임신중 Chlamydia trachomatis 감염에 관한 임상적 연구

Abstract

본 연구는 임신중 Chlamydia trachomatis 감염이 임산부 및 신생아에 미치는 영향을 분석, 관찰하고 아울러 Chlamydia trachomatis감염으로 인한 이환율을 감소시키고자 하는 바이다. 즉 1984년 11월부터 1985년 3월까지 5개월간 이화여자대학교 의과대학 부속병원 산부인과에 입원하여 분만한 임산부 695예에 대하여 분만전 입원시 Chldmydia trachomatis 배양검사를 실시하여 Chlamydia trachomatis 배양양성인 64예를 연구군으로 하고, 이와 동수의 Chlamydia trachomatis 배양음성인 64예를 대조군으로하여 임산부 및 신생아에 미치는 영향을 비교 관찰한 바 다음과 같은 결과를 얻었다. 1. 임신중 Chlamydia trachomatis 감염율은 총임산부 695예중 64예로 9.2%였다. 2. Chlamydia trachomatis 감염군과 비감염군을 비교한 바 연령(평균 ; 27.4세 : 26.5세), 분만 회수(초산부 : 64.1% : 7070.3%), 임신주수(38-41주 ; 79.7% : 85.9%), 출생체중(평균 : 3290 gm : 3330gm), Apgar score(1분 : 8.0 : 8.1), 동반된 질 감염(trichomoniasis ; 3.1% : O, candidiasis : 9.4% : 6.3%) 및 매독(1.6% : O), 임산부의 혈액내 백혈구수(평균 ; l1364 : l1775) 또는 산후 감염성 이환율(4.7% ; 3.1%)은 두 군간에 차이가 없었다. 3. 2.5㎏미만의 저체중아의 빈도는 Chlamydia감염군에서 유의하게 증가하였고 (7.8%), 조기 양막파수의 빈도는 감염군에서 34.4%로 비감염군(18,8%)보다 유의하게 증가하였으며, 조기 진통 역시 감염군에서 6.3%로 유의한 차이를 나타냈다. 반복 제왕절개술시 복막 유착은 Chlamydia 감염군에서 83.3%로 비감염군의 16.7%보다 훨씬 유의하게 증가하였다.;This study was planned to evaluate the effect of Chlamydia trachomatis infection which has recently been recognized on the outcome of pregnancy and their neonates. Chlamydia trachomatis was isolated from the endocervix of 64 of 695 pregnant women admitted into Ewha Womans University Hospital for delivery during a period of 5 months from November, 1984 to March, 1985. The 64 pregnant women with Chlamydia culture positive and those of same number with Chlamydia culture negative selected by random sampling among 631 women with Chlamydia culture negative were participated in this study. Outcome of pregnancy between these two groups was compared and the results obtained were as follows; 1. The incidence of Chlamydla trachomatis infection of the cervix during pregnancy was found to be 64 (9.2%) of 695 pregnant women 2. In the clinical characteristics of both Chlamydia positive and negative group, there were no significant differences in age (mean; 27.4 year vs. 26.5 year), parity (64.1% vs. 70.3% in nullipara), gestational age (79.7% vs. 85.9% at 38 to 41 weeks), birth weight (mean; 3290 gm vs. 3330 gm), Apgar score (mean; 8.0 vs. 8.1 in 1 minute), mixed infections of vaginal trichomaniasis (3.1 % vs. 0), candidiasis (9.4% vs. 6.3%) and syphilis (1.6% vs. 0), maternal white blood cell count (mean; 11364 vs. 11775/mm³) or puerperal infection morbidity (4.7% vs 3.1%). 3. The incidence of low birth weight (2.5 kg) was significantly higher (7.8 %) in the Chlamydia positive group compared with that of Chlamydia negative group. The incidence of premature rupture of membrane was signficantly higher (34.4%) in the Chlamydia positive group than that in the Chlamydia negative group (18.8 %). The incidence of premature labor in the Chlamydia positive group was also higher (6.3%) compared with that matched control group. The incidence of intraperitoneal adhesion at the occasion of repeat cesarean section was found to be highly significant (83.3%) in the Chlamydia positive group compared with that of the Chlamydia negative group (16.7%).