妊娠梅毒112例临床分析

目的 探讨妊娠梅毒的临床特点和影响妊娠结局的因素，降低先天性梅毒的发生率。方法 112例血清学检查确诊为梅毒孕妇，根据妊娠期是否行全疗程抗梅毒治疗，分为治疗组与未治疗组，治疗组52例，行全疗程抗梅毒治疗；未治疗组42例，未能行全疗程抗梅毒治疗；18例妊娠梅毒孕妇自行选择提前终止妊娠。比较两组孕妇的妊娠结局和新生儿梅毒的发生情况。结果 （1）112例妊娠梅毒患者中一期梅毒2例（1．8％），二期15例（13、4％）及潜伏梅毒95例（84，8％）。（2）妊娠结局：治疗组足月分娩率为90．4％（47／52），未治疗组为16．7％（7／42），两组比较差异有显著意义（P〈0．01）。治疗组早产及死产死胎发生率分别为5．8％（3／52）、3．8％（2／52），明显低于未治疗组的19．0％（8／42）、52、4％（22／42），两组比较差异有显著意义（P〈0.01）。治疗组先天性梅毒儿发生率20.0％（10／50）明显低于未治疗组80．0％（12／15），两组比较差异有显著意义（P〈0．01）。（3）治疗孕妇其孕周与用药治疗关系显示：治疗孕周越早，先天性梅毒患儿发生率越低（P〈0．01）。结论 （1）妊娠梅毒患者临床分期以潜伏梅毒为主，体征及症状不典型，容易误诊。因此，妊娠早期常规梅毒筛查特别重要。（2）妊娠梅毒有危害胎儿的严重合并症，有效的抗梅毒治疗是改善妊娠梅毒患者妊娠结局和降低先天性梅毒发生率的关键。

Clicical analysis of 112 pregnant women infected by syphilis

Objective To investigate obst et ic treatment and pregnancy outcomes of syphilis infection during pregnancy. Methods 112 pregnant women diagnosed with syphilis by serological as says were divided into treated group and untreated group according to whether th ey accepted a fucl course anti-syphilis therapy or not.The pregnant outcomes an d congenital syphilis were compared between the two groups.Results (1)There were 2 cases of primary syphilis(1.8%),15 cases of secondary syphil is(13.4%),and 95 cases of latent syphilis(84.8%) anong the 112 cases.(2)Perinata l outcomes:term delivery reached 90.4%(47/52) in treated group.and only 16.7%(7/ 42) in untreated group;The rate of prenalure birth and fetal intraulerine death were 5.8%(3/52) and 3.8%(2/52) in treated group,which were obviously lower than 19.0%(8/42) and 52.4%(22/42) in untreated group(P<0.01);The rat es of congenital syphilis in treated group was 20.0%(10/50),which was obviously lower than 80.0%(12/15) in untreated group(P<0.01).(3)Gestation al week and treatment:the earlier the treatment started during preganancy,the lo wer the rate of congenital syphilis was(P<0.01).Conclus ions (1)Pregnant syphilis is easy to be misdiagnosed because of its sli ght symptom so it is especially important to screen syphilis as a routine among pregnant women.(2)Pregnant syphilis is a serious complication to harm the fetus. Effective anti-syphilis treatment is the key to improving the pregnancy with sy philis and reducing the incidence of congenital syphilis.