2023-09-15
胎儿的健康 从留意私密处分泌物做起 / Fetal Health Begins with Intimate Discharge Checking
霉菌性阴道炎是相当常见的妇科疾病,特别是在气候炎热潮湿的台湾,大约75%的女性一生至少会遭受一次感染….林小姐在多年的西医治疗及中医调养下,好不容易怀孕了,每次产检都十分雀跃地看着超音波上宝宝的状况,眼神中充满了即将为人母的喜悦,但今天却神色慌张地进了诊间:「医生,我最近内裤上都会出现灰白色的分泌物,味道也很奇怪,我上网查了数据,好像是细菌性的阴道炎,而且网站上还说宝宝会夭折?!怎么办啊医生?」生命的孕育神奇且复杂,在这个过程中,为了打造出适合胎儿成长的的环境,妈妈们的身体经由荷尔蒙的调节,产生剧烈的变化。雌激素与黄体素的大量分泌稳定子宫内膜,协助受精卵着床成功,让胎儿顺利发育,同时也使得怀孕妈妈们的私密处分泌物量比以往更多、也较浓稠,但通常是无味且呈蛋白色的,这都是正常的,可是若分泌物产生鱼腥味、呈豆腐渣状,颜色变为灰白色或黄绿色时,就表示阴道正受到感染,必须尽早接受治疗,以保护胎儿的健康,其中以霉菌性及细菌性的感染为大宗。霉菌性阴道炎是相当常见的妇科疾病,特别是在气候炎热潮湿的台湾,大约75%的女性一生至少会遭受一次感染,2015年Current Infectious Disease Reports指出怀孕后的女性更容易受到念珠菌感染引发霉菌性阴道炎。女性的阴道防护力来自于乳酸菌将阴道上皮的『肝醣』分解成『乳酸』,藉由乳酸产生抑菌性来增加私密处的防护力,而阴道上皮的肝醣含量主要则和女性体内雌性激素的含量成正比,但女性怀孕之后,特别是到怀孕的中期,雌性激素的分泌量会下降,使阴道内上皮细胞的肝醣减少,导致阴道的健康更容易受到其他病原体的侵害,又怀孕中期黄体素的增加会减少免疫细胞的抗菌力,抑菌力不足免疫力又下降的情况,霉菌更容易大肆孳生,造成感染。虽然霉菌型的感染不太会影响到胎儿的健康,但仍有千分之三的机率可能会造成羊膜腔发炎,增加早产的机率,甚至威胁到早产儿的性命,所以当出现阴部感到搔痒、分泌物呈豆腐渣、奶酪状等症状,仍不能大意,必须积极治疗。
细菌性阴道炎是另一种常见的感染症状。阴道内本来就寄居了许多的菌丛,大多数为乳酸杆菌,能够维持阴道环境的弱酸性,抵抗坏菌增殖,只是酸碱平衡一旦被破坏,坏菌便会大举入侵,导致感染。虽然目前并没有证据指出怀孕会增加细菌性感染的机率,但据美国孕产协会(American Pregnancy Association)在2015年的统计,约10~30%的怀孕女性会感染细菌性阴道炎。为了让胚胎不被母体排斥,免疫功能会进行调整,使免疫力下降,再加上生理结构的改变,膨胀的子宫压迫到输尿管,让尿液排放不顺,滞留在输尿管中,促使泌尿道成为细菌孳生的温床,导致泌尿道感染,又女性的阴道及尿道相距不远,若卫生没有做好,很容易因为互相感染,使病情更加复杂。许多研究都指出细菌性阴道炎会增加早产的发生,2000年新英格兰医学期刊(NEJM)发表的文章中提到,孕妇若罹患细菌性阴道炎,也有机会使羊膜及绒毛膜受到感染,入侵后的细菌可能会分泌一些有毒物质,促使前列腺素的制造及释放,进而导致子宫收缩增加早产的机率。文章中也提及全球约有10%的新生儿为早产儿,在医疗进步下,虽然拯救了不少新生儿的生命,但仍有1~2%会死于并发症,特别是出生小于32周,体重小于1500克的新生儿,存活下来的早产儿也常面临学习障碍、听力障碍等终生残疾。怀孕的过程中因为免疫功能下降、荷尔蒙的波动以及生理结构的改变,都容易造成私密处感染问题,进而影响胎儿的健康,妇产科 张宇琪 医师建议,为了降低感染风险,就要从培养良好生活习惯做起维持稳定生活作息少熬夜,当有压力时也要适时放松舒缓少吃甜食、油炸等高热量食物,避免阴道的糖分上升,促使霉菌滋生衣着务必保持宽松通风,若因分泌物过多需要使用护垫,每2~3小时就该更换,避免不透气增加感染机率多喝水少憋尿,防止泌尿道感染使阴道健康受影响清洁要做好,可以选用私密处专用且酸碱值3.5左右贴近私密处的沐浴乳,避免破坏酸碱平衡,提升私密处天然保护力随时留意分泌物的状况,一有问题马上治疗孕育新生命是件令人兴奋且美好的事物,同时也相当脆弱,准妈妈们唯有细心呵护自己的健康,才能让即将诞生的宝宝头好壮壮,创造幸福美满的家庭。 Fungal Vaginitis(Yeast Infection) is a very common gynecological disease, especially in hot and humid climate.
