Newton E R, Piper J, Peairs W
Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, USA.
Am J Obstet Gynecol. 1997 Mar;176(3):672-7. doi: 10.1016/s0002-9378(97)70568-4.
We sought to determine the predictors of intraamniotic infection with use of the presence or absence of vaginal microbes and clinical variables.
Vaginal fluid was collected and analyzed on 936 of 2711 (35%) consecutive patients who were delivered over a 7-month period. Subjects were followed up prospectively for the development of intraamniotic infection. Intraamniotic infection was defined as an intrapartum fever > 37.8 degrees C plus at least two of the five following variables: maternal or fetal tachycardia, leukocytosis, tender uterus, or foul-smelling amniotic fluid. Bacterial vaginosis score and the presence or absence of aerobic vaginal organisms were independent microbial variables. Demographic, maternal, labor, and delivery characteristics were independent clinical variables. Stepwise logistic regression analysis was used to develop adjusted odds ratios for predicting intraamniotic infection (expressed as odds ratio [95% confidence interval]). Selection bias and microbiologic reliability were measured.
A bacterial vaginosis score of 7 to 10 (odds ratio 1.7, [95% confidence interval 1.0 to 3.9]), nulliparity (2.1 [1.3 to 3.4]), each hour of internal fetal electrode (1.2 [1.0-1.3]); and, each vaginal examination (1.7 [1.0-3.9]) were predictors of intraamniotic infection. Selected aerobic vaginal organisms such as group B streptococci or gram-negative rods were not predictive. Reanalysis with a bacterial vaginosis score > or = 4 revealed similar predictors of intraamniotic infection. Bacterial vaginosis had an adjusted odds ratio of 1.85 (1.16 to 2.9). Selected higher risk populations, vaginal examinations > or = 6 (n = 365), or rupture of membranes > or = 7 hours (n = 421) did not change the risk of a bacterial vaginosis score > or = 4 (adjusted odds ratio 1.87 and 1.98, respectively).
Abnormal vaginal flora combines with clinical variables to increase the risk of intraamniotic infection.
我们试图通过阴道微生物的存在与否及临床变量来确定羊膜腔内感染的预测因素。
在7个月期间分娩的2711例连续患者中，对936例（35%）患者收集并分析了阴道分泌物。对受试者进行前瞻性随访，观察羊膜腔内感染的发生情况。羊膜腔内感染定义为产时发热>37.8℃，加上以下五个变量中的至少两个：母体或胎儿心动过速、白细胞增多、子宫压痛或羊水有异味。细菌性阴道病评分以及需氧性阴道微生物的存在与否为独立的微生物变量。人口统计学、母体、产程及分娩特征为独立的临床变量。采用逐步逻辑回归分析得出预测羊膜腔内感染的校正比值比（以比值比[95%置信区间]表示）。评估了选择偏倚和微生物学可靠性。
细菌性阴道病评分为7至10（比值比1.7，[95%置信区间1.0至3.9]）、初产（2.1[1.3至3.4]）、每使用1小时胎儿头皮电极（1.2[1.0 - 1.3]）以及每次阴道检查（1.7[1.0 - 3.9]）是羊膜腔内感染的预测因素。某些需氧性阴道微生物，如B族链球菌或革兰氏阴性杆菌，并无预测作用。对细菌性阴道病评分≥4进行重新分析，得出了类似的羊膜腔内感染预测因素。细菌性阴道病的校正比值比为1.85（1.16至2.9）。选定的高危人群、阴道检查≥6次（n = 365）或胎膜破裂≥7小时（n = 421）并未改变细菌性阴道病评分≥4的风险（校正比值比分别为1.87和1.98）。
异常阴道菌群与临床变量相结合会增加羊膜腔内感染的风险。
