产程中羊水胎粪污染行羊水置换预防新生儿窒息的意义

羊水胎粪污染与胎儿窘迫及新生儿窒息有关,可引起新生儿胎粪吸入综合征（MAS）,影响围产儿预后。我们对产程中羊水Ⅱ度以上胎粪污染者行羊水置换,观察其对围产儿预后及剖宫产率的影响。现报道如下。1资料与方法1．1临床资料产程中前羊水Ⅱ度以上污染共60例,随机分为观察组和对照组,每组30例。观察组平均孕41周,初产妇26例,经产妇4例,羊水过少18例,羊水量正常12例。宫口开大3cm,行人工破膜19例,宫口开大4～scm自然破膜11例。羊水Ⅲ度污染21例,Ⅱ度污染9例。胎心监护有变异减速波（VD）及延年减速波（PD）14例,VD波有晚期减…     

羊水粪染的羊水置换与新生儿预后

目的 对Ⅱ度以上羊水粪染的孕妇行羊水置换,旨在改善新生儿预后。方法 ３２例采用自行设计的三通管装置和置换液行羊水置换,作研究组,另３０例作对照组,进行对比分析。结果 新生儿窒息率、胎粪吸入综合征发生率、脐血及股动脉血血气分析,研究组与对照组对比有显著性差异（Ｐ〈０．０１）。产褥病率两组无明显差异（Ｐ〉０．０５）。两组各自脐静脉和股动脉血血气分析对比无显著性差异（Ｐ〉０．０５）。结论 羊水染行羊水和     

羊膜腔输液治疗在产时应用的临床分析

目的 :分析羊膜腔输液 (amnioinfusion,AI)治疗产时羊水过少、胎膜早破和胎粪性羊水的临床意义。方法 :选择产程中发生胎心异常合并羊水过少、胎膜早破和羊水胎粪污染的孕产妇 1 0 1例 ,随机分为治疗组 51例 ,对照组 50例。治疗组在胎心监护下行羊膜腔输液或羊水置换 ;对照组给予吸氧 ,改变体位 ,静滴 5% Na HCO3等治疗。结果 :治疗组经羊膜腔输液 50 0～ 1 0 0 0 ml,胎心可变减速 (variable deceleration,VD)和长时减速 (period long deceleration,PL D)消失或明显改善 44例 ,有效率占 86 .3% ,明显高于对照组 (2 2 % ) ,两组比较差异有显著性 (P<0 .0 1 )。治疗组 1 9例胎粪性羊水行羊水置换 ,有 1 7例羊水转为清亮或 度混浊。治疗组产程时间比对照组缩短 ,治疗组和对照组剖宫产率分别为 1 3.7%和 34.0 % ,新生儿窒息率分别为 3.9%和 42 .0 % ;对照组胎粪吸入性肺炎 9例 ,新生儿死亡 3例 ,治疗组仅一例发生胎粪吸入性肺炎 ,无新生儿死亡。产褥病率两组比较 ,差异无显著性 (P>0 .0 5)。结论 :羊膜腔输液是治疗产时羊水过少、胎膜早破、胎粪性羊水的有效方法     

