The Effect Of GBS And Lower Reproductive Tract Infection For Premature Rupture Of Membrane And Maternal-fetal Outcomes

Objective:Explore the relationship of GBS and lower reproductive tract infection with PROM.Study the effect of each infection bacteria on maternal-fetal outcomes in the purpose of giving timely screening and early prevention and treatment for pregnant women during gestational period.Eventually reduce perinatal complications and improve maternal-fetal outcomes.Methods:Select 317 pregnant women with PROM who delivered in Northern Jiangsu Peoples Hospitai as study group and divided them into two groups: 234 patients between 37 weeks to 41 weeks in full term premature rupture of membranes group(A group);83 patients between 28 weeks to 36+6 weeks in PPROM group(B group).Select 320 pregnant women between 28-41 weeks without PROM as control group.Line cervical secretions bacteria cultivation and test the vagina secretion to examine VVC,BV and TV.In addition,the vaginal and rectal swab specimens were cultivated to study GBS.Analyse the influence of different Pathogenic bacteria on maternalfetal outcomes.Results: 1.The positive rate of GBS,VVC,BV,TV and cervix bacteria culture in the study group were 14.5%,21.5%,10.10%,5.7% and 21.80% respectively.The positive rate of GBS,VVC,BV,TV and cervix bacteria culture in the control group were 4.70%,14.70%,5.3%,2.5% and11.60% respectively.There was significant difference between the two groups(P<0.05).2.The positive rate of GBS,VVC,BV,TV and cervix bacteria culture in group A were 8.1%、13.2%、5.6%、3.0% and 13.70% respectively.The positive rate of GBS,VVC,BV,TV and cervix bacteria culture in group B were 32.5%、44.6%、22.90%、13.3% and 44.60% respectively.There was significant difference between the two groups(P<0.01).3.The incidence of premature delivery,chorioamnionitis,puerperal infection,neonatal asphyxia and meconium-stained amniotic fluid were significantly higher in the study group than the control group(P<0.01).The incidence of neonatal pneumonia,neonatal sepsis,pulmonary hyaline membrane disease and pathological jaundice in neonatal had no statistical significance in the two groups(P<0.01).4.The incidence of premature delivery,puerperal infection,neonatal asphyxia,neonatal sepsis,neonatal asphyxia,meconium-stained amniotic fluid and pulmonary hyaline membrane disease and pathological jaundice in neonatal were significantly higher in pregnant women with GBS infection than pregnant women without(P<0.01),however,the incidence of chorioamnionitis was similar in the two group(P>0.05).The incidence of neonatal pneumonia,neonatal sepsis,pulmonary hyaline membrane disease and pathological jaundice in neonatal had no statistical significance in the two groups(P<0.01).The incidence of premature delivery,puerperal infection,chorioamnionitis,neonatal asphyxia,pathological jaundice in neonatal were significantly higher in pregnant women with lower reproductive tract infection than pregnant women without(P<0.05).5.There were 69 pregnant women in the study group with positive result of cervical secretions germiculture and 37 pregnant women in the control group.The distribution of main bacteria in the two group was approximately identical.E.coli bacteria accounts for most of the percentage(36.8%),followed by GBS(18.9%),the epidermis staphylococcus(16.0%),dung enterococcus(10.3%)and staphylococcus aureus(6.6%).Conclusions: 1.The infection of GBS and lower reproductive tract during gestational period increase the incidence of PROM,especially in PPROM.2.PROM increases the incidence of premature delivery,puerperal infection,chorioamnionitis,neonatal asphyxia and meconium-stained amniotic fluid,leading to adverse maternal-fetal outcomes.3.The incidence of premature delivery,puerperal infection,neonatal asphyxia,neonatal sepsis,neonatal asphyxia,meconium-stained amniotic fluid and pulmonary hyaline membrane disease and pathological jaundice in neonatal were significantly higher in pregnant women with GBS infection than pregnant women without,leading to adverse maternal-fetal outcomes.The incidence of premature delivery,puerperal infection,chorioamnionitis,neonatal asphyxia,pathological jaundice in neonatal were significantly higher in pregnant women with lower reproductive tract infection than pregnant women without.4.The cervical bacterial infection accounts for a significant proportion of the incidence of intrauterine infection and chorioamnionitis,which lead to a range of perinatal complications.The most common pathogenic bacteria are E.coli,GBS,the epidermis staphylococcus and dung enterococcus.