B超诊断羊水偏少孕妇阴道试产196例分析

目的分析足月妊娠妇女Ｂ超检查示羊水偏少时,阴道试产对围产期结局的影响。方法应用羊水指数（ＡＦＩ）法估测羊水量,并测定脐动脉收缩期最大血流速度（Ｓ）和舒张末期血流速度（Ｄ）的比值（Ｓ／Ｄ值）及２４小时尿雌三醇与肌酐的比值,比较分析１９６例Ｂ超诊断羊水偏少者（观察组）和２００例羊水量正常的足月妊娠妇女（对照组）阴道试产后的分娩结局。结果两组新生儿重度窒息发生率和新产儿死亡率差异无显著性（Ｐ＞０．０５）,观察组急诊剖宫产率明显升高（Ｐ＜０．０５）。结论Ｂ超诊断羊水偏少的足月妊娠妇女,在严密监护下可行阴道试产。     

Prostaglandin E2 induction of labor for isolated oligohydramnios in women with unfavorable cervix at term

OBJECTIVE: To evaluate the maternal and neonatal outcomes of pregnancies complicated with isolated oligohydramnios at term, managed by induction of labor. METHODS: We conducted a retrospective case-control study. 138 women with uncomplicated oligohydramnios at term [amniotic fluid index (AFI) < or =5 cm] and a low Bishop score (< or =6) underwent induction of labor with prostaglandin E2. These women were compared to 67 women who underwent induction of labor at 42 weeks' gestation and 276 women at low-risk pregnancy and spontaneous onset of labor, matched for parity and race. RESULTS: Cesarean section (CS) rate was similar in the study and the post-date group (17.4 and 17.9%, respectively), but significantly higher than the spontaneous labor group (5.8%, OR 3.42, 95% CI 1.75-6.68). No differences were found with other outcomes. CONCLUSION: Pregnancies with isolated oligohydramnios at term apparently are not at higher risk of perinatal complications, but induction of labor is associated with increased rate of CS.     

A case controlled study of serial transabdominal amnioinfusions in the management of second trimester oligohydramnios due to premature rupture of membranes

OBJECTIVE: The aim of this study was to evaluate the role of transabdominal amnioinfusion in relieving oligohydramnios and improving pregnancy outcome. STUDY DESIGN: Pregnant women with oligohydramnios amniotic fluid index (AFI<5) and premature rupture of membranes (PROM) from <27 weeks gestation were managed with serial transabdominal amnioinfusions. Under ultrasonic guidance, a 20-gauge needle was instilled in the uterine cavity and normal saline was infused until the AFI was normal. Repeat amnioinfusion was done weekly if oligohydramnios recurred. Amnioinfused cases were compared to cases with pPROM and oligohydramnios who had standard management. RESULTS: The mean gestational age at first procedure was 22 weeks. The mean pre-procedure AFI was 1.1cm and post-procedure was 12 cm. The mean number of infusions was 2.4. The mean first infusion to delivery interval was 33 days. The amnioinfused group when compared to the control group had decreased perinatal mortality of 33% versus 83% (P=0.036, OR=0.4, 95% CI=0.17-0.93), neonatal mortality of 17% versus 71% (P=0.049, OR=0.26, 95% CI=0.07-0.97) and neonatal sepsis 86% versus 27%(P=0.049, OR=0.32, 95% CI=0.12-0.87) with no statistical difference in gestational age at rupture and delivery nor birthweight. Babies discharged home compared to non-survivors had a significant increase in gestational age at delivery, birthweight, NICU days and transabdominal amnioinfusions. Logistic regression showed that only transabdominal amnioinfusion and gestational age correlated with survival. CONCLUSION: In selected cases of oligohydramnios with pPROM, transabdominal amnioinfusions may be associated with fluid retention and improved neonatal survival.     

