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妊娠期钩端螺旋体病的母婴结局:印度西部一家三级医疗中心的观察性描述性研究

Maternal and Foetal Outcomes of Leptospirosis in Pregnancy: An Observational Descriptive Study at a Tertiary Care Centre in Western India.

作者信息

Dwivedi Jyotsna S, Shah Dhruvi R, Desai Gaurav S, Mali Kimaya A, Mayadeo Niranjan M

机构信息

Department of Obstetrics and Gynaecology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra 400012 India.

出版信息

J Obstet Gynaecol India. 2025 Jun;75(3):213-219. doi: 10.1007/s13224-024-02080-7. Epub 2025 Feb 21.

Abstract

BACKGROUND

Leptospirosis is one of the most prevalent zoonoses worldwide. Its presentation is varied in severity and non-specific mimicking other infectious diseases and pregnancy conditions such as HELLP or AFLP.

AIMS AND OBJECTIVES

This study aims to evaluate the maternal and foetal outcomes of leptospirosis and estimate its prevalence in pregnancy at a tertiary care centre.

METHODS

This is an observational descriptive study conducted at a tertiary care teaching hospital in Western India over a duration of 5 years. All pregnant patients diagnosed as leptospirosis via IgM ELISA were included.

RESULTS

A total of 37 patients were enrolled. Majority presented in the first trimester and belonged to the low socio-economic strata. Fever was the most persistent symptom. Five patients had a spontaneous abortion, two underwent MTP, eight had a preterm delivery, whereas 22 patients carried up till term (of which 18 delivered vaginally and four underwent a LSCS). Majority had leucocytosis and were anaemic. Twelve cases had hyperbilirubinaemia, six had deranged transaminases, three had raised serum creatinine values and two had thrombocytopenia. Four patients required management in the ICU out of which two progressed to Weil's disease and one succumbed to death. The research team at our centre yielded an estimated 9.06% prevalence of leptospirosis.

CONCLUSION

Leptospirosis is often underdiagnosed and hence under-reported. Being a re-emerging infectious disease, an early clinical suspicion and sound understanding of the disease process in pregnant women is required.

摘要

背景

钩端螺旋体病是全球最普遍的人畜共患病之一。其临床表现严重程度各异,且缺乏特异性,可类似其他传染病及妊娠相关病症,如溶血、肝酶升高和血小板减少(HELLP)综合征或急性脂肪肝(AFLP)。

目的

本研究旨在评估钩端螺旋体病的母婴结局,并估计其在三级医疗中心妊娠人群中的患病率。

方法

这是一项在印度西部一家三级医疗教学医院开展的观察性描述性研究,为期5年。纳入所有经IgM酶联免疫吸附测定(ELISA)诊断为钩端螺旋体病的孕妇。

结果

共纳入37例患者。多数患者在孕早期就诊,且社会经济地位较低。发热是最持续的症状。5例患者自然流产,2例接受了人工流产,8例早产,而22例患者足月分娩(其中18例经阴道分娩,4例行低位剖宫产术)。多数患者白细胞增多且贫血。12例患者出现高胆红素血症,6例转氨酶异常,3例血清肌酐值升高,2例血小板减少。4例患者需要在重症监护病房治疗,其中2例进展为韦尔病,1例死亡。本中心的研究团队估计钩端螺旋体病的患病率为9.06%。

结论

钩端螺旋体病常常诊断不足,因此报告率也低。作为一种再度出现的传染病,需要对孕妇进行早期临床怀疑并深入了解疾病过程。

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