摘要
中国早产发生率约为7%,约70%属于自发性早产。宫内感染不仅是早产的主要原因,而且还与孕产妇及胎儿预后不良甚至死亡密切相关。30%的胎膜完整的早产和60%的未足月胎膜早破(PPROM)均存在临床或亚临床感染。妊娠期大多数宫内感染是由阴道和子宫颈上行感染引起,常见的上行感染包括B族链球菌(GBS)、细菌性阴道病(BV)、解脲支原体(UU)、沙眼衣原体(CT)、人乳头瘤病毒(HPV)感染等。此外,其他部位感染如牙周炎、肾盂肾炎、无症状菌尿症、新型冠状病毒感染等均与早产风险增加显著相关。治疗不仅要考虑孕妇自身生命体征及病情的变化,而且还需根据实时监测指标及时终止妊娠。妊娠期宫腔感染大部分是依靠产后胎盘病理诊断,少数有明显急性绒毛膜羊膜炎临床症状。因此,如何预防及治疗宫内感染一直是临床关注的焦点。
The incidence of Preterm birth(PTB)in China affects 7%of all pregnancies and 70%of spontaneous PTB(s PTB),which is a leading cause of infant morbidity and mortality.30%of pregnancies with intact membranes and 60%of those with pPROM have a clinical or subclinical infection(which is called histological chorioamnionitis).Most of intrauterine infections are caused by ascending pathogens from the lower genital tract and the vagina,which often includes Group B streptococci(GBS),bacterial vaginosis(BV),ureaplasma urealyticum(UU),Chlamydia trachomatis(CT),human papillomavirus(HPV)infections,etc.Extra-uterine infections are also associated with PTB(e.g.,pyelonephritis,pneumonia).For suspected or confirmed clinical infection,antibiotics are the main⁃stay of treatment and targeted treatment should be also made.If we consider intrauterine infection,delivery should be considered,regardless of the gestational age.Most cases of intrauterine infection during pregnancy are diagnosed by postpartum placental pathology,with a few having obvious clinical symptoms of acute cho⁃rioamnionitis.It is very difficult for us to treat and in⁃tervene timely.Therefore,how to prevent and treat intrauterine infections has always been our goal.
作者
米亚兵
应豪
MI Ya-bing;YING Hao(Department of Obstetrics,Shanghai First Maternity and Infant Hospital,School of Medicine,Tongji University,Shanghai 201204,China)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2023年第12期1197-1200,共4页
Chinese Journal of Practical Gynecology and Obstetrics
基金
国家重点研发计划(2022YFC2704600,2022YFC2704604)
国家自然科学基金(8227060896,82071678,82171683,8190061692)
上海市浦东新区卫生行业专项(PW2020E-1)。
关键词
上行感染
绒毛膜羊膜炎
早产
抗生素
预防
治疗
ascending infection
chorioamnionitis
preterm birth
antibiotic
prevention
treatment
