慢性感染症のリスクが高い女性の妊娠と分娩

Pregnancy and delivery in women with a high risk of infection in pregnancy.

• S V Barinov
• Y I Tirskaya
• T V Kadsyna
• O V Lazareva
• I V Medyannikova
• Yu I Tshulovski

抄録

慢性的な性器感染症や非性器感染症を持つ妊婦は、妊娠中や産後に感染症合併症を起こすリスクが高いとされています。早産は、産科および新生児合併症の主要な原因の一つであり、9人に1人の女性に発生しています。早産の40％は膣内マイクロバイオームの異常が原因と考えられており、細菌感染とウイルス感染の複合感染の寄与については、現在のところコンセンサスが得られていない。慢性感染症のリスクが高い女性における妊娠・分娩の経過および性器マイクロバイオームにおける特定の微生物の存在との関連を評価すること。慢性感染症のリスクが高い妊婦 355 人を対象に、プロスペクティブ対照観察研究を行った。高リスクとは、急性または慢性の性器感染症または性器外感染症の存在、現在の妊娠中の慢性感染症／炎症性疾患の再活性化、および過去の妊娠中に流産、流産未遂、早産、分娩後子宮内膜炎、敗血症などの産科合併症の既往歴と定義した。慢性感染症のリスクが高い女性では、妊娠は、再発の脅迫妊娠損失（49.8％）、胎児膜の早産早産破裂（64.3％）と関連していたが、その後は乏水疱瘡の長期化が続いた。ほぼ2人に1人の女性（47.9％）が妊娠により早産、低出生体重の新生児を出産しました。3人に1人（30％）の女性が、経膣分娩や帝王切開分娩の後に子宮低血圧と出血を経験しています。女性のほぼ3分の1（32.1％）が分娩後に炎症性合併症を発症し、合併症の半数以上（54.4％）が早産の女性に認められた。早産を経験した女性の腟および子宮頸管培養は、非肥満病原体が優勢であった。子宮頸管と子宮腔の両方で家族の持続性が観察され、具体的には（17.2％；95％CI：10％、26.8％）であった。慢性感染症のリスクが高い女性の妊娠は，再発の脅迫性妊娠喪失，膜の早発破裂，早産の高率と関連していた．

Pregnant women with chronic genital and non-genital infections are at a high risk of infections complication during pregnancy and the postpartum period. Preterm birth is one of the leading causes of obstetric and neonatal complications and occurs in one in nine women. Forty per cent of preterm births are considered to be caused by the abnormal vaginal microbiome, and there is currently no consensus on the contribution of combined bacterial and viral infections. To assess the course of pregnancy and delivery in women with a high risk of chronic infections and the association with the presence of specific microorganisms in the genital microbiome. We performed a prospective controlled observational study in 355 pregnant women with a high risk of chronic infections. The high risk was defined as presence acute or chronic genital or extragenital infections, reactivation of chronic infections/inflammatory diseases during current pregnancy and history of obstetric complications during previous pregnancies such as miscarriages, missed miscarriages, preterm deliveries, postpartum endometritis, and sepsis. In women with a high risk of chronic infections, pregnancy was associated with recurrent threatened pregnancy loss (49.8%), preterm premature rupture of fetal membranes (64.3%), followed by prolonged oligohydramnios. Almost in one in two women (47.9%), pregnancy resulted in the delivery of preterm, low-birth-weight neonates. One in three women (30%) experienced uterine hypotony and bleeding after vaginal and cesarean delivery. Almost a third of women (32.1%) developed inflammatory complications postpartum, and more than half of complications (54.4%) was observed in women giving birth prematurely. Vaginal and cervical cultures in women who experienced preterm birth were dominated by non-obligate pathogens. We observed persistence of the family both in the cervical canal and uterine cavity, specifically the (17.2%; 95% CI: 10%, 26.8%). Pregnancies in women with a high risk of chronic infections were associated with high rates of recurrent threatened pregnancy loss, preterm rupture of membranes and preterm delivery.