Распространенность урогенитальных бактериальных инфекций у беременных и их влияние на состояние новорожденных

Abstract

Дослідження присвячені вивченню поширеності урогенітальних бактеріальних інфекцій у вагітних та оцінці їх впливу на стан новонароджених у ранньому неонатальному періоді. Матеріалом для дослідження була венозна кров вагітних у II та III триместра, а також пуповинна кров, отримана під час пологів. Методом імуноферментного аналізу визначали концентрацію IgM до Mycoplasma hominis, Chlamydia trahomatis, Ureaplasma urealyticum. Встановлено, що серед збудників урогенітальних бактеріальних інфекцій основним етіологічним фактором внутрішньоутробного інфікування плода і патологічного перебігу раннього неонатального періоду є Ch. trahomatis - як у вигляді моноінфекції, так і в поєднанні з U. urealyticum і M.hominis в формі мікст-інфекції. Наявність поєднаної урогенітальної бактеріальної інфекції викликало більш важкі клінічні симптоми внутрішньоутробного інфікування у новонароджених з патологічним перебігом неонатального періоду.

Исследования посвящены изучению распространенности урогенитальных бактериальных инфекций у беременных и оценке их влияния на состояние новорожденных в раннем неонатальном периоде. Материалом для исследования служила венозная кровь беременных во II и III триместрах, а также пуповинная кровь, полученная в родах. Методом иммуноферментного анализа определяли концентрацию IgM к Mycoplasma hominis, Chlamydia trahomatis, Ureaplasma urealyticum. Установлено, что среди возбудителей урогенитальных бактериальных инфекций основным этиологическим фактором внутриутробного инфицирования плода и патологического течения раннего неонатального периода является Ch. trahomatis - как в виде моноинфекции, так и в сочетании с U. urealyticum и M.hominis в форме микстинфекции. Наличие сочетанной урогенитальной бактериальной инфекции вызывало более тяжелые клинические симптомы внутриутробного инфицирования у новорожденных с патологическим течением неонатального периода.

The relevance of this study is determined by the prevalence of intrauterine infections among the causes of pathological course of early neonatal period. The purpose of the study was to assess the incidence of urogenital bacterial infections in pregnant and estimate their impact on the state of newborns. The study involved examination of 50 mother-newborn couples. Two groups were formed in early neonatal period depending on the outcome for the newborn. Group 1(control) included 28 women and newborns with a favorable course of perinatal period. Group 2 (main) comprised 22 women and newborns with clinical signs of intrauterine infection. Venous blood of pregnant in the 2nd and 3rd trimesters of pregnancy and umbilical cord blood served as a material for the study. Evaluation of the presence of infection was carried out using serological methods to determine the concentration of anti-infectious immunoglobulins. Concentration of IgM to Mycoplasma hominis, Chlamydia trahomatis, Ureaplasma urealyticum was determined by enzyme immunoassay in the biomaterial. The obtained data were statistically processed using STATISTICA 6.1 software. Venous blood was found to have an elevated concentration of M antibodies to M. hominis in 16.0% of the examined patients. Elevated IgM titres to U. urealyticum were observed in 20% of the examined women. The highest incidence of the serological marker of the infectious process was revealed in relation to Ch. Trahomatis - antibodies of this specificity were found in 72%. In umbilical blood the incidence of IgM to Ch. trahomatis was also the highest and comprised 24%. M antibodies to M. hominis and U. urealyticum were detected in 8% of cases. Assessment of the incidence of the serological marker of the infectious process in the examined groups showed that venous blood in group 1 patients contained an increased concentration of antibodies to M. hominis in 21.4% of cases; antibodies of this specificity in the umbilical blood of group 1 patients were detected in 18.2% of samples. Moreover, elevated IgM titres to M. hominis in group 2 were detected in 9.1% of cases in venous blood and were absent in umbilical blood. Besides, venous and umbilical blood in this group was found to have elevated titers of IgM to U. urealyticum with the same frequency of 45.4%, while in group 1 antibodies of this specificity were not detected in the biomaterial. Distribution of incidence of increased IgM concentration to Ch. trahomatis in the groups was as follows: these antibodies were detected in 64.2% in venous blood of the first group and in 81.8% of the examined patients of the second group. Umbilical blood contained high titres of antichlamydia antibodies in 36.7% of cases in the first group and 9.1% in the second group. Concentration of IgM to M. hominis in all the examined women was repeatedly increased. Assessment of the results of the study for the presence of urogenital bacterial infections in mother-newborn couples showed the following findings: 22% of the examined patients in the control group were not found to have urogenital bacterial infections, in 21% of the examined women mycoplasmal infection was combined with chlamydial infection, and 57% of the couples were shown to have a monoinfection caused by Ch. Trahomatis. Biomaterial of the main group was found to have markers of the infectious process in all the examined patients, while in 45% of cases ureaplasma infection was combined with chlamydial infection, and 9% of the examined couples had elevated titres of M antibodies both to Ch. trahomatis and M. hominis. Patients with combined urogenital infection had a more intense and prolonged course of conjunctive jaundice; intrauterine pneumonia was combined with severe respiratory failure and asphyxia. Conclusions 1. Ch. trahomatis is the main etiologic factor of intrauterine infection of the fetus and pathological course of early neonatal period among urogenital bacterial infections, both in the form of a monoinfection and in combination with U. urealyticum and M. hominis in the form of a mixed infection. 2. Presence of combined urogenital bacterial infection causes more severe clinical symptoms of intrauterine infection in newborns, triggering pathological course of neonatal period.