PDF(Pubmed)
Abstract：
Mixed vaginitis is a complex vaginal dysbiosis that differs from single vaginitis. Vaginitis in the third trimester may lead to adverse maternal and neonatal outcomes. The clinical characteristics, microbiological characteristics, and adverse pregnancy outcomes of mixed vaginitis in late pregnancy are worth studying. Therefore, this study investigated the clinical and microbiological characteristics of vaginitis and adverse pregnancy outcomes of patients with mixed vaginitis. We studied 1,674 women in late pregnancy who attended the Tianjin Medical University General Hospital from November, 2019 to October, 2021. We administered standardized questionnaires, performed vaginal examination and sampling plus microscope examinations, and assessed follow-up pregnancy outcomes. We cultured the vaginal discharge of the patients with mixed vaginitis to isolate pathogens and performed antimicrobial susceptibility tests of the isolated pathogens. For the patients with peripartum infection, we collected a sample to isolate pathogens. Among the 1,674 women, 66 (3.9%) had mixed vaginitis. The independent risk factor for mixed vaginitis in late pregnancy was a history of vaginitis during early and middle pregnancy (OR = 5.637, 95% CI: 3.314-9.580). The signs of vaginal erythema (63.6% vs. 42.0%), yellow discharge (81.8% vs. 59.6%), and malodor (31.8% vs. 18.8%) (P <0.05) were significantly higher in patients with mixed vaginitis than in patients with single vaginitis. Bacterial isolates of the vaginal secretions of patients with mixed bacterial vaginitis were mainly the pathogens of aerobic vaginitis and bacterial vaginosis, such as Gardnerella vaginalis, Streptococcus anginosus, and Staphylococcus epidermidis. Pathogen isolation of the vaginal secretions of patients with mixed fungus and bacteria vaginitis mainly included Candida albicans, followed by S. anginosus, Enterococcus faecalis, Staphylococcus hemolyticus, Staphylococcus aureus, Streptococcus agalactiae and Staphylococcus simulans. Women with mixed vaginitis had an increased incidence and risk of peripartum infections (6.1% vs. 1.4%, P <0.05; OR = 3.985, 95% CI:1.214-13.079). Escherichia coli is the main pathogen that causes peripartum infection. Mixed vaginitis in late pregnancy is characterized by a severe and complex phenotype, complex vaginal dysbiosis, and a long course of vaginal dysbiosis. This can lead to an increased incidence and risk of peripartum infection. Therefore, more attention should be paid to patients with mixed vaginitis in the third trimester of pregnancy.
摘要：
混合性阴道炎是一种复杂的阴道生态失调，不同于单一阴道炎。妊娠晚期阴道炎可能导致不良的母婴结局。临床特点,微生物学特征，妊娠晚期混合性阴道炎的不良妊娠结局值得研究。因此,本研究调查了混合性阴道炎患者的临床和微生物学特征以及不良妊娠结局。我们研究了11月在天津医科大学总医院就诊的1,674名妊娠晚期妇女，2019年10月,2021年。我们管理标准化问卷，进行了阴道检查和取样以及显微镜检查，并评估随访妊娠结局。我们对混合性阴道炎患者的阴道分泌物进行培养以分离病原体，并对分离的病原体进行抗菌药敏试验。对于患有围产期感染的患者，我们收集了样本以分离病原体。在1674名妇女中，66例(3.9%)患有混合性阴道炎。妊娠晚期混合性阴道炎的独立危险因素是孕早期和中期有阴道炎史(OR=5.637,95%CI:3.314~9.580)。阴道红斑的体征(63.6%vs.42.0%），黄色放电(81.8%vs.59.6%），和恶臭（31.8%与18.8%)(P<0.05),混合性阴道炎患者明显高于单发阴道炎患者。混合性细菌性阴道炎患者阴道分泌物的病原菌主要为需氧性阴道炎和细菌性阴道炎,比如阴道加德纳菌，硬化链球菌,和表皮葡萄球菌.真菌和细菌混合阴道炎患者阴道分泌物的病原菌分离主要包括白色念珠菌,其次是安吉诺斯，粪肠球菌,溶血葡萄球菌,金黄色葡萄球菌,无乳链球菌和模拟葡萄球菌。患有混合性阴道炎的妇女围产期感染的发生率和风险增加（6.1％vs.1.4%,P<0.05;OR=3.985,95%CI:1.214-13.079)。大肠杆菌是引起围产期感染的主要病原体。妊娠晚期混合性阴道炎的特征是严重和复杂的表型，复杂的阴道菌群失调，和长期的阴道生态失调。这可能导致围产期感染的发生率和风险增加。因此,混合性阴道炎患者在妊娠晚期更应重视。
