【作者】 严丽；

【导师】 邵红； 刘宁；

【作者基本信息】 新疆医科大学 ， 公共卫生， 2010， 硕士

【摘要】 目的：通过对乌市妇幼保健院2247例早产患者病历资料的回顾性分析,探讨早产的相关危险因素；再通过对268例妊娠期妇女进行细菌性阴道病(bacterial vaglnosls, BV)筛查并跟踪随访至分娩,探讨早产与BV的关系。方法：1、回顾性分析乌鲁木齐妇幼保健院2004年1月至2009年12月早产病例,与该院同期足月分娩病例进行对照,找出两组间差异有统计学意义的因素,把这些因素进行Logistic回归分析,筛选早产的相关危险因素。2、对2010年1月份以来的268例妊娠期妇女,采用细菌性阴道病快速试剂盒筛查妊娠中晚期孕妇,了解妊娠期的BV发病情况,并跟踪阳性者的妊娠结局。结果：1、2004年至2009年各年度早产构成比分别为6.6%、6.4%、5.4%、6．1%、7.6%、10.5%,早产构成比近年无明显降低,甚至呈现上升趋势。医源性早产中,子痫前期、胎盘因素所致产前出血及胎儿窘迫为其前三位原因；前次早产史、胎膜早破(Premature rupure of membrane, PROM)、产前出血、子痫前期、胎位异常、多双胎、妊娠期内外科合并症、羊水过多等为早产的相关危险因素。2、268例妊娠中晚期妇女中检出BV患者68例,妊娠合并BV的检出率为25.4%。妊娠期BV患者早产发病率明显高于正常妊娠妇女(p<0.01)。甲硝唑泡腾片治疗细菌性阴道病有效率为80.0%。结论：1、本院的早产构成比近年无明显降低,甚至呈现上升趋势。2、早产是多因素共同作用的结果。年龄、早产史、反复流产史、产检次数、多／双胎、胎膜早破、产前出血、子痫前期、胎位异常、妊娠期内外科合并症、羊水过多和子宫因素等为早产的相关危险因素。3、医源性早产中子痫前期,胎盘因素所致产前出血,胎儿窘迫,为其前三位主要原因。医源性早产与自发性早产的主要原因不同,但早产在病因学上存在同质性,从病因上不能将其截然分开。4、BV是在细菌学上表现为生殖道正常菌群(H202产乳杆菌)数量的减少,代之以一组厌氧菌群(类杆菌、和支原体等)数量增加的临床症侯群,BV表现出与早产的相关性。妊娠期BV阳性者早产的发生率明显升高。治疗妊娠合并BV对降低围产期母婴的不良结局具有积极意义。更多还原

【Abstract】 Objective:To investigate the risk factors of premature delivery,in order to provide a screening basis of high-risk group of premature delivery pregnant women for clinical. Methods:retrospective study:Change tendency of preterm birth total and the rate of preterm birth from January of 2004 to December of 2009 in Urumqi Maternal and Child Health Hospital. To investigate main causaes of preterm birth and iatrogenic preterm birth.Take normal term labor cases as control group, To carry out regression analysis screening high-risk factors of preterm birth. Prospective Studie:Adopt bacterial vaginosis(BV) fast kit to screen pregnant women during the second and advanced stage trimester, to probe incidence rate in pregnant women and follow their Pregnancy Outcome. Results:Part 1:retrospective study:1. the rate of preterm birth from 2004 to 2009 each is 6.6%、6.4%、5.4%、6.1%、7.6%、10.5% the rate of preterm birth, doesn’t decrease obviously recent years,even show tendency of upgrade. The main first three causes of iatrogenic preterm birth were preeclampsia,vaginal bleeding caused by placenta previa and placental abruption, fetal distress in uterus.2. Anterior preterm birth history, Premature rupture of fetal membranes (PROM), Pregnant-induced hypertension(PIH), Abnormal fetal position、Placenta factors、Multiple or double pregnancies、hydramnios、medical or surgical department complication were the major relevant risk factors of preterm delivery.Part 2:Prospective Study:68 cases with BV patient were checkd out during the 268 second and advanced stage trimester pregnant women. detection rate of Pregnancy combined BV is 25.4%. preterm delivery rate of patient with BV duringgestationalperiod issuper-to normal pregnant moman(p<0.01) effective power of metronidazole is 80.0%. Conclusions:1. the rate of preterm birth, doesn’t decrease obviously recent years,even show tendency of upgrade.2. multiple factors all can cause preterm birth, age, anterior preterm birth history, Premature rupture of fetal membranes (PROM), Pregnant-induced hypertension(PIH), Abnormal fetal position, Placenta factors, Multiple or double pregnancies, hydramnios, medical or surgical department complication were the major relevant risk factors of preterm delivery.3. The main first three causes of iatrogenic preterm birth were preeclampsia,vaginal bleeding caused by placenta previa and placental abruption, fetal distress in uterus. The major cause of iatrogenic preterm iatrogenic preterm is different, but they ara homogeneity in preterm etiologically and can’t be taken apart completely.4.BV shows correlation with preterm delivery. The incidence of premature delivery in patients with BV were significantly higher than that in normal pregnant women. Treatment to getational pregnant women with BV will have Positive significance for reducing maternal and infant’s bad outcome during perinatal period.更多还原