Reevaluation of the relationship between amniotic fluid volume and perinatal outcome

OBJECTIVE: Ultrasound estimation of amniotic fluid volume (AFI) is a critical component of antenatal surveillance. Alterations in AFI have classically been considered an indication of fetal compromise, but recent studies have called this into question. The present study was undertaken to reevaluate the relationship between AFI and perinatal outcome. STUDY DESIGN: The perinatal data base of the authors' institution was queried for all patients in a 6-year period who had AFI evaluated. Two groups, 1 high-risk and 1 low-risk, were evaluated to determine the relationship between AFI and gestational age. An additional high-risk group that had AFI determined within 48 hours of delivery was also used to correlate AFI with intrapartum and perinatal outcomes. Statistical analysis was performed using linear regression analysis to evaluate the correlation between AFI and gestational age or birth weight. Additional correlations were done using analysis of variance, chi-square, Fisher exact test, or Student t test. Interaction between variables was analyses using logistic regression analysis. RESULTS: Fourteen thousand seven hundred forty-seven AFI determinations in 4337 high-risk patients, and 1153 AFI determinations in 1153 low-risk patients were evaluated. There were no clinically significant correlations between AFI and gestational age. In the second high-risk group of 454 patients there was a significant correlation between polyhydramnios and large-for-gestational age infants, congenital anomalies, and an increase in cesarean section for delivery. There was an increased risk of nonreassuring fetal heart rate patterns during labor for the oligohydramnios patient, but only in preterm patients. There was no strong relationship between AFI and neonatal complications or length of stay in the neonatal intensive care unit. Logistic regression confirmed that AFI was not significantly correlated with perinatal outcome. CONCLUSION: The present study suggests that AFI is a weaker predictor of perinatal outcome than has been classically suggested. Although the AFI identification of polyhydramnios was helpful in identifying LGA fetuses and fetuses at risk for congenital abnormalities, oligohydramnios was a rather weak predictor of poor perinatal outcome.     

Biophysical profile with amniotic fluid volume assessments

OBJECTIVE: To compare the amniotic fluid index (AFI) with the single deepest pocket technique along with the other components of the biophysical profile (BPP) in predicting an adverse pregnancy outcome. METHODS: Prospective, randomized trial of amniotic fluid assessment by AFI or single deepest pocket during a BPP. Cesarean delivery for fetal distress was the primary outcome evaluated. RESULTS: The AFI was used in 273 pregnancies and the single deepest pocket in 264. The AFI significantly increased the number of pregnancies labeled as oligohydramnios, 102 women (38%) compared with 46 women (17%; P <.001), odds ratio (OR) = 2.84, 95% confidence interval 1.90-4.25 in the single deepest pocket group. There was no difference in the number of women with oligohydramnios in the AFI group, 16 of 102 (16%), undergoing a cesarean delivery for fetal intolerance of labor compared with the single deepest pocket group, 6 of 46 (13%; P =.676). More women with normal fluid by the AFI method (AFI > 5), 20 of 170 (12%), underwent a cesarean delivery for fetal distress than the women with normal fluid by the single deepest pocket technique (2 cm x 1 cm pocket present) group, 12 of 218 (6%; P =.037, OR = 2.22, 95% confidence interval 1.05-4.70). CONCLUSION: The AFI offers no advantage in detecting adverse outcomes compared with the single deepest pocket when performed with the BPP. The AFI may cause more interventions by labeling twice as many at-risk pregnancies as having oligohydramnios than with the single deepest pocket technique.     

The association between isolated oligohydramnios at term and pregnancy outcome

Purpose

As conflicting data exist concerning the implications of isolated oligohydramnios on pregnancy outcome at term, we aimed to assess this association in low-risk pregnancies.

Methods

A retrospective cohort study of term pregnancies with sonographic finding of isolated oligohydramnios (amniotic fluid index (AFI) <5 cm) between 2007 and 2012. Outcome was compared to a control group of pregnancies with normal AFI (5–25 cm). Pregnancies complicated by thrombophilia, hypertension, diabetes, deviant fetal growth or chromosomal/structural abnormalities were excluded. Composite adverse outcome included CS/operative delivery due to non-reassuring heart rate (NRFHR), low Apgar score, umbilical artery pH < 7.10, neonatal intensive care admission, meconium aspiration syndrome, intubation or hypoxic-ischemic encephalopathy.

Results

Overall, 987 pregnancies complicated by isolated oligohydramnios were compared to 22,280 low-risk pregnancies with normal AFI. Isolated oligohydramnios was associated with a higher rate of induction of labor (27.7 vs. 3.7 %, p < 0.001), CS due to NRFHR (2.3 vs. 1.1 %, p < 0.01) and composite adverse outcome (9.7 vs. 7.1 %, p < 0.01). However, after adjusting for potential confounders as induction of labor and nulliparity using multivariable logistic regression analysis, isolated oligohydramnios was not found to be independently associated with increased risk for composite adverse outcome (OR 1.01, 95 % CI 0.80–1.27, p = 0.93).