羊膜腔输注药物治疗羊水过少并发胎儿窘迫的临床效果观察

目的探讨羊膜腔输液、羊水置换及羊膜腔输注碱性药物治疗胎儿窘迫酸中毒的临床效果。方法对40例羊水过少、产程中胎心监护出现胎心律异常波形、Ⅱ度以上羊水胎粪污染产妇,在持续内监护下行羊膜腔输液、羊水置换治疗,其中20例分娩前行羊膜腔输入5%NaHCO3150ml(研究组),20例分娩前行静脉注射5%NaHCO3150ml(对照组),分娩后立即抽取两组新生儿脐动脉血行血气分析,并对两组新生儿行Apgar评分比较。结果(1)羊膜腔输液治疗:两组40例产妇中胎心律异常波形消失27例(27/40,68%),胎心律异常波形明显减少8例(8/40,20%),治疗有效率为88%(35/40);无变化或加重5例(5/40,13%)。(2)羊水置换治疗:两组40例产妇平均每例羊水置换Ⅱ~Ⅲ度胎类污染羊水900ml,最少700ml,最多1200ml。经羊水置换后抽出羊水清亮者21例(21/40,53%),羊水Ⅰ度污染者13例(13/40,33%),有效率为85%(34/40);仍有羊水Ⅱ度污染6例(6/40,15%)。(3)研究组脐动脉血二氧化碳分压(PCO2)、氧分压(PO2)、碳酸氢盐(HCO3-)、剩余碱(ABE)、标准碱(SBE)等指标明显好于对照组,两组比较,差异均有统计学意义(P<0·05,P<0·01)。(4)研究组新生儿出生后1分钟Apgar评分平均为(9·2±1·1)分,对照组平均为(8·7±1·7)分,两组比较,差异有统计学意义(P<0·05)。结论羊膜腔输液及羊水置换是治疗因胎儿窘迫及预防新生儿胎粪吸入综合征的有效方法,羊膜腔输注碱性药物能有效纠正胎儿酸中毒。     

羊水胎粪污染的产科处理方法探讨

目的 探讨羊水胎粪污染的产科处理时机与方法。方法 对1998年1月至1998年12月在我院分娩的、产程中羊水为Ⅱ～Ⅲ度污染的220例初产妇的母婴结局进行回顾性分析,其中破膜时羊水粪染(Ⅰ组)有120例,产程中羊水由清亮变为污染(Ⅱ组)有100例;另随机选择同期产程中羊水清亮的210例产妇为对照组。结果 1254例产妇中,羊水胎粪污染的发生率为17.5％;粪染组在母体合并症、胎心监护异常发生率、剖宫产率及新生儿窒息率上均高于对照组(P<0.01);Ⅱ组在胎心监护异常及新生儿窒息的发生率上高于羊水粪染Ⅰ组(P<0.01)。结论 重视羊水粪染的临床处理。在伴发母体合并症、胎心监护异常及产程中羊水由清亮变为粪染时处理需积极,以及早剖宫产及缩短第二产程为宜。在无上述情况下,可在严密监护下阴道分娩。     

远程胎监对羊水过少孕妇监测的临床应用

目的研究羊水过少孕妇行远程胎儿监护、住院监护及自数胎动的监测效果.方法根据监护系统不同,将269例羊水过少孕妇分为远程监护组(A组)、住院监护组(B组)和自数胎动组(C组),分别比较3组无应激试验(NST)结果,比较剖宫产率、围生儿结局(胎儿窘迫、羊水Ⅲ度污染、新生儿窒息率)的资料.结果C组NST反应型、无反应型发生率显著高于A、B两组(P＜0.05),A、B两组的差异无显著性(P＞0.05).C组胎儿窘迫、羊水Ⅲ度污染率、新生儿窒息率显著高于A、B两组(P＜0.05).A组剖宫产率(51.0%)显著低于B组(55.1%)和C组(65.3%)(P＜0.05).结论远程胎儿监护与住院监护同样有效,能减少过早干预,为羊水过少孕妇家庭自我监护提供了一条可行途径.     

