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조산 임신부의 분만 전 생식기 Mycoplasmas 감염과 임신 및 신생아 예후에 관한 연구

ASSOCIATION OF GENITAL MYCOPLASMAS INFECTION IN WOMEN WHO HAD PRETERM DELIVERY AND OUTCOMES IN PREMATURE INFANTS

박은애|박소연|박미혜|김영주|전선희|조수진|정현경
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2012.03|Obstetrics & Gynecology Science|제55권 제03호|pp. 158-165

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키워드

Preterm birthPremature infants조산Ureaplasma urealyticumMycoplasma hominis생식기 마이코플라즈마조산아Genital Mycoplasmas
주제분류산부인과학

초록

목적조기분만 시 Mycoplasmas 감염이 임신 및 신생아의 이환율에 미치는 영향을 알아보고자 하였다. 연구방법본 연구는 의무기록 분석을 통한 후향적 연구로, 2009년 8월부터 2010년 12월까지 이화여자대학교 이대목동병원 산부인과에 입원하여단태아 조산아를 분만한 116명의 산모 및 이들에게서 태어난 신생아들을 대상으로 하였다. 검체는 자궁경부에서 채취하여 배양 혹은 중합효소연쇄반응법을 시행하였으며, 감염에 따른 신생아 이환율을 비교 분석하였다결과총 116명의 대상 산모 중 생식기 Mycoplasmas 감염된 경우가 42명(36.2%)이었다. 연구군에서 대조군보다 자궁경부 길이가 유의하게 짧았고, 조산 기왕력의 빈도는 높았다. 산과적 합병증으로 임상적 융모양막염과 조직학적 융모양막염, 제대혈관염의 발생빈도 및 산욕기 감염 발생을 비교하였을 때 두 군 간에 차이를 보이지 않았으며, 연구군과 대조군에서 태어난 신생아의 평균 몸무게, 성별, 부당경량아 비율, 1분 및 5분 Apgar 점수, 제대동맥혈 pH, 인공환기기 사용 여부, 입원 기간, 신생아호흡곤란증후군(respiratory distress syndrome, RDS),sepsis, 뇌실내 출혈(intraventricular hemorrhage), 동맥관개존(patent ductus arteriosus) 이환율을 분석한 결과 통계학적으로 유의한 차이는 없었다. RDS 및 기관지폐 형성이상(bronchopulmonary dysplasia)의 상대위험비(relative risk)는 각각 1.55 (95% confidence interval [CI],0.65-3.70), 1.24 (95% CI, 0.42-3.67)였다. 결론임상적 특징으로는 연구군에서 조산 과거력이 더 많고, 자궁경부 길이가 더 짧은 것으로 나타났다. 그러나 조산모의 질내 Mycoplasmas 감염은 여러 신생아의 질환 발생에 거의 영향을 주지 않는 것으로 확인되었다.

Abstract

Objective We conducted this study to evaluate the relationship between genital Mycoplasmas infection in women who had preterm delivery and the neontal outcomes. Methods We studied 116 women with preterm delivery (gestational age, ranged from 24 to 37 weeks) and their 116 premature infants born at Ewha Womans University Mokdong Hospital from August 2009 to December 2010. Culture for genital Mycoplasmas or a polymerase chain reaction was performed in vaginal fl uid obtained from women who had preterm delivery. For perinatal outcomes,chorioamnionitis, funisitis and puerperal infection were analysed. We also evaluated the following neonatal data; birth weight,sex, small for gestational age, Apgar score, cord blood pH, ventilator care, hospital days, incidence of respiratory distress syndrome,bronchopulmonary dysplasia, sepsis, intraventricular hemorrhage and patent ductus arteriosus. Results Genital Mycoplasmas were isolated in 36.2% (42 of 116 patients). History of prior preterm birth was signifi cantly higher and the cervical length at admission was signifi cantly shorter in patients with genital Mycoplasmas infection (P < 0.05). Perinatal outcomes according to the Mycoplasmas infection and the neonatal outcomes were not statistically different between study and control groups. The relative risk of respiratory distress syndrome and bronchopulmonary dysplasia were 1.55 (95% confi dence interval [CI],0.65-3.70), and 1.24 (95% CI, 0.42-3.67), respectively. Conclusion There is higher incidence of prior preterm birth and shorter cervical length in patient with genital Mycoplasmas infection. However,genital Mycoplasmas infection does not affect the neonatal outcomes

