乌干达穆拉戈医院的生殖道感染与胎膜早破风险：一项病例对照研究
Genital infections and risk of premature rupture of membranes in Mulago Hospital, Uganda: a case control study.
作者信息
Nakubulwa Sarah, Kaye Dan K, Bwanga Freddie, Tumwesigye Nazarius Mbona, Mirembe Florence M
机构信息
Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda.
Department of Microbiology, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda.
出版信息
BMC Res Notes. 2015 Oct 16;8:573. doi: 10.1186/s13104-015-1545-6.
BACKGROUND
Inflammatory mediators that weaken and cause membrane rupture are released during the course of genital infections among pregnant women. We set out to determine the association of common genital infections (Trichomonas vaginalis, syphilis, Neisseria gonorrhea, Chlamydia trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 and candidiasis) and premature rupture of membranes in Mulago hospital, Uganda.
METHODS
We conducted an unmatched case-control study among women who were in the third trimester of pregnancy at New Mulago hospital, Uganda. The cases had PROM and the controls had intact membranes during latent phase of labour in the labour ward. We used interviewer-administered questionnaires to collect data on socio-demographic characteristics, obstetric and medical history. Laboratory tests were conducted to identify T. vaginalis, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 (HSV-2) and candidiasis. Logistic regression models were used to estimate the odds ratios (OR) and 95% CI of the association between genital infections and PROM.
RESULTS
There was an association between PROM and abnormal vaginal discharge (OR = 2.02, 95% CI 1.10-3.70 and AOR = 2.30, 95% CI 1.18-4.47), presence of candidiasis (OR = 0.27, 95% CI 0.14-0.52 and AOR = 0.22, 95% CI 0.10-0.46) and T. vaginalis (OR = 2.98, 95% CI 1.18-7.56 and AOR = 4.22, 95% CI 1.51-11.80). However, there was no association between PROM and presence of C. trachomatis (OR = 2.05, 95% CI 0.37-11.49) and HSV-2 serostatus (OR = 1.15, 95% CI 0.63-2.09). Few or no patients with Bacterial vaginosis, Neisseria gonorrhoea, Group B streptococcus or syphilis were identified among the cases and controls. Co-infection of Trichomoniasis and candidiasis was not associated with PROM (AOR = 1.34, 95% CI 0.16-11.10). Co infection with T. vaginalis and C. trachomatis was associated with PROM (OR = 3.09, 95% CI 1.21-7.84 and AOR = 4.22, 95% CI 1.51-11.83).
CONCLUSION
Trichomonas vaginalis alone, T. vaginalis with C. trachomatis co-infection and abnormal per vaginal discharge were found as risk factors for PROM. There was no association of HSV-2 serostatus, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus and Bacterial vaginosis with PROM. Candidiasis seemed to have a protective effect on PROM.
背景
在孕妇生殖器感染过程中，会释放出削弱并导致胎膜破裂的炎症介质。我们旨在确定乌干达穆拉戈医院常见生殖器感染（阴道毛滴虫、梅毒、淋病奈瑟菌、沙眼衣原体、B族链球菌、细菌性阴道病、2型单纯疱疹病毒和念珠菌病）与胎膜早破之间的关联。
方法
我们在乌干达新穆拉戈医院对处于妊娠晚期的女性进行了一项非匹配病例对照研究。病例组为胎膜早破患者，对照组为产程潜伏期胎膜完整的产妇，均在产房。我们使用访谈式问卷收集社会人口学特征、产科和病史数据。进行实验室检测以鉴定阴道毛滴虫、梅毒、淋病奈瑟菌、沙眼衣原体、B族链球菌、细菌性阴道病、2型单纯疱疹病毒（HSV - 2）和念珠菌病。使用逻辑回归模型估计生殖器感染与胎膜早破之间关联的比值比（OR）和95%置信区间（CI）。
结果
胎膜早破与异常阴道分泌物（OR = 2.02，95% CI 1.10 - 3.70，校正后OR = 2.30，95% CI 1.18 - 4.47）、念珠菌病（OR = 0.27，95% CI 0.14 - 0.52，校正后OR = 0.22，95% CI 0.10 - 0.46）和阴道毛滴虫（OR = 2.98，95% CI 1.18 - 7.56，校正后OR = 4.22，95% CI 1.51 - 11.80）之间存在关联。然而，胎膜早破与沙眼衣原体感染（OR = 2.05，95% CI 0.37 - 11.49）和HSV - 病毒血清学状态（OR = 1.15，95% CI 0.63 - 2.09）之间无关联。在病例组和对照组中，很少或未发现细菌性阴道病、淋病奈瑟菌、B族链球菌或梅毒患者。滴虫病和念珠菌病合并感染与胎膜早破无关（校正后OR = 1.34，95% CI 0.16 - 11.10）。阴道毛滴虫和沙眼衣原体合并感染与胎膜早破有关（OR = 3.09，95% CI 1.21 - 7.84，校正后OR = 4.22，95% CI 1.51 - 11.83）。
结论
单独的阴道毛滴虫、阴道毛滴虫与沙眼衣原体合并感染以及异常阴道分泌物被发现是胎膜早破的危险因素。HSV - 2血清学状态、梅毒、淋病奈瑟菌、沙眼衣原体、B族链球菌和细菌性阴道病与胎膜早破无关联。念珠菌病似乎对胎膜早破有保护作用。
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