Ⅲ度羊水胎粪污染新生儿74例脑组织氧饱和度研究

目的探讨Ⅲ度羊水胎粪污染与新生儿脑组织氧饱和度的关系及影响新生儿脑组织氧饱和度的围生因素。方法将2004年1月至2005年3月在暨南大学第二临床学院妇产科分娩的Ⅲ度羊水胎粪污染的足月新生儿,根据胎粪吸入综合征(MAS)诊断标准分为MAS组和无MAS组,羊水清的足月新生儿为对照组,在新生儿出生后2～8h,第2、3、5、7天测量脑组织氧饱和度。结果MAS组新生儿出生后2～8h,第2、3、5、7天脑组织氧饱和度与无MAS组、对照组比较明显降低,差异有极显著性意义(P<0.01),无MAS组新生儿在第2、3天脑组织氧饱和度与对照组比较明显降低,差异有极显著性意义(P<0.01)。顺产组新生儿出生后2～8h脑组织氧饱和度比剖宫产组低,差异有极显著性意义(P<0.01),在第2、3、5、7天比较差异则无显著性意义(P>0.05)。新生儿出生后脑组织氧饱和度持续异常的围生因素有:绒毛膜羊膜炎合并Ⅲ度羊水胎粪污染及Ⅲ度羊水胎粪污染伴随新生儿窒息。结论MAS组新生儿脑组织氧饱和度受到影响并发生脑损伤。Ⅲ度羊水胎粪污染应立即结束分娩。绒毛膜羊膜炎出现Ⅲ度羊水胎粪污染及Ⅲ度羊水胎粪污染伴随新生儿窒息可导致严重的围生期脑损伤。     

足月妊娠分娩期羊水粪染220例临床分析

羊水胎粪污染在产科较为常见 ,为探讨其产科处理及降低对新生儿的不良影响 ,现对我院产程中出现羊水粪染的2 2 0例足月妊娠病例进行回顾性分析。1　临床资料1.1　研究对象　 2 0 0 1年 3月至 2 0 0 1年 9月在我院分娩产妇12 5 4例 ,产程中发现羊水Ⅱ～Ⅲ度粪染的初产妇 2 2 0例为研究组 ,产程中羊水清亮的 2 10例初产妇作为对照组。两组产妇年龄 ,孕周 ,实验室检查无明显差异。1.2　处理　在人工破膜或自然破膜时发现羊水Ⅱ～Ⅲ度粪染者 ,在第一产程时给予吸氧、电子胎心监护 ,严密观察产程进展。估计短期内不能经阴分娩、胎儿监护异常及产…     

羊水胎粪污染与胎粪吸入综合征

1　胎粪污染羊水国外报道 ,所有的出生新生儿中 ,羊水的胎粪污染率为5 %～ 15 % ,其中 5 %发生胎粪吸入性肺炎 ,后者中 30 %需要机械通气 ,死亡率 5 %～ 10 % [1] ,国内报道羊水污染率达19 12 % [2 ] 。许多临床医生将羊水胎粪污染认为是胎儿窘迫的标志 ,但很多人则持有异议。国外 (1994年 )有报道[3 ] ,对比 8136例胎粪污染与 345 73例无胎粪污染的预后发现 ,前者围生期死亡率较后者增加 4倍 ,脐动脉血 pH <7 0 0者增加 2 5倍 ,剖宫产率从 7%增加到 14 %。故对该问题的临床意义需要正确认识 ,以便正确处理。1 1　宫内胎粪排出机制有两种…     

前羊水胎粪污染与新生儿窒息

本文通过950例前羊水性状的临床观察,表明前羊水Ⅱ°或Ⅲ°污染时,其新生儿Apgar 评分≤7分者(分别为13.3%及26.2%)较无污染组(3.1%)明显增高(P<0.005),胎心图异常及脐带异常发生率亦明显增高;羊水污染越重,新生儿重度窒息发生率越高.本文认为前羊水胎粪污染是胎儿宫内缺氧的表现,其严重程度与新生儿Apgar 评分密切相关.新生儿预后取决于胎儿代偿能力、产程长短及临床处理.     

Myoglobin in third trimester amniotic fluid of human pregnancy--a potential indicator of fetal hypoxia

