宫颈细胞学检查异常对妊娠结局的影响及处理

目的研究妊娠期宫颈细胞学异常对妊娠结局的影响及处理。方法用液基超薄细胞涂片法对1 157例孕妇和453名正常体检者进行宫颈细胞学检查,其结果诊断采用伯塞斯达系统（TBS）分级法。结果 1 157例孕妇中有127例（10.98%）患有感染性病变,其中细菌感染率为3.02%、霉菌感染率为4.84%,这二者均高于正常对照组;滴虫感染率为1.81%,人乳头状病毒（HPV）的感染率为1.30%,与正常对照组相比无明显差异。妊娠期孕妇中有62例（5.36%）检出宫颈上皮细胞内病变,其中性质未定的不典型鳞状上皮细胞（ASCUS）、低度鳞状上皮内病变（LSIL）、高度鳞状上皮内病变（HSIL）和宫颈原位癌（CIS）的病变率分别为3.89%、1.21%、0.26%和0.0%,与正常对照组相比差异均无统计学意义。127例患感染性病变的孕妇中有91例随访至分娩,其中有9例（9.89%）产妇有不良妊娠结局,其中胎膜早破3例（3.30%）、早产2例（2.19%）、产褥感染4例（4.39%）。与正常无感染孕妇相比,胎膜早破和早产无差异,但产褥感染率高于正常孕妇。结论细胞涂片取材无困难,易接受,有利于早发现、早治疗,降低孕产妇及胎儿合并症,提高妊娠结局。

Influence of abnormal cervical cytological determination results on pregnancy outcome and management

Objective To study the influence of abnormal cervical cytological determination results on pregnancy outcome and the management.Methods 1 157 pregnant women and 453 healthy women were received the cervical cytological determination by thinprep cytology test.The cytological determination results were graded by the Bethesda system（TBS）.Results In the pregnant group,10.98%（127/1 157） pregnant women had inflammatory lesion,including 3.02% bacterial infection and 4.84% mycosis infection,which were higher than those in the healthy group.The rates of trichomonas infusorian infection（1.81%） and human papillomavirus（HPV） infection（1.30%） had no difference with those in the healthy group.There were 62（5.36%） pregnant women who were diagnosed as atypical epithelial cells,and the infection rates of atypical squamous cell of undetermined significance（ASCUS）,low grade squamous intraepithelial lesion（LSIL）,high grade squamous intraepithelial lesion（HSIL）,and cervical carcinoma in situ（CIS） were 3.89%,1.21%,0.26% and 0.0%,respectively.There was no statistical significance with those in healthy group.In the 127 pregnant women with inflammatory lesion,there were 9 cases followed until delivery.The 9 cases（9.89%） who were attacked with inflammatory lesion had the abnormal pregnant outcome,including 3 cases（3.30%） of premature rupture of membranes,2 cases（2.19%） of premature birth and 4 cases（4.39%） of puerperal infection.Compared with those of the healthy group,the infection rates of membrane premature rupture group and premature birth group had no difference,while the infection rate of puerperal infection was higher than that of healthy group.Conclusions Cervical thinprep cytology test can be operated and be accepted easily.It′s helpful for the early diagnosis and therapy,and it can decrease the complication disease of mothers and neonates as well as improve the pregnancy outcome.