Conclusion

Isolated oligohydramnios at term by itself is not associated with increased obstetrical morbidity.     

Oligohydramnios in uncomplicated pregnancies beyond 40 completed weeks. A prospective, randomised, pilot study on maternal and neonatal outcomes

OBJECTIVES: In low-risk pregnancies, the management of oligohydramnios is not clear. The aim of this study was to compare maternal and neonatal outcomes in cases of isolated oligohydramnios randomised to either induction of labour or expectant management. METHODS: 87 women pregnant beyond 40 completed weeks were asked to participate in the study. Fifty-four accepted and were randomised at 288 days of pregnancy. Twenty-six were randomised to expectant management and 28 to induction of labour. The primary maternal outcome was the mode of delivery and the primary neonatal outcomes were cord blood pH and Apgar score at delivery. RESULTS: No significant differences were found for any important maternal or neonatal outcome. CONCLUSION: Based on these results, the decisions about management could be individualised. Even though the number of patients included was small, these results are well in concordance with others.     

Serial assessment of amniotic fluid index in uncomplicated term pregnancies: prognostic value of amniotic fluid reduction.

OBJECTIVE: Assessment of amniotic fluid volume in association with a non-stress test is a commonly used method to monitor fetal well-being in high-risk pregnancies. The aims of our study were to determine whether oligohydramnios and the trend in amniotic fluid volume have prognostic significance in low-risk pregnancies between 40.0 and 41.6 weeks' gestation. METHODS: Between January 1997 and December 2000, all uncomplicated gestations with a singleton non-anomalous fetus reaching 40.0 weeks' gestation underwent semi-weekly monitoring of amniotic fluid index (AFI) until delivery. Oligohydramnios was defined as an AFI of < or = 5 cm. Changes in AFI were expressed as centimeters per day, and were calculated as: [(last AFI before delivery minus first AFI at 40.0 weeks) / interval in days between the two scans]. Adverse outcome was considered the occurrence of 5-min Apgar score < 7; umbilical artery pH < 7.0; Cesarean section for fetal distress; or fetal death. Comparisons between the groups with favorable and adverse outcomes was performed with chi(2) or Fisher's exact test for categorical variables, and Student's t test for continuous variables. A two-tailed p value < 0.05 was considered significant. RESULTS: A total of 3050 women met the study criteria, and underwent a median number of two (range 1-7) sonographic assessments of AFI after 40.0 weeks, with oligohydramnios detected in 341 women. In 1466 women at least two serial AFI determinations were obtained, allowing computation of an AFI trend. Gestations resulting in adverse perinatal outcome (n = 167, 5.5%) had a significantly higher rate of oligohydramnios (33/167, 19.8% vs. 308/2883, 10.7%, p = 0.001), but a similar rate of reduction in AFI ( -0.65 +/- 0.64 vs. - 0.66 +/- 0.66 cm/day; p = 0.85) than those with favorable outcome. The difference in rate of reduction of AFI between the two groups was not significant, even in the subset of gestations that developed oligohydramnios ( -1.08 +/- 0.87 vs. -1.26 +/- 0.89 cm/day; p = 0.27). CONCLUSION: A sonographic diagnosis of oligohydramnios carries an increased risk of adverse perinatal outcome, even in low-risk pregnancies after 40 weeks. The trend in amniotic fluid volume reduction does not seem to have prognostic significance.     

Isolated oligohydramnios in term pregnancy as an indication for induction of labor

Objective. To evaluate the outcome of active induction of labor for isolated oligohydramnios in low-risk term gestation.

Methods. This retrospective study analyzed the obstetric and perinatal outcome of 412 singleton term pregnancies with cephalic presentation and no maternal risk factors or fetal abnormalities. Two groups were compared: 206 deliveries after induced labor for isolated oligohydramnios, and 206 deliveries matched for gestational age following spontaneous labor with normal amniotic fluid index.

Results. The overall rate of cesarean deliveries and cesarean deliveries for nonreassuring fetal status, and operative vaginal delivery rates and those for nonreassuring fetal status were higher in the oligohydramnios group than in the control group. There were no differences between groups in neonatal outcome or perinatal morbidity or mortality.

Conclusion. Active induction of labor in term low risk gestations with isolated oligohydramnios translated into higher labor induction, operative vaginal delivery and cesarean section rates. This led to increased maternal risk and an increase in costs with no differences in neonatal outcome.     