195 amniotic fluid samples from the third trimester were examined for their content of myoglobin by means of radio-immunoassay. 151 of the samples were obtained intrapartum, the rest (44) was taken antepartum by transabdominal amniocentesis within one week prior to delivery. Depending on the myoglobin levels measured, different amniotic fluid groups were defined: (A) amniotic fluids containing no myoglobin or traces of it (less than 3 ng/ml), (B) amniotic fluids with moderately elevated myoglobin levels (3-10 ng/ml), (C) amniotic fluids with high myoglobin levels (greater than 10 ng/ml). Myoglobin levels above 3 ng/ml could be measured in 98 of the 151 samples taken intrapartum. In the amniotic fluids drawn antepartum the proportion of "myoglobin-positive" samples (greater than 3 ng/ml) amounted to only 22.7% (10 out of 44 samples). In pregnancies with amniotic fluids showing high myoglobin levels intrapartum, the prevalence of meconium staining of the samples, pathological cardiotocograms intrapartum and metabolic acidoses in umbilical artery blood samples was significantly higher than in pregnancies with myoglobin-negative amniotic fluids. The frequency of cesarean sections for fetal distress rose with increasing myoglobin levels in amniotic fluid, being 5.7, 13, and 18.2% in Group A, B and C respectively. In the pregnancies in which the amniotic fluid samples were taken antepartum, the prevalence of meconium-stained amniotic fluid increased with elevating amniotic fluid myoglobin (p less than 0.05, Group A vs. Group C). The frequency of cesarean sections for fetal distress and of neonatal depression immediately after delivery was considerably heightened in the cases with myoglobin-positive amniotic fluids antepartum compared to those with myoglobin-negative liquor.(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of Intrapartum Transcervical Amnioinfusion in Patients with Meconium-Stained Amniotic Fluid

Objectives

The study was undertaken to evaluate maternal, perinatal outcomes following transcervical intrapartum amnioinfusion in women with meconium-stained amniotic fluid.

Methods

A prospective comparative study was conducted on 100 women with meconium-stained amniotic fluid in labor. Group A: study group (50 cases) received amnioinfusion. Group B: control group (50 cases) did not receive amnioinfusion. FHR monitoring was done using cardiotocography.

Results

Significant relief from variable decelerations was seen in 68.18 % cases in the amnioinfusion group as compared to 7.1 % cases in the control group. 78 % cases who were given amnioinfusion had vaginal delivery as compared to 18 % cases in the control group. Fourteen percent cases in the study group had cesarean delivery as compared to 68 % cases in the control group. Meconium aspiration syndrome was seen in six percent neonates in the study group as compared to 20 % in the control group. Two neonates died in the control group due to meconium aspiration syndrome. There was no maternal mortality or major maternal complication.

Conclusions

Intrapartum transcervical amnioinfusion is valuable in patients with meconium-stained amniotic fluid.     

Meconium-stained amniotic fluid across gestation and neonatal acid-base status

OBJECTIVE: To estimate whether the acid-base status of neonates born to women with meconium-stained amniotic fluid varies across gestation. METHODS: We carried out a retrospective cohort study of all pregnancies that were complicated by meconium-stained amniotic fluid in 2004. Cases were identified from a perinatal pathology database that contained data on all pregnancies complicated by meconium-stained amniotic fluid. Data abstracted from the charts included gestational age at delivery, umbilical arterial pH, birth weight, and the presence or absence of labor. Cases were stratified according to gestational age at delivery. The distribution of meconium-stained amniotic fluid across gestation was computed. The mean umbilical arterial pH values (with 95% confidence intervals) across gestation were assessed by analysis of variance. RESULTS: The mean umbilical arterial pH in women with meconium-stained amniotic fluid did not differ across gestation. The overall incidence of meconium-stained amniotic fluid was 12.0% (766 of 6,403 deliveries). The rates of meconium-stained amniotic fluid increased from 1.2% at 32 weeks to 100% at 42 weeks. CONCLUSION: The rising incidence of meconium-stained amniotic fluid with gestational age is consistent with the hypothesis that fetal maturation is a major etiologic factor in meconium passage. Also, the lack of variation of mean umbilical arterial pH across gestation suggests that fetal acidemia is not increased when meconium passage occurs earlier in pregnancy rather than at later gestational ages.     

