Udagawa H, Oshio Y, Shimizu Y
Department of Obstetrics and Gynecology, Asahi General Hospital, Asahi City, Chiba, Japan.
Obstet Gynecol. 1999 Jul;94(1):153-7. doi: 10.1016/s0029-7844(99)00238-0.
To differentiate the features of serious, perinatal, group A streptococcal infection from other types of streptococcal toxic shock syndrome.
Thirty-eight obstetric cases that were fatal or fulfilled the criteria of Centers of Disease Control and Prevention for streptococcal toxic shock syndrome were reviewed. Three cases were from Asahi General Hospital, 26 from MEDLINE (1966-December 1998), four from Japana Centra Revuo Medicina (1987-November 1998) using the search terms "Streptococcus," "Streptococcus pyogenes," "Streptococcal infection," "pregnancy," "labor," "delivery," "sepsis," and "shock," and five from official records of the Ministry of Health and Welfare of Japan. Cases of early pregnancy or cases that had unclear intervals between delivery and deterioration were eliminated. INTEGRATION AND RESULTS: The 30 cases were divided into two groups by interval between delivery and deterioration. Seventeen cases deteriorated before, during, or within 12 hours of delivery (perinatal group). They were compared with 13 cases of the puerperal group. The mortality rates for infants and mothers in the perinatal group were higher than those of the puerperal group (infant: ten of 17 versus zero of 13, mother: 15 of 17 versus seven of 13). The other differences of description were unusually strong labor (eight of 17 versus one of 13), obvious serious inflammation (zero of 17 versus ten of 13), and evidence of serious sepsis (eight of 17 versus zero of 13). Purulent myometritis without neighboring inflammation was found in our three cases. In ten cases, subjects or their family members had preceding sore throats.
The cases in the perinatal group had characteristic features. We suspected that after invading the myometrium through the upper respiratory tract, large amounts of cocci were dispersed into the systemic circulation of the mother by active uterine contractions caused by purulent myometritis. Unusual clinical signs were important for diagnosis.
鉴别严重的围产期A组链球菌感染与其他类型链球菌中毒性休克综合征的特征。
回顾了38例致命或符合美国疾病控制与预防中心链球菌中毒性休克综合征标准的产科病例。3例来自朝日综合医院，26例来自MEDLINE（1966年至1998年12月），4例来自日本医学中央杂志（1987年至1998年11月），检索词为“链球菌”“化脓性链球菌”“链球菌感染”“妊娠”“分娩”“产褥期”“败血症”和“休克”，5例来自日本厚生省官方记录。排除早孕病例或分娩与病情恶化间隔不明的病例。
根据分娩与病情恶化的间隔时间，将30例病例分为两组。17例在分娩前、分娩期间或分娩后12小时内病情恶化（围产期组）。将其与产褥期组的13例病例进行比较。围产期组婴儿和母亲的死亡率高于产褥期组（婴儿：17例中有10例死亡，产褥期组13例中0例死亡；母亲：17例中有15例死亡，产褥期组13例中有7例死亡）。其他描述差异包括异常强烈的宫缩（17例中有8例，产褥期组13例中有1例）、明显的严重炎症（17例中0例，产褥期组13例中有10例）和严重败血症的证据（17例中有8例，产褥期组13例中0例）。我们的3例病例中发现了无邻近炎症的脓性子宫肌炎。10例病例中，患者或其家庭成员之前有咽喉痛。
围产期组病例具有特征性表现。我们怀疑球菌通过上呼吸道侵入子宫肌层后，脓性子宫肌炎引起的活跃子宫收缩将大量球菌散布到母亲的体循环中。异常的临床体征对诊断很重要。
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