PDF(Pubmed)
Abstract：
Background: To investigate the clinical value of cervical secretion culture in pregnant women with premature rupture of membranes (PROM) in predicting maternal and fetal outcomes. Methods: We retrospectively reviewed clinical records of pregnant women who underwent obstetric examination and delivered in Fujian Maternal and Child Healthcare from December 2013 to December 2016. Pregnant women with a clear diagnosis of PROM, who underwent cervical secretion culture immediately after hospital admission were selected for the study. The primary outcome was the occurrence of chorioamnionitis. The secondary outcome was neonatal admission to the neonatal intensive care unit (NICU). Correlation between maternal and fetal outcomes and the results of the cervical secretion culture was analyzed by one-way analysis and multifactorial analysis, respectively. The predictive efficacy of cervical secretion culture was evaluated using receiver operating characteristic curve (ROC), area under the curve (AUC) and the integrated discrimination improvement (IDI). Results: A total of 7,727 pregnant women with PROM were included in the study. Of them, 1812 had positive cervical secretion cultures (635 positive for mycoplasma infection, 475 for bacterial, 637 for fungal, and 65 for chlamydial infections). Pregnant women with positive mycoplasma and bacterial cultures had higher rates of developing chorioamnionitis compared to women with negative cervical secretion cultures (9%, 12% vs. 1%, respectively). Similarly, positive mycoplasma and bacterial cultures were associated with higher rate of the preterm (before 34 weeks) labor (3%, 3% vs. 1% in women with negative cultures, respectively), and neonatal admission to the NICU (9%, 11% vs. 7%, respectively). After adjusting for various confounding factors, our analysis demonstrated that a positive cervical secretion culture for mycoplasma or bacterial pathogens remained an independent risk factor for chorioamnionitis. Cervical secretion culture outcome was less effective in predicting chorioamnionitis (AUC 0.569) compared to white blood count (WBC) (AUC 0.626) and C-reactive protein (CRP) levels (AUC 0.605). The IDI of the combined predictive model incorporating WBC, CRP, maternal fever and cervical secretion culture results was 0.0029. Conclusion: Positive cervical secretion cultures, especially for mycoplasma and bacteria, are associated with higher incidence of adverse maternal and fetal outcomes. However, the predictive value of this test is poor, and cannot be efficiently used for predicting chorioamnionitis.
摘要：
背景:探讨宫颈分泌物培养在胎膜早破(PROM)孕妇中预测母婴结局的临床价值。方法:回顾性分析2013年12月至2016年12月在福建省妇幼保健院接受产科检查分娩的孕妇的临床资料。明确诊断为胎膜早破的孕妇,选择入院后立即接受宫颈分泌物培养的患者进行研究.主要结果是绒毛膜羊膜炎的发生。次要结局是新生儿入住新生儿重症监护病房（NICU）。采用单因素分析和多因素分析分析母胎结局与宫颈分泌物培养结果的相关性,分别。采用受试者工作特征曲线(ROC)评价宫颈分泌物培养的预测效果,曲线下面积(AUC)和综合辨别改善(IDI)。结果：共有7,727名患有PROM的孕妇被纳入研究。其中,1812例宫颈分泌物培养阳性（635例支原体感染阳性，475为细菌，637真菌，衣原体感染为65）。与宫颈分泌物培养阴性的孕妇相比，支原体和细菌培养阳性的孕妇发生绒毛膜羊膜炎的比率更高（9％，12%vs.1%,分别)。同样，支原体和细菌培养阳性与早产（34周前）分娩率较高相关（3％，3%vs.1%的负面文化女性，分别)，和新生儿入住NICU(9%，11%vs.7%,分别)。在调整了各种混杂因素后，我们的分析表明,宫颈分泌物支原体或细菌病原体培养阳性仍然是绒毛膜羊膜炎的独立危险因素.与白细胞计数（WBC）（AUC0.626）和C反应蛋白（CRP）水平（AUC0.605）相比，宫颈分泌物培养结果在预测绒毛膜羊膜炎（AUC0.569）方面效果较差。结合WBC的组合预测模型的IDI，CRP,产妇发热和宫颈分泌物培养结果为0.0029。结论:宫颈分泌物培养阳性,尤其是支原体和细菌，与不良母婴结局的发生率较高相关。然而,该测试的预测值较差，并且不能有效地用于预测绒毛膜羊膜炎。