Efficacy of bulb versus DeLee suction at deliveries complicated by meconium stained amniotic fluid

A combined obstetric-pediatric approach to the management of deliveries complicated by meconium-stained amniotic fluid has been recommended to decrease the incidence of meconium aspiration syndrome. Although pharyngeal suction with a DeLee catheter is generally recommended, many obstetricians prefer to use a bulb syringe for suction at the perineum. A thorough review of the literature reveals no prospective studies in humans comparing the two techniques. In the present study, these two techniques of pharyngeal suction were prospectively compared at deliveries complicated by meconium-stained amniotic fluid. Of the total 2874 deliveries, 127 (4%) were complicated by moderate or thickly meconium-stained amniotic fluid, and 107 of these were included in the study. There were 53 infants in the DeLee-suctioned group and 54 in the bulb-suctioned group. Of the 107 studied infants, four (4%) developed meconium aspiration syndrome, three in the DeLee group and one in the bulb group. There was no significant difference in the amount of meconium found below the vocal cords, comparing pharyngeal DeLee suction to bulb suction (0.22 cc versus 0.24 cc; p = NS). In conclusion, the data fail to support a significant difference in efficacy between bulb and DeLee suction in clearing the naso- and oropharynx of the neonate of meconium in cephalic-presenting vaginal or cesarean delivery.     

Maternal age and primary cesarean section rates: a multivariate analysis

To study the effect of maternal age on primary cesarean section rates, 3458 consecutive deliveries were analyzed. The cesarean section rates in primiparous women less than 25, 25 to 34, and over 34 years of age were 13.1%, 18.5%, and 28.2%, respectively. A similarly dramatic rise with advancing maternal age was seen in multiparous women with rates of 3.4%, 4.7%, and 10.1%, respectively, in the three age groups. The strong association between cesarean section and maternal age persisted after multivariate adjustment for induction of labor, epidural anesthesia, meconium-stained amniotic fluid, and fetal distress, and thus these factors do not explain the relationship.     

Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity

The purpose of this study was to determine whether meconium-stained amniotic fluid is a marker for microbial invasion of the amniotic cavity. Amniocentesis was performed on 707 patients presenting with preterm labor and intact membranes. Meconium-stained amniotic fluid was present in 4.2% (30/707) of patients with preterm labor. The prevalence of positive amniotic fluid cultures was significantly higher in women with meconium-stained amniotic fluid than in women with clear fluid (33% [10/30] vs 11% [75/677]; p = 0.001; odds ratio = 4.01; 95% confidence interval = 1.6 to 9.4). Patients with meconium-stained amniotic fluid were also more likely to have failed tocolysis and delivered a preterm neonate more frequently than patients with clear fluid (83% [25/30] vs 38% (258/677); p = 0.0001; odds ratio = 8.1; 95% confidence interval = 2.9 to 24.4). We conclude that meconium-stained amniotic fluid is a risk factor for microbial invasion of the amniotic cavity and preterm delivery in women with preterm labor and intact membranes.     

Relationship between meconium staining and amniotic fluid volume in term pregnancies

OBJECTIVE: Our purpose was to evaluate the relationship between meconium-stained amniotic fluid (MEC-AF) and amniotic fluid volume (AFV) and their impact on the risk of cesarean delivery for fetal indications in term pregnancies. METHODS: 1,655 live-born singleton gestations delivering at > or = 37 weeks within 7 days of sonographic assessment of the amniotic fluid index (AFI) were studied. AFI was categorized as: oligohydramnios (< or = 5.0 cm); decreased (5.1-8.0 cm); normal (8.1-18.0 cm); increased (18.1-23.9 cm), and polyhydramnios (> or = 24.0 cm). Frequencies of MEC-AF for each AFV category were stratified by gestational age (GA) and rates of cesarean delivery for fetal indications compared between patients with clear amniotic fluid and those with MEC-AF. Stepwise logistic regression analyses were performed for determinants of MEC-AF and the need for cesarean delivery for fetal indications. RESULTS: The frequency of MEC-AF at birth in term pregnancies was not related to AFV: oligohydramnios (16.7%); decreased (16.7%); normal (20.1%); increased (24.4%), and polyhydramnios (22.1%). The only factor associated with the occurrence of MEC-AF was increasing GA at delivery (p < 0.01). Both MEC-AF (p < 0.02) and decreasing neonatal ponderal index (p < 0.02) were independently associated with cesarean delivery for fetal distress. CONCLUSIONS: MEC-AF does not appear to be related to AFV in term pregnancies, and its presence increases the risk of cesarean delivery for fetal distress independent of AFV and neonatal ponderal index.     