Induction of labor and perinatal outcome: the impact of the amniotic fluid index

OBJECTIVE: The purpose was to determine the impact of the amniotic fluid index on the perinatal outcome of patients admitted for induction of labor at term. STUDY DESIGN: Patients (n=180) included in the study were those admitted for induction of labor at 37-42 weeks' gestation, with unfavorable cervix and intact membranes. The amniotic fluid index (AFI) was determined in all patients using the four-quadrant technique within 24 h of the induction of labor. Patients were divided into two groups based on their AFI: the oligohydramnios group with AFI < or = 5 cm (n = 66) and a normal group with AFI > 5 cm (n = 114). The perinatal outcomes of the two groups were compared. RESULTS: The two groups were similar with regard to maternal age, gestational age, and birth weight. Meconium staining of the amniotic fluid was significantly higher in the group with AFI < or = 5 cm (p = 0.040). The number of cesarean deliveries due to fetal distress was significantly higher even after adjusting for other confounding factors in the group with AFI < or = 5 cm (adjusted OR 6.52 [95% CI 1.82, 23.2]; p < or = 0.0001). There was no significant difference between the two groups with regard to Apgar scores or neonatal admission. CONCLUSION: Induction of labor at term in patients with oligohydramnios is associated with an increased risk of cesarean delivery due to fetal distress.     

Isolated oligohydramnios in term pregnancy as an indication for induction of labor.

OBJECTIVE: To evaluate the outcome of active induction of labor for isolated oligohydramnios in low-risk term gestation. METHODS: This retrospective study analyzed the obstetric and perinatal outcome of 412 singleton term pregnancies with cephalic presentation and no maternal risk factors or fetal abnormalities. Two groups were compared: 206 deliveries after induced labor for isolated oligohydramnios, and 206 deliveries matched for gestational age following spontaneous labor with normal amniotic fluid index. RESULTS: The overall rate of cesarean deliveries and cesarean deliveries for nonreassuring fetal status, and operative vaginal delivery rates and those for nonreassuring fetal status were higher in the oligohydramnios group than in the control group. There were no differences between groups in neonatal outcome or perinatal morbidity or mortality. CONCLUSION: Active induction of labor in term low risk gestations with isolated oligohydramnios translated into higher labor induction, operative vaginal delivery and cesarean section rates. This led to increased maternal risk and an increase in costs with no differences in neonatal outcome.     

Induction of labor in women with oligohydramnios.

OBJECTIVE: To prospectively evaluate the outcome of labor induction in women with oligohydramnios at term. METHODS: This was a prospective case-control study which included 120 consecutive patients with Amniotic Fluid Index (AFI) < or =5 undergoing labor induction. One hundred and sixteen patients with normal amniotic fluid matched for gestational age (+/- 3 days) and Bishop-score served as controls. Inclusion criteria were: requirement of labor induction, singleton pregnancy, nulliparity, Bishop score <5, gestational age > or =266. Preinduction treatment included the use of up to 3 successive doses of dinoprostone intracervical gel (0.5 mg). Vaginal dinoprostone (2 mg) and/or oxytocin were then applied to induction labor, if necessary. RESULTS: The rate of cesarean section in AFI < or = 5 group (38.3%) was not significantly different to that in control group (34.2%). The interval from induction to vaginal delivery was not significantly different for AFI < or =5 group (1499 +/- 895 min.) and control group (1398 +/- 852 min.). The changes in Bishop score evaluated at 6th and 12th hour after dinoprostone were not significantly different in control and AFI< or =5 group. More women in the latter group (11.7% vs 3.3%, Chi Square:4.86, p = 0.027) required the use of drugs in order to manage tachysystole/hyperstimulation allowing a OR = 3.83 (95%C.I. = 1.13-14.27). The length of stay at hospital was 4.2 +/- 1.8 days for AFI < or =5 group and 4.3 +/- 1.3 for control group. CONCLUSIONS: Oligohydranmios at term did not influence the outcome of induction of labour in nulliparous women with unfavorable cervix.     

