| Objective:1.Based on the monitoring data of maternal syphilis in Zhejiang province,this study explored the factors influencing the diagnosis of maternal syphilis in different periods,providing scientific basis for optimizing intervention strategies.2.To explore the relationship between treatment of pregnancy syphilis and adverse perinatal outcomes,and provide a scientific basis for effectively improving maternal and infant outcomes.Methods:1.Data were based on maternal syphilis monitoring system of Zhejiang province.Pregnant women with syphilis during 2013-2016 were collected.We used the unconditional Logistic regression model to analyze the influencing factors of maternal syphilis diagnosed occasion,p<0.05 was considered statistically significant.2.Data were based on maternal syphilis monitoring system of Zhejiang province.Pregnant women with syphilis during 2013-2016 were collected.Unconditional logistic regression was used to analyze the influencing factors of adverse pregnancy outcomes.Results:1.Analysis of factors influencing the diagnosis of parturient syphilis infection(1)Univariate analysis showed significant differences in distribution of maternal ethnicity,status of residence,education,employment,parity,number of children,syphilis stage,infection status of sexual partner,and reporting year,between women diagnosed at delivery and during pregnancy(for all,p<0.01).(2)Multivariate analysis indicated that Han nationality,Women with higher parity(OR=3.05;95%CI:2.25?4.15 for parity=1 and OR=4.46;95%CI:2.94?6.7 for parity? 2),with more children(OR=1.79;95%CI:1.18?2.72),with primary syphilis(OR=1.54;95%CI:1.16?2.05)and partner infection(OR=1.76;95%CI:1.60?1.94)increased risk of diagnose at delivery.2.Relationship between treatment of pregnancy syphilis and perinatal outcome(1)general conditionTotal of 9038 pregnant women were collected.Age range from 15-45 years,mostly range from 20-34 years,about 7298 cases(80.75%),54.23%of them were non local resident,most of them reported had low level education,primary or low about 1378 cases,junior and senior high school about 6808 cases,college or above about 770 cases;83.65%of them were first marriage,42.99%of them were unemployed.(2)fertility circumstanceAs the gravidity increasing,the one who diagnosed syphilis infection was increasing,but as the parity increasing,littler pregnant women diagnosed syphilis infection,[4688 cases(51.87%)for gravidity?3,4034 cases(44.63%)for parity=0,3788 cases(41.91%)for parity=0 44.63%].Currently,there were 4346 cases(48.09%)without children,and there were 3703 cases(40.97%)with one children.(3)Syphilis infectionThere were 7472 cases(82.76%)of latent syphilis;sexual transmission were 4100 cases(45.36%)and mother-to-child transmission were 34 cases(0.38%);in the study showed that 5962 women whose sexual partner knew nothing of whether infected syphilis,5456 cases tested RPR positive:3904 cases in<1:4;1169 cases in 1:4-1:8,383 cases in>1:8;3582 cases tested TRUST positive:2600 cases in<1:4;751 cases in 1:4-1:8,231 cases in>1:8.(4)Treatment of syphilis and adverse pregnancy outcomes? Overall situation In total,about 2837 women suffered serious adverse pregnancy outcomes,including 712 cases of natural abortion,163 cases of stillbirth or neonatal death,853 cases of premature birth,36 cases of birth defects,529 cases of low birth weight,and 544 cases of other adverse pregnancy outcomes.? Number of course The risk of adverse pregnancy outcome was increased by one course of treatment over two courses of treatment,mostly about low birth weight(OR 3.63,95%CI 2.23-5.90).? Treatment versus untreatment The untreated increased risk of adverse pregnancy outcomes(OR 6.42,95%CI 3.32-12.44).Among them,low birth weight was infected mostly.(OR 33.50,95%CI 13.09-85.76).?Treatment period The risk of adverse pregnancy outcome was increased by anti-syphilis treatment in the third trimester,mostly premature birth(OR 1.52,95%CI 1.13-2.06),and low birth weight(OR 1.45,95%CI 1.23-1.719).(5)infant statement?general conditionA total of 9169 infants were born with an average birth weight of 3216±70.5 1g and an average gestational age of 38±0.45 weeks.There were 853 premature infants(9.44%),527 infants with low birth weight(5.85%)and 88 infants with congenital syphilis(0.96%).There were 4,741 male infants(51.71%)and 4,282 female infants(46.70%).?congenital syphilisIn this study,89 infants were diagnosed with congenital syphilis,with an average gestational age of 35±0.45 weeks,an average birth weight of 2362±61.25g,43 cases were male infants(48.86%),45 cases were female infants(51.14%),43 cases were premature infants(48.86%),48 cases were infants of low birth weight(54.55%),79 cases diagnosed with congenital syphilis were tested positive through serological titer,and 0 cases were detected by dark field spirulina,9 cases were detected positive by IgM of treponema pallidum.There were 51 cases of infants tested RPR positive:9 cases in<1:4;7 cases in 1:4-1:8,35 cases in>1:8;28 cases of infants tested TRUST positive:1 cases in<1:4;7 cases in 1:4-1:8,20 cases in>1:8;55 cases whose mother tested RPR positive:9 cases in<1:4;19 cases in 1:4-1:8,27 cases in>1:8;33 cases whose mother tested TRUST positive:8 cases in<1:4;11 cases in 1:4-1:8,14 cases in>1:8,the proportion of infants with congenital syphilis and their mothers at different titers was statistically significant(P<0.05).Conclusion:1.There were significant differences in the demographic characteristics of pregnant and parturient women diagnosed with syphilis at different stages.The proportion of pregnant and parturient women who were diagnosed with syphilis at childbirth was higher than that of ethnic minorities,non-registration,low educational level,no fixed occupation,multiple parity,multiple children,high stage syphilis and sexual partner infection.2.The risk factors identified at birth included:multiple parity,multiple children,primary syphilis and sexual partner infections.3.The pregnant and parturient women infected by syphilis have a high proportion of non-residents,low education level,no fixed occupation,and mostly with multiple pregnancies.4.Pregnancy syphilis is mostly latent syphilis and sexually transmitted,but the rate of sexual partner detection is low.5.Untreated and inadequate treatment pregnancy syphilis,increases the risk of miscarriage,stillbirth,premature birth,low birth weight and other adverse pregnancy outcomes,while late pregnancy treatment also increases the risk of adverse pregnancy outcomes.6.Children with congenital syphilis have high rates of premature delivery and low birth weight infants.The serum titer level was higher,and the mother's blood titer level was higher. |
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