不同阶段驱梅治疗的妊娠结局分析

目的探讨在不同阶段驱梅治疗后的妊娠结局,以及其对新生儿的影响。方法根据注射首剂青霉素时的孕期,将261例妊娠梅毒患者分为3组:早孕组(妊娠≤12周)92例,中孕组(妊娠13～28周)94例,晚孕组(妊娠≥29周)75例。各组均予以规范青霉素驱梅治疗,治疗结束后比较三组梅毒孕妇的妊娠结局、围产儿预后及先天性梅毒的发病率,同时根据孕妇血清快速血浆反应素环状卡片试验(RPR)滴度高低,分为RPR≤1:4组和RPR≥1:8组,观察血清RPR滴度与围产儿预后的关系。结果早孕组、中孕组和晚孕组三组梅毒孕妇的足月分娩率分别为92.83%,89.36%和53.33%;先天性梅毒发病率分别为2.17%,5.32%和28.00%。早孕组及中孕组梅毒孕妇的妊娠结局和围产儿预后均明显优于晚孕组,先天性梅毒发病率明显低于晚孕组。RPR≤1:4组159例,先天性梅毒发病率为1.26%;RPR≥1:8组102例,先天性梅毒发病率为25.49%,差异有显著性(P0.05)。结论妊娠合并梅毒时,首剂青霉素治疗早晚和其妊娠结局、围产儿预后及先天性梅毒发病率密切相关,早期进行正规青霉素治疗可以有效防止胎儿感染梅毒,且梅毒孕妇血清RPR滴度高低是影响其妊娠结局的重要因素。

Perinatal Outcomes of Pregnant Women with Syphllis Treated by Procaine Penicillin at Different Gestations

Objective To investigate the perinatal outcomes of pregnant women with syphilis treated by procaine penicillin at different gestations.Methods Totally,261 pregnant women with syphilis were divided into three groups based on the stage of pregnancy when the first dose of procaine penicillin were given:early pregnancy group( ≤12 weeks of gestation,92 cases);midterm pregnancy group(13～28 weeks of gestation,94 cases);late pregnancy group( ≥29 weeks of gestation,75 cases).After standard treatment of penicillin,the pregnant outcome,perinatal prognosis and the incidence of congenital syphilis were compared.Meanwhile,they were also divided into two groups according to maternal serum rapid plasma reagin (RPR)test:RPR titer≤ 1:4 and RPR titer ≥1:8.The perinatal prognosis were compared between two groups.Results The rate of term delivery in three groups were seperately 92.83%,89.36% and 53.33%;the incidence of congenital syphilis were 2.17%,5.32% and 28.00%.The pregnant outcome,perinatal prognosis and the incidence of congenital syphilis were better in early pregnancy group and midterm pregnancy group.The incidence of congenital syphilis in RPR titer≤1:4(1.26%) group was lower than that in RPR titer≥1:8 (25.49%)group.The findings were tested by χ2 statistic analysis,P<0.05.Conclusion The pregnant outcome,perinatal prognosis and the incidence of congenital syphilis in pregnancy with syphilis are associated with the time penicillin started.For pregnant women with syphilis,earlier treatment with penicillin in sufficient doses may effectively prevent syphilis infection of the fetus.Maternal serum RPR titer is an risk factor on the outcomes of pregnancy with syphilis.