Amniotic fluid index in low-risk pregnancy as an admission test to the labor ward

BACKGROUND: Oligohydramnios has been shown to be a predictor of intrapartal fetal distress. In a selected group of low-risk pregnancies, however, it has not yet been established that oligohydramnios contributes to intrapartal fetal distress. METHODS: Ultrasonically estimated four-quadrant amniotic fluid index as a test for admission to the labor ward was evaluated as a predictive factor for fetal distress during labor in a prospective "blind" study comprising 600 low-risk pregnancies. Oligohydramnios was defined as an amniotic fluid index < or = 50 mm. The parturients were divided into two groups according to the status of the fetal membranes. The amniotic fluid index results were correlated to fetal outcome: Apgar score at 1 and 5 min, pH of blood in umbilical artery and vein, operative delivery because of fetal distress, cesarean delivery because of fetal distress, and number of babies referred to the neonatal intensive care unit. RESULTS: Two-hundred and sixty-seven women had ruptured membranes. Among these a significant increase in operative delivery because of fetal distress was seen in cases of oligohydramnios compared with the normal amount of amniotic fluid (odds ratio 3.86, confidence interval = 1.25-11.9). No significant differences were seen regarding other variables of perinatal outcome. The group with intact membranes comprised 333 parturients. Among these, no significant differences in perinatal outcome could be seen in relationship to the amniotic fluid index, although a 50% increase in emergency operations for fetal distress was seen in women with oligohydramnios. A significant correlation might have been evident even in that group if a larger sample had been studied. CONCLUSION: The results indicate that measurement of the amniotic fluid index in low-risk pregnant women admitted for labor might identify parturients with an increased risk of intrapartal fetal distress.     

Prediction of oligohydramnios in prolonged pregnancy.

A decrease in amniotic fluid in prolonged pregnancy is associated with increased fetal morbidity. However, few investigations have been reported on the prediction of this condition. Fetal renal arterial pulsatility index (PI), hourly fetal urine production rate (HFUPR) and amniotic fluid index (AFI) at 39 weeks were studied in 51 singleton pregnancies with (n = 14) and without oligohydramnios (AFI < 5, n = 37) in prolonged pregnancy. There was no difference in the average fetal renal arterial PI and HFUPR between the oligohydramnios group and the normal group. However, the average AFI in the oligohydramnios group was 7.5 +/- 0.9, which was lower than that in the normal group (p < 0.05). We speculated that AFI value at 39 weeks is useful for predicting the incidence of oligohydramnios in prolonged pregnancy.     

Decreased amniotic fluid index in low-risk pregnancy

OBJECTIVE: To evaluate the perinatal outcomes of pregnancies complicated by isolated decreased amniotic fluid volume (AFI) after 30 weeks' gestation (AFI < or = 5 or > 5 cm but < 2.5th percentile). STUDY DESIGN: We retrospectively studied 150 low-risk singleton pregnancies > 30 weeks' gestation with decreased AFI. We also compared the outcomes of 57 pregnancies with AFI < or = 5 cm to those of 93 pregnancies with AFI > 5 cm but < 2.5th percentile (borderline AFI). Pregnancy outcome was assessed with respect to antepartum, intrapartum and neonatal measures. Statistical significance (P < .05) between groups was determined by means of the Student t test and chi 2 analysis. RESULTS: There were no statistically significant differences between pregnancies with AFI < or = 5 cm and those with AFI > 5 cm but < 2.5th percentile with respect to labor induction for an abnormal nonstress test (7.0% vs. 7.5%, overall 7.3%), cesarean sections for fetal heart rate abnormalities (7.0% vs. 7.5%, overall 7.3%), presence of meconium (16.1% vs. 15.7%, overall 16%) and Apgar score < 7 at five minutes (0 vs. 1.1%, overall 0.66%). There were no perinatal deaths in either group. Antepartum variable decelerations were more common in pregnancies with AFI < or = 5 cm as compared to those with AFI > 5 cm but < 2.5th percentile (63.1% vs. 45.1%, P = .007; overall 53.3%). CONCLUSION: With antepartum monitoring, perinatal outcome in low-risk pregnancies with an isolated decreased AFI after 30 weeks' gestation (< or = 5 or > 5 cm but < 2.5th percentile) appears to be good.     

Use of the fetal biophysical profile in severe oligohydramnios after preterm premature rupture of the membranes

A protocol of expectant management using daily fetal biophysical assessment was applied to 23 consecutive women with severe oligohydramnios after preterm premature rupture of the membranes. A persistently low biophysical score (less than or equal to 6 on two examinations two hours apart) in the presence of a nonreactive nonstress test and absence of fetal breathing was used as an indication for delivery. The pregnancy outcome in this group was compared to that in a historic control group managed similarly except that an abnormal biophysical assessment was not an indication for delivery. The results suggest that the management of women with severe oligohydramnios after preterm premature rupture of the membranes with daily fetal biophysical profiles decreases the incidence of low five-minute Apgar scores as well as that of maternal and neonatal infection.     

