摘要
目的探讨妊娠合并梅毒在不周孕期驱梅治疗后的围产儿结局。方法将286例妊娠合并梅毒孕妇,根据首剂青霉素使用时间,分为五组:1.早孕组(妊娠≤12周)34例;2.早中孕组(13周～)56例;3.中孕组(24周～)64例;4.中晚孕组(28周～)98例;5.晚孕组(妊娠>34周至分娩)34例。各组均规范青霉素驱梅治疗后,比较各组之间妊娠结局、围产儿预后,同时通过胎盘病理检查、尸体解剖等检查分析梅毒苍白螺旋体对胚胎影响。结果早孕组、中早孕组妊娠结局、围产儿预后方面明显优于其他各组,组间比较呈递增性。早孕组、早中孕组未见胎盘绒毛病变,而中孕组、中晚孕组和晚孕组比较有差异。在驱梅治疗时,约11.5%出现吉-海(J-H)反应,有多例流产、死胎发生,应引起重视。围产儿尸解中发现梅毒螺旋体可影响胎儿各组织器官,新生儿死亡可能和其肝脏大部纤维化有关。结论妊娠合并梅毒,首剂青霉素治疗早晚和其妊娠结局、围产儿预后密切相关,在孕中期(24周)前治疗较果最佳,也即越早发现、越早治疗,可使围产儿不良结局及先天梅毒临床发生率降至最低点。
Objective To investigate the perinatal outcomes of pregnancy with syphilis treated by benzylpenicillin at various gestations. Methods Totally, 286 pregnant women with syphilis were divided into five groups based on the time of the first dose of penicillin was given： Early pregnancy group （Group 1, ≤12 weeks of gestation, 34 cases） ; early-midterm pregnancy group （Group 2, 13- 23 weeks of gestation, 56 cases） ; midterm pregnancy group （Group 3, 24-27 weeks of gestation, 64 cases）; mid-late pregnancy group （Group 4, 28-33 weeks of gestation, 98 cases）; late pregnancy group （Group 5, 〉34 weeks of gestation, 34 cases）. After standard treatment of penicillin, the pregnant outcome and prognosis of the infants were compared. The effect of syphilis treponema palliudum on the embryo were analyzed by placental pathology and autopsy. Results The pregnant outcome and perinatal prognosis were better in Group 1 and 2. And no placenta villi pathological changes was found in Group 1 and 2, but significant difference was found among the other 3 groups. During the treatment with penicillin, 11.5 % of the patients showed J-H reaction with several cases of abortion and stillbirth. Autopsy showed that syphilis treponema pallidum had adverse effect on fetal organs. Neonatal death may be associated with liver fibrosis. Conclusions The pregnant outcome and perinatal prognosis in pregnancy with syphilis is associated with the time when penicillin was started. The best outcome can be achieved if the natients is treated before midterm pregnancy （〈24th week）.
出处
《中华围产医学杂志》
CAS
2006年第6期400-403,共4页
Chinese Journal of Perinatal Medicine
关键词
妊娠并发症
感染性
梅毒
妊娠结局
Pregnancy complications, infectious
Syphilis
Pregnancy outcome
