羊水过少的监测与围生儿预后的相关研究

Relative study on monitoring of oligohydramnios and perinatal fetal prognosis

目的:探讨羊水过少对围生儿预后的相关关系。方法:采用B超检测羊水指数、无应激试验、胎动计数及临床胎心监护等手段对322例羊水过少孕妇(观察组)的羊水进行监测,并与同期310例羊水正常孕妇(对照组)在妊娠并发症、分娩方式、新生儿情况等方面进行对比分析,对监测结果与确诊率进行相关分析。结果:羊水过少严重影响围生儿预后,观察组羊水污染、胎儿宫内窘迫、新生儿窒息发生率及围生儿病死率均高于对照组,差异有统计学意义(P<0.01)。B超测定与分娩时羊水量结果相符率达95.7%。无应激试验正常者胎儿窘迫发生率、新生儿窒息发生率和围生儿病死率均低于无应激试验异常者(P<0.01)。观察组剖宫产分娩282例,胎儿窘迫19例,新生儿窒息3例,羊水胎粪污染11例;经阴道分娩40例,均发生胎儿窘迫、羊水胎粪污染,新生儿窒息38例,2种分娩方式比较差异有统计学意义(P<0.05)。结论:羊水过少不是剖宫产的绝对手术指征,羊水过少确诊后要联合电子胎心监护,了解胎儿宫内缺氧状况,结合有无高危因素及宫颈条件选择合理的分娩方式。

Objective To analyze the relationship between oligohydramnios and perinatal fetal prognosis. Methods Amniotic fluid index, non-stress test, fetal movement counting and fetal heart rate monitoring were used to monitor amniotic fluid in perinatal period dynamically in 322 pregnant women with oligohydramnios, and were compared the pregnancy complications, delivery methods and the condition of newborns with 310 normal pregnant women. The results and diagnostic rate were analyzed. Results Oligohydramintos affected the prognosis of perineonates. The amniotic fluid polluteod by fetal stool, intrauterine fetal distress and the fatality rate of perneonates were significantly higher than those in control group （P 〈 0. 01）. The diagnostic accurate rate of oligohydramnitos was 95. 7% by ultrasonography. The incidence rates of fetal distress, neonatal asphyxia and fatality rate of perinoates were significantly higher in abnormal non stress test group than those in normal non-stress test group （P〈0.01）. Conclusion Oligohydramnios is not an absolute surgical indication for the cesarean section in pernaital period. An appropriate manner of delivery should be selected by combined with monitoring fetal heart rate, acquiring the fetus anoxia condition, cervix condition and whether there is a high risk factor.