Intrapartum amnioinfusion for meconium-stained amniotic fluid: a systematic review of randomised controlled trials

BACKGROUND: Amnioinfusion (AI) is thought to dilute meconium when present in the amniotic fluid and so reduces the risk of meconium aspiration. OBJECTIVES: To evaluate if AI reduces meconium aspiration syndrome (MAS) and other indicators of morbidity in babies born to women with meconium-stained amniotic fluid (MSAF). SEARCH STRATEGY: PubMed, Medline, EMBASE, and the Cochrane Controlled Trials Register from January 1980 to May 30, 2005, using the keywords 'amnioinfusion' and 'meconium'. SELECTION CRITERIA: Randomised trials comparing AI with no AI for women in labour with MSAF. Trial quality was evaluated using pre-established criteria. DATA COLLECTION AND ANALYSIS: The following morbidity indicators were assessed: MAS, 5-minute Apgar score < 7, arterial cord pH < 7.2, and caesarean section. Studies were stratified according to the level of peripartum surveillance (standard versus limited). Typical relative risks (RRs) with their 95% confidence intervals were calculated for each outcome using a random effects model. MAIN RESULTS: In clinical settings with standard peripartum surveillance, we found no evidence that AI reduced the risk of MAS (RR 0.59, 95% CI 0.28-1.25), 5-minute Apgar score < 7 (RR 0.90, 95% CI 0.58-1.41), or caesarean delivery (RR 0.89, 95% CI 0.73-1.10). In clinical settings with limited peripartum surveillance, AI appeared to reduce the risk of MAS (RR 0.25, 95% CI 0.13-0.47). CONCLUSION: In clinical settings with standard peripartum surveillance, the evidence does not support the use of AI for MSAF. In settings with limited peripartum surveillance, where complications of MSAF are common, AI appears to reduce the risk of MAS. However, this finding requires confirmation by further studies.     

Predicting concordance of biochemical lung maturity in the preterm twin gestation

Objective: To determine the occurrence of maternal and fetal complications in low-risk pregnancies beyond 39 weeks and to re-evaluate the acceptable cut-off (42 weeks) for induction of labor. Study design: A total of 36 160 low-risk pregnancies with reliable dating of gestational age (last menstrual period and early ultrasound examination) were evaluated retrospectively for fetal and maternal complications, including non-progressive labor, cervical tear, retained placenta, postpartum hemorrhage, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid, non-reassuring fetal heart rate monitoring and ante-, intra- and postpartum death. Pregnancy outcomes at different gestational ages were compared using univariate and multivariate analysis and receiver operator curves. Results: The rates of non-progressive labor stage I and II, retained placenta, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid and non-reassuring fetal heart rate monitoring were found to be significantly higher with increasing gestational age in the univariate analysis. These parameters were evaluated using multivariate analysis and the following were found to be significantly higher: non-progressive labor stage I and II, macrosomia, meconium-stained amniotic fluid and Cesarean section. Statistical analysis (receiver operator curves) showed that the most significant rise in the risk for non-progressive labor occurred after 42 completed weeks of gestation, and after 41 completed weeks for macrosomia, meconium-stained amniotic fluid and Cesarean section. Conclusions: The rates of non-progressive labor stage I and II, meconium-stained amniotic fluid, macrosomia and Cesarean section were significantly higher with increasing gestational age. In order to decrease the rate of macrosomia, meconium-stained amniotic fluid and Cesarean section, we suggest that induction of labor should be considered before 42 weeks.