未足月羊水过少孕妇期待治疗时限和不同分娩方式对新生儿的影响

目的 探讨未足月羊水过少期待治疗时限和不同分娩方式对新生儿的影响.方法 采用回顾性分析法,选择2009年8月至2010年10月在本院产科住院且分娩,未足月孕周≥33周反复多次在本院行超声检查提示羊水过少的孕妇100例作为研究对象(除外合并妊高症、糖尿病,妊娠合并肝内胆汁淤积症、胎儿畸形、胎盘功能低下等妊娠合并症及并发症).其中选择性剖宫产68例,急诊剖宫产22例,阴道分娩10例.观察期待治疗时限和不同分娩方式对新生儿的影响.结果 静脉营养+水化治疗+低分子肝素皮下注射不一定增加羊水指数.期待治疗≥5d则新生儿体重明显增加,平均增加243g(t=3.065,P=0.002).期待治疗≥5d新生儿入住NICU率(2.5%)与期待治疗＜5d组新生儿入住NICU率(35.0%)比较明显降低(x2=18.773,P＜0.01).羊水过少合并出生体重＜2500g者入住NICU率明显增加,高达33.3%(x2=13.52,P＜0.01)).选择性剖宫产较急诊剖宫产和阴道分娩出现胎儿窘迫、新生儿窒息、胎粪吸入综合征等并发症发生率低(χ2分别为18.288、9.281、9.271,P均＜0.01)结论 对于未足月羊水过少孕妇,宜尽量实施期待治疗,以降低医源性早产发生率;并加强对羊水过少的产前、产时监护,结合胎心监护(NST)及宫颈评分选择最佳分娩方式,可改善新生儿预后.

The influence on newborn infant of duration of expectant treatment and different modes of delivery for preterm oligohydramnios gestation

Objective To explore the influence on newborn infant of duration of expectant treatment and different modes ofdelivery for preterm oligohydramnios gestation. Methods Retrospect Analysis will be applied in the study. 100 pregnant women of gestation weeks no less than 33 weeks （with an exception of women with such pregnancy complications as hypertensive disorders in pregnancy, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy, fetal malformation, deceased placental function, etc. ） with repeated ultrasonic - proved Preterm Oligohydramnios who delivered in Zhuzhou No. 1 Hospital between Aug 2009 and Oct 2010, including 68 cases of selective cesarean delivery, 22 cases of emergency cesarean section and 10 cases of vaginal delivery, will be enrolled in our study to observe the influence on newborn infant of duration of expectant treatment and different modes of delivery for preterm oligohydramnios gestation. Results Nutritional venous transfusion together with rehydration therapy and injection of low molecular heparin do not necessarily increase the amniotic fluid index. The birth weight could be significantly increased 243g by average if the duration of expectant treatment was not less than 5 days （ x^2 = 20. 16, P 〈 0. 01 ）. The rate of newborn infant who should be accepted in NICU among those with duration of expectant treatment not less than 5 days was significantly decreased by 2. 5% , compared with 35% of those with duration of expectation treatment less than 5days （ x^2 = 18. 773, P 〈 0. 01 ）. Compared with cases of emergency cesarean section （ x2 = 9.281, P 〈 0. 01 ） and vaginal delivery （ x^2 = 9.271, P 〈 0. 01 ） , rate of such complications as infant distress, suffocation, meconium aspiration was lower in cases of selective cesarean delivery （ x^2 = 18. 288, P 〈 0. 01 ）. Conclusion Expectant treatment should be applied for preterm oligohydramnios pregnant women to decrease the rate of iatrogenic preterm labor. Prenatal and natal monitoring for Preterm Oligohydramnios should be combined with NST and cervical scoreing to decide the best delivery mode to improve neonate outcome.