Serial assessment of amniotic fluid index in uncomplicated term pregnancies: prognostic value of amniotic fluid reduction

Objective: Assessment of amniotic fluid volume in association with a non-stress test is a commonly used method to monitor fetal well-being in high-risk pregnancies. The aims of our study were to determine whether oligohydramnios and the trend in amniotic fluid volume have prognostic significance in low-risk pregnancies between 40.0 and 41.6 weeks' gestation.

Methods: Between January 1997 and December 2000, all uncomplicated gestations with a singleton non-anomalous fetus reaching 40.0 weeks' gestation underwent semi-weekly monitoring of amniotic fluid index (AFI) until delivery. Oligohydramnios was defined as an AFI of ??5?cm. Changes in AFI were expressed as centimeters per day, and were calculated as: [(last AFI before delivery minus first AFI at 40.0 weeks) / interval in days between the two scans]. Adverse outcome was considered the occurrence of 5-min Apgar score <?7; umbilical artery pH <?7.0; Cesarean section for fetal distress; or fetal death. Comparisons between the groups with favorable and adverse outcomes was performed with χ² or Fisher's exact test for categorical variables, and Student's t test for continuous variables. A two-tailed p value <?0.05 was considered significant.

Results: A total of 3050 women met the study criteria, and underwent a median number of two (range 1–7) sonographic assessments of AFI after 40.0 weeks, with oligohydramnios detected in 341 women. In 1466 women at least two serial AFI determinations were obtained, allowing computation of an AFI trend. Gestations resulting in adverse perinatal outcome (n?=?167, 5.5%) had a significantly higher rate of oligohydramnios (33/167, 19.8% vs. 308/2883, 10.7%, p?=?0.001), but a similar rate of reduction in AFI (???0.65?±?0.64 vs. –?0.66?±?0.66?cm/day; p?=?0.85) than those with favorable outcome. The difference in rate of reduction of AFI between the two groups was not significant, even in the subset of gestations that developed oligohydramnios (???1.08?±?0.87 vs. –?1.26?±?0.89?cm/day; p?=?0.27).

Conclusion: A sonographic diagnosis of oligohydramnios carries an increased risk of adverse perinatal outcome, even in low-risk pregnancies after 40 weeks. The trend in amniotic fluid volume reduction does not seem to have prognostic significance.     

未足月胎膜早破孕妇剩余羊水量与母儿结局

目的 探讨未足月胎膜早破(PPROM)发生后剩余羊水量与母儿结局的关系.方法 选择2002年1月-2009年2月重庆医科大学附属第一医院产科住院分娩的PPROM孕妇78例,2005年1月-2009年2月重庆市妇幼保健院产科住院分娩的PPROM孕妇67例,共计145例.根据胎膜破裂后羊水指数(AFI)结果将孕妇分为3组:羊水量正常组(80 mm≤AFI＜180 mm)78例;羊水量偏少组(50 mm≤AFI＜80 mm)31例;羊水量过少组(AFI＜50 mm)36例.观察各组AFI、孕妇发热情况、白细胞计数、发生PPROM的孕周、潜伏期时限、分娩方式、围产期感染、胎儿窘迫、新生儿窒息情况及出生体重、新生儿呼吸窘迫综合征(NRDS)、新牛儿呼吸衰竭、新生儿缺血缺氧性脑病(HIE)、缺血缺氧性心肌损害等,并对各组的母儿围产期发病情况进行分析.结果 (1)3组孕妇破膜时间、新生儿出生体重、胎盘早剥、白细胞计数、发热等指标分别比较,差异无统计学意义(P＞0.05).羊水量过少组孕妇潜伏期时间明显短于羊水量偏少组及羊水量正常组,分别比较,差异有统计学意义(P＜0.01).羊水量过少组孕妇剖官产率(69%)明显高于羊水量正常组(39%),两组比较,差异有统计学意义(P＜0.01).(2)羊水量过少组羊膜腔感染13例(36%,13/36),羊水量偏少组8例(26%,8/31),羊水量正常组7例(9%,7/78),3组分别比较,差异均有统计学意义(P＜0.01).(3)羊水量过少组新生儿败血症10例(28%,10/36),羊水量偏少组8例(26%,8/31),羊水量正常组7例(9%,7/78),3组分别比较,差异均有统计学意义(P＜0.05).(4)羊水量过少组的胎儿窘迫(19%)、新生儿窜息(28%)、缺血缺氧性心肌损伤发生率(56%)明显高于羊水量正常组(分别为3%、8%、13%),差异均有统计学意义(P＜0.01);3组的NRDS、呼吸衰竭、新生儿HIE、新生儿黄疸、新生儿低血糖、新生儿脑室出血发生率分别比较,差异均无统计学意义(P＞0.05).(5)以羊膜腔感染为应变量,logistic回归分析显示,PPROM剩余羊水量过少为羊膜腔感染的惟一有效自变量(r=0.863±0.374,P＜0.05);以新生儿病率为应变量,logistic回归分析显示,PPROM剩余羊水量过少是新生儿败血症的惟一有效白变量(γ=0.874±0.462,P＜0.05).结论 PPROM后的剩余羊水量过少与潜伏期缩短,剖官产率升高、羊膜腔感染、胎儿窘迫、新生儿窒息、新生儿败血症、新生儿缺氧缺血性心肌损害的增加有关;PPROM后剩余羊水量的多少可作为期待治疗时有效预测母儿结局的指标.     