The process of pregnancy is both miraculous and complex. During this time, the mother’s body undergoes dramatic changes regulated by hormones to create an environment suitable for the fetus’s growth. Large amounts of estrogen and progesterone are secreted to stabilize the endometrium, helping the fertilized egg successfully implant and allowing the fetus to develop properly. This also causes pregnant women to experience more and thicker vaginal discharge than usual, which is typically odorless and milky white. However, if the discharge starts to smell fishy, becomes curd-like, or turns grayish-white or yellow-green, it indicates a vaginal infection that needs immediate treatment to protect the fetus’s health, with fungal and bacterial infections being the most common.Fungal vaginitis is very common, especially in hot and humid climate. According to the 2015 Current Infectious Disease Reports, pregnant women are more susceptible to Candida infections, leading to fungal vaginitis.The protection of a woman’s vagina mainly comes from lactobacilli, which break down the glycogen in the vaginal epithelium into lactic acid, thereby enhancing the defense of the intimate area. The glycogen content in the vaginal epithelium is mainly proportional to the amount of estrogen in the body. However, after pregnancy, especially in the second trimester, the secretion of estrogen decreases, reducing the glycogen in the vaginal epithelial cells, making the vagina more susceptible to other pathogens. At the same time, the increase in progesterone during the second trimester reduces the antibacterial ability of immune cells. With insufficient antibacterial ability and lowered immunity, fungi can proliferate easily, leading to infection. Although fungal infections are unlikely to affect the fetus’s health, there is a small risk (three in a thousand) that it could cause inflammation of the amniotic cavity, increasing the chances of preterm birth and even threatening the life of a premature baby. Therefore, if symptoms such as itching in the genital area, curd-like, or cheesy discharge appear, it is important not to ignore them and to seek treatment actively.Bacterial vaginosis is another common infection. The vagina naturally harbors many bacteria, most of which are lactobacilli that maintain the slightly acidic environment of the vagina, preventing harmful bacteria from proliferating. However, once the acid-base balance is disrupted, harmful bacteria can invade, leading to infection. Although there is no evidence that pregnancy increases the risk of bacterial infections, the American Pregnancy Association reported in 2015 that about 10-30% of pregnant women develop bacterial vaginosis.To prevent the embryo from being rejected by the mother’s body, the immune system adjusts, lowering immunity. In addition, physiological changes, such as the expanding uterus compressing the ureters, make it difficult to expel urine, which can stagnate in the ureters, turning the urinary tract into a breeding ground for bacteria, leading to urinary tract infections. Because the vagina and urethra are close to each other, poor hygiene can easily cause cross-infection, making the situation more complicated.Many studies have pointed out that bacterial vaginosis increases the risk of preterm birth. An article published in the New England Journal of Medicine (NEJM) in 2000 mentioned that bacterial vaginosis in pregnant women could infect the amniotic and chorionic membranes. Bacteria that invade may secrete toxins, promoting the production and release of prostaglandins, which in turn causes uterine contractions, increasing the likelihood of preterm birth. The article also noted that about 10% of newborns worldwide are preterm. Although medical advances have saved many of these infants, 1-2% still die from complications, particularly those born before 32 weeks or weighing less than 1500 grams. Surviving preterm babies often face lifelong disabilities such as learning and hearing impairments.During pregnancy, the decline in immune function, hormonal fluctuations, and physiological changes make the intimate area more susceptible to infections, which can affect the fetus’s health. Gynecologist Dr. Zhang advises that to reduce the risk of infection, it is important to cultivate good lifestyle habits:
Maintain a stable routine, avoid staying up late, and relax when stressed.Avoid sweets, fried foods, and other high-calorie foods to prevent an increase in vaginal sugar levels, which promotes fungal growth.Wear loose and breathable clothing. If you need to use panty liners due to excessive discharge, change them every 2-3 hours to reduce the risk of infection from lack of ventilation.Drink plenty of water and avoid holding your urine to prevent urinary tract infections that could affect vaginal health.Practice good hygiene using intimate cleansers with a pH close to 3.5 to avoid disrupting the acid-base balance and to enhance the natural protection of the intimate area.Always monitor the condition of your discharge, and seek treatment immediately if problems arise.
Nurturing new life is an exciting and beautiful experience, but it is also very delicate. Only by carefully protecting your health can expectant mothers ensure that their babies are born healthy and strong, creating a happy and fulfilling family. 参考文献:T. J. Aguin , J. D. Sobel. Vulvovaginal candidiasis in pregnancy. Curr Infect Dis Rep. 2015 Jun;17(6):462. doi: 10.1007/s11908-015-0462-0.Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med. 2000 May 18;342(20):1500-7.美国孕产学会网站https://americanpregnancy.org/pregnancy-complications/bacterial-vaginosis-during-pregnancy/