摘要
目的探讨妊娠合并梅毒患者的母婴传播规律与干预方法。方法对确诊的847例妊娠合并梅毒孕妇进行孕期干预,孕早期3个月内(或)一经确诊梅毒、及孕晚期3个月时各行抗梅毒治疗1个疗程共计2个疗程。以普鲁卡因青霉素80万 U/d,肌内注射,连续10～15 d;路远不便者用苄星青霉素240万 U,分两侧臀部注射,1次/周,连续3次为1个疗程。对青霉素过敏者改用红霉素治疗,每次0.5 g 口服,4次/d,连续15 d 为1个疗程。随访并观察其妊娠结局。新生儿进行快速血浆反应素环状卡片试验(RPR)及梅毒密螺旋体血凝试验(TPHA)确诊检查,对其中 RPR 及 TPHA 阳性的新生儿进行干预,以普鲁卡因青霉素5万 U·kg^(-1)·d^(-1),肌内注射,连续10～15 d。并于出生后3、6、9、12、24个月复查静脉血 RPR。结果 (1)847例妊娠合并梅毒孕妇中,已分娩772例,活产新生儿733例,行 RPR 检查626例,新生儿 RPR 阳性率为55.1%(345/626)。(2)RPR 滴度≥1:8的孕妇分娩的新生儿 RPR 阳性率、围产儿死亡率、早产率、低出生体重儿发生率均高于 RPR 滴度<1:8的孕妇(P<0.01)。(3)新生儿 RPR 阳性率与孕妇治疗时机:①孕前抗梅毒治疗孕妇与孕前未抗梅毒治疗孕妇的新生儿 RPR 阳性率分别为22.4%(15/67)和49.6%(330/666,P<0.01);②孕前抗梅毒治疗孕妇与孕期抗梅毒治疗孕妇的新生儿 RPR 阳性率分别为22.4%(15/67)和40.3%(240/595,P<0.05);③孕早、晚期各抗梅毒治疗1个疗程与仅孕晚期抗梅毒治疗1个疗程比较,新生儿 RPR 阳性率分别为28.5%(45/158)和56.9%(95/167,P<0.01)。孕中、晚期各抗梅毒治疗1个疗程者与仅孕晚期抗梅毒治疗1个疗程者比较,新生儿 RPR 阳性率分别为37.0%(100/270)和56.9%(95/167,P<0.05)。(4)RPR 阳性新生儿随访至出生后24个月时全部转为阴性。结论妊娠合并梅毒孕妇的母婴传播率、围产儿预后与孕妇 RPR 滴度、治疗时机有关;孕前抗梅毒治疗孕妇的新生儿 RPR 阳性�
Objective To explore the maternal-fetal transmission patterns and interventional methods of syphilis during pregnancy. Methods A total of 847 eases of syphilis in pregnaney eonfirmed by rapid plasma reagin test （RPR） and treponema pallidum hemoagglutination test （TPHA）were treated with procaine benzylpenicillin intramuseular injection, and with erythroein oral medieation if hypersensitive to benzylpenieillin. Eight hundred forty seven eases of syphilis during pregnaney were followed up for pregnaney outcomes. And their newborn babies were tested using the RPR. The newborns with positive results were given intervention and followed up until 24 months after birth. Results （1） A total of 733 eases among the total 847 have given birth to living-babies, in which 626 eases were tested using RPR, and the positive rate was 55.1% （345/626）. （2） The RPR positive rate, neonatal mortality, preterm birth rate and low birth rate in the newborn of mothers with an RPR titer higher than or at 1：8 were higher than those of mothers with an RPR titer lower than 1： 8 （ P 〈 0. O1 ）. （3） The neonatal RPR positive rate was related to the timing of the treatment of the women.①The neonatal RPR positive rate was 22.4% （ 15/67 ） for treatment eompared with49. 6% （330/666） for non-treatment before pregnancy（ P 〈 0. 01 ）.②The positive RPR rate of neonates between treatment before pregnancy and treatment during pregnancy was different, being 22. 4% （ 15/67 ） and 40. 3% （ 240/595 ） respectively （ P 〈 0. 05 ）③In comparison between treatment both in the early pregnancy and in late pregnancy with only treatment in the late pregnancy, the positive RPR rate of neonates was 28.5% （45/158） and 56. 9% （95/167） respectively （ P 〈 0.01 ）. In comparison between treatment beth in the mid-term pregnancy and in late pregnancy and treatment in only one period in the terminal, the positive RPR rate of neonates was 37.0% （ 100/270 ） and 56. 9% （ 95/167 ） respectively （ P
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2007年第7期438-442,共5页
Chinese Journal of Obstetrics and Gynecology
基金
福建省社会发展科技计划(2004F003)
关键词
梅毒
妊娠并发症
感染性
疾病传播
垂直
青霉素G
普鲁卡因
红霉素
Syphilis
Pregnancy complications, infectious
Disease transmission, vertical
Penicillin G, procaine
Erythromycin
