Goldenberg Robert L, Thompson Cortney
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
Am J Obstet Gynecol. 2003 Sep;189(3):861-73. doi: 10.1067/s0002-9378(03)00470-8.
Our objective was to determine the relationship between various types of perinatal infections and stillbirths.
By use of various textbooks on perinatal infections, multiple MEDLINE searches, and the reference list of all appropriate manuscripts, the appropriate English language literature was reviewed to define the relationship between various perinatal infections and stillbirths.
Infection may cause stillbirth by a number of mechanisms, including direct infection, placental damage, and severe maternal illness. A large variety of organisms have been associated with stillbirth, including many bacteria, viruses, and protozoa. In developed countries, between 10% and 25% of stillbirths may be caused by an infection, whereas in developing countries, which often have much higher stillbirth rates, the contribution of infection is much greater. Ascending bacterial infection, both before and after membrane rupture, with organisms such as Escherichia coli, group B streptococci, and Ureaplasma urealyticum is usually the most common infectious cause of stillbirth. However, in areas where syphilis is very prevalent, up to half of all stillbirths may be caused by this infection alone. Malaria may be an important cause of stillbirth in women infected for the first time in pregnancy. The two most important viral causes of stillbirth are parvovirus and Coxsackie virus, although a number of other viral infections appear to be causal. Toxoplasma gondii, leptospirosis, Listeria monocytogenes, and the organisms that cause leptospirosis, Q fever, and Lyme disease have all been implicated as etiologic for stillbirth.
Because infection-related stillbirth is relatively rare in developed countries, and those that do occur are caused by a wide variety of organisms, reducing this etiologic component of stillbirth much further will be difficult. However, in certain developing countries, the stillbirth rate is so high and the infection-related component so great that achieving a substantial reduction in stillbirth should be possible simply by reducing maternal infections.
我们的目的是确定各种围产期感染与死产之间的关系。
通过查阅各种围产期感染方面的教科书、多次进行医学文献数据库检索以及所有相关手稿的参考文献列表，对合适的英文文献进行综述，以明确各种围产期感染与死产之间的关系。
感染可通过多种机制导致死产，包括直接感染、胎盘损伤和严重的母体疾病。多种生物体与死产有关，包括许多细菌、病毒和原生动物。在发达国家，10%至25%的死产可能由感染引起，而在死产率通常高得多的发展中国家，感染的影响要大得多。胎膜破裂前后由大肠杆菌、B族链球菌和解脲脲原体等生物体引起的上行性细菌感染通常是死产最常见的感染原因。然而，在梅毒非常流行的地区，高达一半的死产可能仅由这种感染引起。疟疾可能是孕期首次感染的妇女死产的一个重要原因。死产的两个最重要的病毒原因是细小病毒和柯萨奇病毒，尽管其他一些病毒感染似乎也有因果关系。弓形虫、钩端螺旋体、单核细胞增生李斯特菌以及引起钩端螺旋体病、Q热和莱姆病的生物体都被认为是死产的病因。
由于在发达国家与感染相关的死产相对较少，而且发生的那些死产是由多种生物体引起的，要进一步降低死产的这一病因构成将很困难。然而，在某些发展中国家，死产率如此之高，与感染相关的部分如此之大，以至于仅通过减少母体感染就有可能大幅降低死产率。
