χ2检验和趋势χ2检验分析高龄与适龄产妇的人口学特征、妊娠合并症、并发症和不良妊娠结局发生率变化趋势及差异。结果：2015-2019年温州市分娩产妇共536 456人,其中高龄产妇为56 637人（占10.56%）,年龄≥40岁的高龄产妇共8 787人（占15.51%）,最大年龄为55岁。2015-2019年温州市高龄产妇占产妇总数的比例呈现上升趋势（χ2趋势=1 225.00,P＜0.001）,二胎及以上产妇数中高龄产妇占比呈现先下降后上升趋势（χ2趋势=21.64,P＜0.001）。高龄产妇的非初胎比例、剖宫产比例均高于适龄组,产检次数、文化程度、职业构成在两组分布差异均有统计学意义（均P＜0.001）。高龄与适龄产妇的妊娠期合并症（妊娠期糖尿病、子痫前期）和并发症（产后出血、胎膜早破）的发生率均呈逐年增加趋势（P＜0.01）,但是高龄产妇的早产、巨大儿和低出生体质量的发生率未显示逐年增加或降低的变化趋势（P＞0.05）。高龄产妇2015-2019年合计的妊娠并发症、合并症和不良妊娠结局的发生率均高于适龄组（P＜0.001）。结论：2015-2019年高龄产妇的妊娠期糖尿病和胎膜早破发生率明显增加,且不良妊娠结局的发生率明显高于适龄产妇,需要妇幼保健及产科重点关注。