未足月特发性羊水过少的临床处理及妊娠结局

Management of preterm idiopathic oligohydramnios and pregnancy outcome

目的探讨未足月特发性羊水过少的临床处理、妊娠结局以及二者之间的关系。方法选择2009—2013年在温州医科大学附属第一医院产前检查的晚孕单胎妊娠孕妇（28~36＋6周）,按照羊水指数（AFI）进行分组：羊水过少组（27例）、羊水偏少组（47例）及羊水正常组（70例）。对羊水过少组及偏少组给予补液治疗,对3组的妊娠结局以及补液治疗效果与妊娠结局的关系进行比较。结果 ①母体结局：补液治疗总有效率51.35%。补液治疗明显延长羊水偏少组的妊娠时间。早产为主要的并发症。羊水过少组的早产发生率为37.04%,主要为医源性早产。羊水过少组及羊水偏少组均以剖宫产为主要的终止妊娠方式,且2组的引产率均明显增加。②围产儿结局：羊水过少组围产儿不良结局发生率最高,为44.44%。羊水过少组新生儿体重最低。但如果期待治疗至37周后分娩,则3组围产儿不良结局发生率差异无统计学意义。③治疗效果与妊娠结局的关系：妊娠并发症发生率及剖宫产率与治疗效果无关,治疗有效孕妇早产及围产儿不良结局发生率明显降低、可维持的妊娠时间及新生儿体重明显增加。结论有效的补液治疗对于改善未足月特发性羊水过少的妊娠结局可能是有益的。治疗有效及≥37周后分娩对未足月特发性羊水过少妊娠结局的改善可能有一定的预测作用。

Objective To explore the management and pregnancy outcome of preterm idiopathic oligohydramnios and their relationships. Methods The women with a singleton term pregnancy received ultrasound examinations at 28 - 36 ＋6 gesta- tional weeks in our hospital from 2009 to 2013. The pregnancies were divided into three groups according to amniotic fluid index （ AFI ） ： oligohydramnios group （ AFI ≤ 5 cm）, borderline group （ AFI 5.1 - 8.0 cm） and normal group （ AFI 8.1 - 18 cm ）. Women with decreased AFI received treatment of intravenous and/or oral hydration. The effect of hydration, pregnan- cy outcome and the association between them were assessed. Results ①pregnant women：The effective rate of hydration was 51.35 %. Hydration prolonged gestational weeks significantly in borderline group. Oligohydramnios group had a higher rate of premature delivery with 37.04% ,most of which were iatrogenie preterm delivery. Women with decreased AFI also had a higher rate of cesarean section（CS） and labor induction. ②perinatal fetus ：The incidence of adverse perinatal out- comes was significantly higher in oligohydramnios group. Neonatal birth weight was significantly lower in fetus whose moth- er with decrease AFI, especially much lower with isolated oligohydramnios. These differences were eliminated when women with decreased AFI delivered at term. There was no correlation between effective treatment and the rate of new onset preg- nancy complications and CS, but a lower rate of premature delivery and adverse perinatal outcome and increased neonatal birth weight. Conclusion The effective hydration may improve the pregnancy outcome in women with decreased AFI es- pecially with isolated oligohydramnios. Effective hydration and delivery at term may be a useful index to predict improved pregnancy outcome in isolated oligohydramnios diagnosed before 37 gestational weeks.