Yang Xiu-li, Yang Hui-xia, Duan Tao, He Jing, Sun Li-zhou, Yu Yan-hong, Liu Xing-hui, Li Xiao-mao
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
Zhonghua Fu Chan Ke Za Zhi. 2009 Jul;44(7):496-9.
To find out the bacterial species in the vagina of postpartum women and the possible influencing factors on colonization.
From Jun. 2007 to Oct. 2007, 560 postpartum women from 7 hospitals in China were enrolled. Questionnaire survey, gynecological examination and Nugent score of vaginal smear and microbial spectrum study of the vaginal flora were completed.
(1) According to the Nugent score, 48 out of the 560 women were normal (8.6%), 337 at the borderline (60.2%) and 175 (31.2%) were complicated with bacterial vaginosis (BV). Among the 560 women, Bacterium lacticum were identified in 74 cases (13.2%), but not in the rest 486 cases (86.8%). Gardnerella and bacteroids were detected in 322 women (57.5%) and small flectobacillus in 214 women (38.2%) out of the 560 subjects. (2) Influencing factors on vaginal microflora: among the 266 women who had normal vaginal delivery, 25 (9.4%) showed normal vaginal microflora, 148 (55.6%) at borderline and BV was diagnosed in 93 women (35.0%). The corresponding figures among the 294 women who underwent cesarean section were 23 (7.8%), 189 (64.3%) and 82 (27.9%), respectively. However, the incidence of BV had no statistical difference between these two groups (P = 0.204). In the 233 women who received episiotomy, 22 (9.4%) showed normal vaginal microflora, 135 (57.9%) at borderline and 76 presented with BV (32.6%), the corresponding figures among the 327 women without episiotomy were 26 (8.0%), 202 (61.8%) and 99 (30.2%), respectively. The incidence of BV did not show any statistical difference between the above two groups (P = 0.790). (3) Prenatal vaginitis were reported in 46 women, among which 5 (10.9%) with normal vaginal flora, 26 (56.5%) at borderline and 15 (32.6%) with BV, and again in the 514 women without prenatal vaginits, the above figures changed to 43 (8.4%), 311 (60.5%) and 160 (31.1%). No significant difference was found in the incidence of BV between the two groups (P = 0.962). The rate of BV in women without sex, with sex occasionally and with sex frequently during pregnancy was 27.5% (78/284), 35.6% (96/270) and 1/6, respectively (P = 0.185), and the numbers in women who had breast-feeding, bottle feeding and mixed feeding were 31.0% (67/216), 39.3% (35/89) and 28.6% (73/255), respectively (P = 0.573).
The amount of Lactobacillus in vagina of postpartum women is greatly reduced leading to dysbacteria. The incidence of BV is not affected by vaginal delivery, episiotomy, vaginitis, prenatal intercourse and the way of feeding, but is higher in postpartum women.
了解产后妇女阴道内的细菌种类及其定植的可能影响因素。
选取2007年6月至2007年10月期间来自中国7家医院的560例产后妇女。完成问卷调查、妇科检查、阴道涂片的 Nugent评分以及阴道菌群的微生物谱研究。
（1）根据 Nugent评分，560例妇女中48例正常（8.6%），337例处于临界状态（60.2%），175例（31.2%）合并细菌性阴道病（BV）。560例妇女中，74例（13.2%）检测到乳酸杆菌，其余486例（86.8%）未检测到。560例受试者中，322例（57.5%）检测到加德纳菌和拟杆菌，214例（38.2%）检测到小弯曲杆菌。（2）阴道微生物群的影响因素：266例顺产妇女中，25例（9.4%）阴道微生物群正常，148例（55.6%）处于临界状态，93例（35.0%）诊断为BV。294例剖宫产妇女中的相应数字分别为23例（7.8%）、189例（64.3%）和82例（27.9%）。然而，两组之间BV的发生率无统计学差异（P = 0.204）。233例行会阴切开术的妇女中，22例（9.4%）阴道微生物群正常，135例（57.9%）处于临界状态，76例（32.6%）患有BV，327例未行会阴切开术的妇女中的相应数字分别为26例（8.0%）、202例（61.8%）和99例（30.2%）。上述两组之间BV的发生率无统计学差异（P = 0.790）。46例报告有产前阴道炎的妇女中，5例（10.9%）阴道菌群正常，26例（56.5%）处于临界状态，15例（32.6%）患有BV，514例无产前阴道炎的妇女中的上述数字分别变为43例（8.4%）、311例（60.5%）和160例（31.1%）。两组之间BV的发生率无显著差异（P = 0.962）。孕期无性生活、偶尔有性生活和频繁有性生活的妇女中BV的发生率分别为27.5%（78/284）、35.6%（96/270）和1/6（P = 0.185），母乳喂养、人工喂养和混合喂养的妇女中BV的发生率分别为31.0%（67/216）、39.3%（35/89）和28.6%（73/255）（P = 0.573）。
产后妇女阴道内乳酸杆菌数量大幅减少，导致菌群失调。BV的发生率不受阴道分娩、会阴切开术、阴道炎、产前性交和喂养方式的影响，但产后妇女的发生率较高。