참고문헌 (40)

  1. Challis JR, "Under standing preterm labor", Ann N Y Acad Sci, 943, pp.225~234 (2001)
  2. Romero R, "Infection and preterm labor", Clin Obstet Gynecol, 31, pp.553~584 (1988)
  3. Romero R, "Infection and labor. VI. Prevalence, microbiology, and clinical signifi cance of intraamniotic infection in twin gestations with preterm labor", Am J Obstet Gynecol, 163, pp.757~761 (1990)
  4. Yoon BH, "The relationship among infl ammatory lesions of the umbilical cord (funisitis), umbilical cord plasma interleukin 6 concentration, amniotic fl uid infection, and neonatal sepsis", Am J Obstet Gynecol, 183, pp.1124~1129 (2000)
  5. Romero R, "A fetal systemic infl ammatory response is followed by the spontaneous onset of preterm parturition", Am J Obstet Gynecol, 179, pp.186~193 (1998)
  6. Lamont RF, "Intravaginal clindamycin to reduce preterm birth in women with abnormal genital tract fl ora", Obstet Gynecol, 101, pp.516~522 (2003)
  7. Anagrius C, "Mycoplasma genitalium: prevalence, clinical signifi cance, and transmission", Sex Transm Infect, 81, pp.458~462 (2005)
  8. Kataoka S, "Association between preterm birth and vaginal colonization by mycoplasmas in early pregnancy", J Clin Microbiol, 44, pp.51~55 (2006)
  9. Cassell GH, "Ureaplasma urealyticum intrauterine infection: role in prematurity and disease in newborns", Clin Microbiol Rev, 6, pp.69~87 (1993)
  10. Velemínský M, "Relationship of vaginal microfl ora to PROM, pPROM and the risk of early-onset neonatal sepsis", Neuro Endocrinol Lett, 29, pp.205~221 (2008)
  11. Katz B, "Characterization of ureaplasmas isolated from preterm infants with and without bronchopulmonary dysplasia", J Clin Microbiol, 43, pp.4852~4854 (2005)
  12. 김미주, "조산통 혹은 조기양막파수 산모와 임신 중반기 무증상 산모에서 Ureaplasma urealyticum과 Mycoplasma hominis의 검출율", 대한주산의학회잡지, 19(4), pp.370~376 (2008), 대한주산의학회
  13. 김소영, "조산모와 조기 양막파수에서 Mycoplasma Hominis와 Ureaplasma Urealyticum의 감염율 분석", Obstetrics & Gynecology Science, 47(8), pp.1469~1473 (2004), 대한산부인과학회
  14. Iams JD, "The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network", N Engl J Med, 334, pp.567~572 (1996)
  15. "Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy", Am J Obstet Gynecol, 183, pp.1~22 (2000)
  16. National Diabetes Data Group, "Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance", Diabetes, 28, pp.1039~1057 (1979)
  17. "WHO Expert Committee on Diabetes Mellitus: second report", World Health Organ Tech Rep Ser, 646, pp.1~80 (1980)
  18. Gibbs RS, "Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term", J Infect Dis, 145, pp.1~8 (1982)
  19. Hollander D, "Diagnosis of chorioamnionitis", Clin Obstet Gynecol, 29, pp.816~825 (1986)
  20. Lubchenco LO, "Intrauterine Growth as Estimated from Liveborn Birth-Weight Data at 24 to 42 Weeks of Gestation", Pediatrics, 32, pp.793~800 (1963)
  21. Volpe JJ, "Neonatal intracranial hemorrhage. Pathophysiology, neuropathology, and clinical features", Clin Perinatol, 4, pp.77~102 (1977)
  22. Jobe AH, "Bronchopulmonary dysplasia", Am J Respir Crit Care Med, 163, pp.1723~1729 (2001)
