妊娠合并乙型肝炎病毒感染母婴结局观察

目的探讨妊娠合并乙型肝炎病毒（HBV）感染对母婴结局的影响。方法以260例妊娠合并HBV感染而临床无乙型肝炎症状的孕妇为研究组，以同期、同年龄、同产次、同孕周HBsAg和HBeAg阴性的260例孕妇作为对照组。了解HBV感染的母婴传播、胎儿宫内窘迫、新生儿窒息和新生儿畸形的发生率。同时了解HBV感染孕妇合并妊娠高血压综合征（PIH）、妊娠糖尿病（GDM）、妊娠肝内胆汁淤积症（ICP）、胎膜早破、产后出血的发生率及其剖宫产率。结果研究组中，HBsAg、HBeAg均为阳性的双阳性病例102例，仅HBsAg阳性的单阳性病例158例，HBV宫内感染发生率为26．1％，胎儿宫内窘迫发生率为7．7％，新生儿先天性畸形发生率为3．4％，均明显高于对照组（P值均〈0．05）。研究组胎膜早破发生率为16．9％，产后出血发生率为17．7％，ICP发生率为5．0％，均明显高于对照组（P值均〈0．05）。研究组与对照组、单阳性亚组与双阳性亚组的剖宫产率、PIH及GDM发生率的差异均无显著性（P值均〉0．05）。结论妊娠合并HBV感染可使胎儿宫内窘迫、新生儿畸形的发生率增高，同时使孕妇胎膜早破、产后出血、ICP发生率升高，对母婴影响较大。

Observation on maternal-infant outcome in pregnancy with hepatitis B virus infection

Objective To appraise the effect on pregnancy complicated by hepatitis B virus(HBV) infection on maternal-infant outcome. Methods 260 pregnant women with newborn group having presence of positive hepatitis B surface antigen(HBsAg) and absence of clinical symptoms of hepatitis were selected in the study group.The control group was set up in 260 pregnant women with same gestational weeks,same ages and absence of HBV infection. This study was intended to identify the relationship of HBV infection with the incidence of maternal-infant transmission,fetal distress,infant asphyxia,infantile congenital malformation,as well as the morbidity of pregnancy-induced hypertension(PIH),gestational diabetes mellitus(GDM),intrahepatic cholestasis of pregnancy(ICP),premature rupture of membrane(PROM) and the rate of Cesarean section and postpartum hemorrhage. Results Among the 260 HBV infected pregnant women,102 cases were positive for both HBsAg and HBeAg and 158 were positive for HBsAg only.The incidence was 26.1% for mother-infant transmission,7.7%,4.6%,and 3.4% were for fetal distress,infant hypoxia,and infantile congenital malformation,respectively.The incidences of maternal PROM,postpartum hemorrhage and ICP were 16.9%,17.7%,and 5.0%,respectively,which were higher than those of the control group(P<0.05).In positive HBsAg and HBeAg group,the incidences of the above items were also significantlyhigher than those in only positive HBsAg group.As for the incidences of Caesarean section and the morbidity of PIH and GDM,no significant difference occurred between the study group and control group,as well as between the dual-positive serum and single-positive serum group.(Conclusions) Pregnancy with HBV infection can increase the incidences of fetal distress,infant asphyxia and infantile congenital malformation.Furthermore;pregnancy with HBV infection can also increase the morbidity of PROM,postpartum hemorrhage and ICP in pregnant women.Consequently,HBV infection has a great influence on maternal-infant.