Postdate fetal surveillance: is 41 weeks too early?

During an 18-month period, 293 patients had a nonstress test and ultrasonographic evaluation of amniotic fluid volume twice weekly beginning at 41 weeks' gestation. Patients were admitted for induction of labor for either an abnormal nonstress test result or oligohydramnios. A control population consisted of 59 low-risk patients who were delivered between 39 and 41 weeks' gestation and had antepartum testing within 4 days of delivery. Study patients who were delivered between 41 and 42 weeks' gestation had a significantly increased incidence of abnormal nonstress tests, oligohydramnios, cesarean sections for fetal distress, and admissions to the neonatal intensive care unit compared with control patients. The abnormal fetal testing and adverse perinatal outcome associated with pregnancies over 42 weeks were also found in pregnancies between 41 and 42 weeks' gestation. These data support the concept that postdate fetal testing should begin at 41 weeks of gestation.     

Perinatal outcome associated with oligohydramnios in uncomplicated term pregnancies

Purpose In high-risk pregnancies, oligohydramnios is frequently used to identify fetuses at risk of an adverse outcome. The purpose of this study was to evaluate the effect of oligohydramnios on perinatal outcome in uncomplicated pregnancies between 40.0 and 41.6 weeks.Methods From January 1997 to December 2000 all uncomplicated pregnancies reaching 40.0 weeks' gestation with a singleton non-malformed fetus and reliable dating underwent monitoring with serial determination of amniotic fluid index (AFI) and biophysical profile. Labor was induced for AFI 5 cm, biophysical profile score of 6 or less, rise in maternal blood pressure >140/90 mm Hg, or gestational age of 42.0 weeks. Perinatal outcome was compared between cases with AFI 5 cm and those with AFI >5 cm using Chi-square or Fisher's exact test for categorical variables, Student's t-test for continuous variables, and logistic regression analysis. A two-tailed p value <0.05 or an odds ratio (OR) with 95% confidence interval (CI) not inclusive of the unity was considered significant.Results Three thousand and forty-nine women met the inclusion criteria, 341 of which (11%) had an AFI 5 cm. Gestational age at delivery, rates of nulliparity and induction of labor were significantly different between cases with oligohydramnios and those with normal AFI (all p<0.001). Rates of cesarean delivery for non-reassuring fetal testing (8.2% vs. 3.9%, p<0.001) and of neonates with birth weight <10th percentile (13.2% vs. 5.5%, p<0.001) were significantly higher in the AFI 5 cm group compared with the AFI >5 cm. No significant differences were identified between the two groups in rates of meconium-stained amniotic fluid, 5-min Apgar score <7, or umbilical artery pH <7. Logistic regression analysis demonstrated that the association between oligohydramnios and rate of cesarean delivery for non-reassuring fetal testing lost significance after controlling for gestational age at delivery, nulliparity and induction of labor, whereas the association between AFI 5 cm and low birth weight centiles remained statistically significant (OR=2.2, 95% CI 1.5, 3.2).Conclusion In conclusion, in uncomplicated pregnancies at 40.0 to 41.6 weeks, oligohydramnios is independently associated with a higher risk of low birth weight centile.