孕期阴道炎：准妈妈不可忽视的健康威胁

目前，B族链球菌感染是全球新生儿死亡的首要原因。妊娠期B族链球菌定植可引起绒毛膜羊膜炎，胎膜早破和产后子宫内膜炎，从而增加早产、胎膜破裂和死产的发生率，还可能导致新生儿脓毒症和脑膜炎^{(2, 3)}。

大肠杆菌感染与流产、胎膜早破、早产、死产和其他不良妊娠结局有关。此外，在小鼠研究中发现，妊娠小鼠阴道中的大肠杆菌会上行到子宫腔并诱导早产⁽⁴⁾。

金黄色葡萄球菌感染可导致胎膜早破和新生儿败血症，最终导致绒毛膜羊膜炎和新生儿死亡⁽⁵⁾。金黄色葡萄球菌感染占新生儿迟发性脓毒症的90%以上。极低出生体重儿迟发性金黄色葡萄球菌脓毒症的发生率是正常婴儿的4倍⁽⁶⁾。此外，金黄色葡萄球菌可穿透绒毛膜但未穿过羊膜。金黄色葡萄球菌可在绒毛膜蜕膜表面生长并形成生物膜，显著提高白介素1β、白介素2、白介素6、粒细胞巨噬细胞刺激因子、干扰素γ和肿瘤坏死因子α水平⁽⁷⁾。

在怀孕35至37周从婴儿的耳朵、咽部、胃内容物和第一次胎粪以及直肠阴道拭子中收集标本，发现婴儿粪肠球菌定植与早产有关⁽⁸⁾。此外，在新生儿中，粪肠球菌与早发性败血症的死亡率相关为6%，在迟发性败血症中这一比例增至15% ⁽⁹⁾。

克林霉素是一种广谱抗生素，可覆盖革兰氏阳性菌和厌氧菌感染，并可降低感染相关早产的发生率。克林霉素作为B类药物，是用于妊娠女性需氧性阴道炎感染的常用抗生素⁽¹²⁾。

碳青霉烯类和β-内酰胺类-β-内酰胺酶抑制剂结合是最有效的抗生素，是应用于妊娠期需氧性阴道炎患者的B类药物⁽¹³⁾。

阴道菌群异常的女性还可以口服或阴道使用益生菌，以改善阴道菌群状况⁽¹⁴⁾。

总的来说，在孕期感染阴道炎后，孕妈妈应该遵循医嘱要求及时治疗，结合阴道炎类型合理用药，确保母婴安全。

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