不同类型胎膜早破孕妇阴道微生态的对比研究

目的 对比足月胎膜早破(PROM)与未足月胎膜早破(PPROM)孕妇的阴道微生态状况,分析阴道微生态变化与足月胎膜早破、未足月胎膜早破的相关性,及其对孕产妇和新生儿的影响.方法 选取2014年1月至2015年12月西安交通大学第一附属医院产科收治的PPROM孕妇76例,PROM孕妇69例.记录两组孕妇的外阴不适情况、阴道微生态检查结果、分娩方式、新生儿Apgar评分等情况.结果 PPROM组孕妇平均孕周(32.2±1.6)周,PROM组孕妇平均孕周(38.6±1.2)周.PPROM组阴道炎症状阳性患者比例显著高于PROM组43(56.58%) vs 18(26.10%),χ2=13.797,P=0.000],PPROM组剖宫产率显著高于PROM组47(61.84%) vs 23(33.33%),χ2=11.771,P=0.001];PPROM组Apgar评分≤3的新生儿重度窒息发生率为9.21%,PROM组为2.90%,但无统计学差异(χ2=2.475,P=0.171);PPROM组Apgar评分≥4且≤7分的新生儿轻度窒息率高于PROM组18(23.68%) vs 5(7.25%),χ2=7.322,P=0.011],Apgar评分≥8的正常新生儿分娩率两组比较有统计学差异,PROM组高于PPROM组62(89.85%) vs 51(67.11%),χ2=10.883,P=0.001];PPROM组阴道微生态正常者显著低于PROM组26(34.21%) vs 42(60.87%),χ2=10.321,P=0.002].PPROM组阴道微生态正常者显著低于PROM组26(34.21%) vs 42(60.87%),χ2=10.321,P=0.002];PPROM组BV及VVC检出率均显著高于PROM组(P<0.05);PPROM组阴道菌群失调率显著高于PROM组(χ2=9.184,P=0.012).结论 孕妇阴道微生态的改变、生殖道感染的发生是导致PPROM的首要致病因素.

A comparative study of vaginal microflora status of pregnant women with different premature rupture of membrane

Objective To compare the vaginal microflora status of pregnant women with term premature rupture of membrane (PROM) to that with preterm premature rupture of membrane (PPROM) and analyze their correlation as well as the influence on pregnant women and neonates.Methods Seventy-six pregnant women with PPROM and 69 pregnant women with PROM admitted in department of obstetrics and gynecology of First Affiliated Hospital of Xi'an Jiaotong University from January 2014 to December 2015 were chosen.Vaginal symptoms, vaginal microflora test results, delivering ways of pregnant women in two groups and Apgar scores of neonates were recorded and analyzed.Results Mean gestational age of pregnant women with PPROM and PROM was 32.2±1.6 weeks and 38.6±1.2 weeks, respectively.Positive rate of vaginitis symptoms in PPROM group was significantly higher than that in PROM group 43 (56.58%) vs.18 (26.10%), χ2=13.797, P=0.000].Cesarean rate in PPROM group was significantly higher than that in PROM group 47(61.84%) vs.23(33.33%), χ2=11.771, P=0.001].Incidence of severe asphyxia of neonates with Apgar score lower than 3 in PPROM group was 9.21% and 2.90% in PROM group, but there was no statistically significant difference between them (χ2=2.475, P=0.171).Incidence of mild asphyxia of neonates with Apgar score between 4 and 7 in PPROM group was higher than that in PROM group 18(23.68%) vs.5(7.25%), χ2=7.322, P=0.011].Difference in delivery rate of healthy newborns with Apgar score more than 8 between two groups had statistical significance, and the rate was higher in PROM group than in PPROM group 62(89.85%) vs.51(67.11%), χ2=10.883,P=0.001].Number of pregnant women with normal vaginal microflora in PPROM group was significantly lower than that in PROM group 26 (34.21%) vs.42 (60.87%), χ2=10.321, P=0.002].Detection rates of BV and VVC in PPROM group were significantly higher than those in PROM group (P<0.05).Vaginal flora imbalance rate in PPROM group was significantly higher than that in PROM group (χ2=9.184, P=0.012).Conclusion The most common cause of PPROM is the change of vaginal microflora status and reproductive tract inflammation.