  23. Taylor-Robinson D, "The genital mycoplasmas (fi rst of two parts)", N Engl J Med, 302, pp.1003~1010 (1980)
  24. Kong F, "Species identification and subtyping of Ureaplasma parvum and Ureaplasma urealyticum using PCR-based assays", J Clin Microbiol, 38, pp.1175~1179 (2000)
  25. McCormack WM, "Colonization with genital mycoplasmas in women", Am J Epidemiol, 97, pp.240~245 (1973)
  26. Chang MW, "Isolation of Ureaplasma urealyticum and Mycoplasma hominis from patients with genitourinary tract infection", Hiroshima J Med Sci, 33, pp.53~56 (1984)
  27. Mårdh PA, "T-mycoplasmas in the genito-urinary tract of the female", Acta Pathol Microbiol Scand B Microbiol Immunol, 78, pp.269~ (1970)
  28. Klein JO, "Colonization of newborn infants by mycoplasmas", N Engl J Med, 280, pp.1025~1030 (1969)
  29. Braun P, "Birth weight and genital mycoplasmas in pregnancy", N Engl J Med, 284, pp.167~171 (1971)
  30. Embree JE, "Placental infection with Mycoplasma homonis and Ureaplasma urealyticum: clinical correlation", Obstet Gynecol, 56, pp.475~481 (1980)
  31. Yoon BH, "The clinical signifi cance of detecting Ureaplasma urealyticum by the polymerase chain reaction in the amniotic fl uid of patients with preterm labor", Am J Obstet Gynecol, 189, pp.919~924 (2003)
  32. Hannaford K, "Role of ureaplasma urealyticum in lung disease of prematurity", Arch Dis Child Fetal Neonatal Ed, 81, pp.162~167 (1999)
  33. Cultrera R, "Molecular evidence of Ureaplasma urealyticum and Ureaplasma parvum colonization in preterm infants during respiratory distress syndrome", BMC Infect Dis, 6, pp.166~ (2006)
  34. Benstein BD, "Ureaplasma in lung. 2. Association with bronchopulmonary dysplasia in premature newborns", Exp Mol Pathol, 75, pp.171~177 (2003)
  35. Colaizy TT, "Detection of ureaplasma DNA in endotracheal samples is associated with bronchopulmonary dysplasia after adjustment for multiple risk factors", Pediatr Res, 61, pp.578~583 (2007)
  36. Walsh WF, "A primate model of Ureaplasma urealyticum infection in the premature infant with hyaline membrane disease", Clin Infect Dis, 17(1), pp.158~162 (1993)
  37. Patterson AM, "Ureaplasma urealyticum respiratory tract colonization is associated with an increase in interleukin 1-beta and tumor necrosis factor alpha relative to interleukin 6 in tracheal aspirates of preterm infants", Pediatr Infect Dis J, 17, pp.321~328 (1998)
  38. Ollikainen J, "Chronic lung disease of the newborn is not associated with Ureaplasma urealyticum", Pediatr Pulmonol, 32, pp.303~307 (2001)
  39. Cassell GH, "Isolation of Mycoplasma hominis and Ureaplasma urealyticum from amniotic fl uid at 16-20 weeks of gestation: potential effect on outcome of pregnancy", Sex Transm Dis, 10, pp.294~302 (1983)
  40. Cassell GH, "Association of Ureaplasma urealyticum infection of the lower respiratory tract with chronic lung disease and death in very-low-birth-weight infants", Lancet, 2, pp.240~245 (1988)

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