Analysis Of Cases Of Pregnancy With Syphilis And Influencing Factors Of Adverse Pregnancy Outcomes

Objective:This study aims to grasp the clinical features and epidemiological characteristics of patients with syphilis in pregnancy in Changchun,and to explore the influencing factors of adverse pregnancy outcomes(APOs),and to provide a theoretical basis for preventing and controlling the prevalence of syphilis in pregnancy and reducing the incidence of APOs.Methods:The clinical data of all pregnant women with syphilis in hospitals for five years from January 1,2013 to December 31,2017 were collected for retrospective studies.The research included general demographic characteristics,reproductive history,and maternity.History,pregnancy status and laboratory test results.Epidata 3.1 software was used to establish the database,and SPSS24.0 software was used for data analysis.Measured data were described using mean±standard deviation,median(interquartile range);description of count data was composed of constituent ratios and rates;single factor analysis was analyzed using Chi-square test,t test,and rank testamong improvement rate,the difference was statistically significant if P<0.05;multivariate analysis was performed using non-conditional Logistic regression.Results:1.From 2013 to 2017,Changchun City Obstetrics and Gynecology Hospital received a total of 87286 cases of inpatients,all of whom were screened for syphilis serology.A total of 271 cases of syphilis were diagnosed,and the incidence of total syphilis was 0.31%.The incidence of syphilis was 0.35%(56/16134),0.26%(52/20244),0.34%(43/12595),0.32%(65/20545)and 0.31%(55/17768),respectively.There was no difference in the incidence of pregnancy-associated syphilis among hospitalized women in each year(P>0.05).2.Of the 271 patients with syphilis in pregnancy,the oldest was 43 years old and the youngest was 17 years old.The average age was(27.62±5.42)years old;the 25-29 year-old age group had the largest number of 110 cases,accounting for 40.59%;the Han nationality was mostly,259 cases(95.58%);non-professionals accounted for the majority,200 cases,accounting for 73.80%(200/217);urban residents were 152 cases(56.09%),the largest proportion.3.93 cases(34.32%)of the first pregnancies,gestation 1-3 times most,229 cases(84.51%),71 cases of maternal,accounting for 26.20%;144 cases have abortion history(53.14%);17 patients(6.27%)had a history of cesarean section in 23 cases(8.49%).4.There were a total of 98 cases of internal and external diseases during pregnancy,with an incidence of 36.16%.Among them,80 cases(29.52%)were combined with anemia,and 55 cases were pregnancy-specific pregnancy-related diseases.The incidence rate was 20.30%,including hypertension during pregnancy.In 42 cases(15.50%),in addition to syphilis,there were only 6 patients with gonorrhea in sexually transmitted diseases,and the incidence was 2.21%.5.There were 119 cases of perinatal abnormalities diagnosed with an incidence rate of 43.91%,of which the highest rate was umbilical cord entanglement,which was 75 cases(27.68%),followed by premature rupture of fetal membranes,41 cases(15.13%);the highest RPR titer was 1:64,a total of 25 cases,accounting for 9.22%,RPR patients with low titer(titers ?1:8)a total of 190 cases(70.11%);most patients during the pregnancy did not drive melon treatment(74.54%,202/271).6.Among 230 patients with syphilis associated with syphilis,230 were born with live births,126 were vaginal deliveries accounted for 54.78%;230 live births were born with slightly more men than 126(54.78%),with an average birth weight of 3108.47±625.74 g,median length(interquartile range)50.00(49.00,50.25)cm,median gestational age(interquartile range)39(37,40)weeks,1 minute Apgar score 0 to 7 in 41 patients(17.82%),32 patients(13.91%)had 5-minute Apgar scores of 0 to 7.7.119 cases of APOs occurred with a total incidence rate of 43.91%.The occurrence of various APOs: spontaneous abortion in 14 cases(5.17%),stillbirth in 27 cases(9.96%),preterm infants in 45 cases(16.61%),low birth weight in 48 cases(17.71%),macrosomia in 13 cases(4.80%),neonatal asphyxia in 42 cases(15.50%);The incidence of syphilis-induced maternal APOs during pregnancy from 2013 to 2017 was 50.00%(28/56),55.77%(29/52),44.19%(19/43),33.85%(22/65)and 38.18%(21/55),there was no significant difference in the incidence of APOs among pregnant women with syphilis in each year(P>0.05).8.Univariate analysis of APOs in patients with syphilis during pregnancy revealed age,premature rupture of membranes,syphilis rapid plasma receptor test(RPR)titers,syphilis treatment during pregnancy,white blood cell count(WBC),hematocrit(HCT),neutrophil count(NEUT),platelet volume distribution width(PDW),red blood cell distribution width(RDW),blood urea nitrogen(BUN),albumin(ALB),high density lipoprotein(HDL),C-reactive protein(CRP)in normal pregnancy outcome groups and there was a statistically significant difference in the distribution of APOs(P<0.05).9.Multivariate logistic regression analysis of APOs in patients with syphilis during pregnancy showed that no anti-syphilis treatment was performed during pregnancy(OR=2.133;95%CI:1.038 ~ 4.384),high RPR titer(OR=3.278;95%CI:1.619~6.634)and high CRP(OR=1.047;95%CI:1.023~1.071)are risk factors for APOs in patients with syphilis during pregnancy;high ALB(OR=0.911;95% CI:0.850~0.977)is a protective factor for APOs.Conclusions:1.Between 2013 and 2017,the incidence of syphilis in hospitalized women in Changchun City Maternity Hospital were all at low level;2.Patients are mostly young,unemployed and urban population;3.Most of the patients had a miscarriage history,abnormal diagnosis of pregnancy and incidence of anemia were high,most patients did not receive anti-syphilis treatment during pregnancy;4.Prevalence of APOs in pregnancy with syphilis;5.Treatment without anti-syphilis during pregnancy,high RPR titers,and elevated CRP increase the risk of APOs in patients with syphilis in pregnancy,higher ALB reduces the risk of APOs.