足月妊娠合并羊水过少287例分娩结局临床分析

Clinical analysis of pregnancy outcomes on 287full-term pregnancy with oligohydramnios

目的探讨足月妊娠合并羊水过少对分娩期孕妇及围生儿的影响。方法选择2013年1月至2014年12月在第三军医大学第一附属医院确诊为足月妊娠合并羊水过少的287例孕妇为研究对象,并纳入羊水过少组。随机抽取同期在该院分娩的300例足月妊娠且羊水量正常孕妇纳入对照组。统计学比较两组孕妇胎儿畸形、过期妊娠、胎儿生长受限(FGR)及妊娠期高血压疾病发生率和剖宫产率差异,分别比较两组孕妇在不同分娩方式下,其围生儿结局差异。结果 1羊水过少组胎儿畸形、过期妊娠、FGR及妊娠期高血压疾病发生率和剖宫产率均较羊水正常组高,且差异均有统计学意义(1.7%vs 0.3%,χ2=2.83,P<0.01;13.2%vs 3.0%,χ2=20.88,P<0.05;3.8%vs 0.6%,χ2=6.70,P<0.01;7.0%vs 1.6%,χ2=10.11,P<0.05;82.9%vs 30.7%,χ2=162.76,P<0.01)。2羊水过少组中,阴道分娩孕妇的新生儿平均体质量较剖宫产孕妇分娩新生儿重,阴道分娩孕妇新生儿宫内窘迫、吸入性肺炎及新生儿窒息发生率均较剖宫产孕妇分娩新生儿高,上述差异均有统计学意义[(3 308±346)g vs(3 194±373)g,t=2.03,P<0.05;36.7%vs 18.1%,χ2=8.46,P<0.05;32.6%vs 17.6%,χ2=5.52,P<0.01;30.6%vs 15.6%,χ2=6.22,P<0.01]。结论足月妊娠合并羊水过少孕妇,分娩期阴道分娩的风险高于羊水正常孕妇。对羊水过少孕妇应加强围生期保健,定期做好产前检查,以改善围生儿结局。

Objective To explore the impact of oligohydramnios on delivery outcomes of full-term pregnant women and perineonates. Methods A total of 287 cases of full-term pregnant women with oligohydramnios （oligohydramnios group） in the First Affiliated Hospital of Third Military Medical University from January 2013 to December 2014 were selected as study objects,and a total of 300 cases of normal full-term pregnant women in the same period were randomly selected and bringing into control group. The differences of incidence rate of fetal anomaly, prolonged pregnancy, fetal growth restriction （FGR）, hypertensive disorders in pregnancy and the cesarean section between two groups, and perineonate outcomes between two delivery ways in each group were compared statistically. Results ①The incidence rate of fetal anomaly,prolonged pregnancy, FGR and hypertensive disorders in pregnancy,and the cesarean section rate in oligohydramnios group were all higher than those of control group,and the differences were statistically significant（ 1.7 % vs 0.3 %, X2 = 2.83, P〈0.01 ; 13.2 % vs 3.0 %, X2 = 20.88, P〈 0.05 ; 3.8 % vs 0. 6%,X^2=6. 70,P〈0. 01;7. 0% vs 1. 6%,X2 =10. 11,P〈0. 05;82. 9% vs 30. 7%,X2 =162. 76,P〈0. 01）. ② In oligohydramnios group, the average weight Of newborns, incidence rate of fetal distress, aspiration pneumonitis of newborns and neonatal asphyxia were all higher in pregnancy with vaginal delivery than those in pregnancy with cesarean section delivery, and the differences were statistically significant [（3 308±346） g vs （3 194±373） g,t=2.03,P〈0.05;36.7% vs 18.1%,X2=8. 46,P〈0. 05;32. 6% vs 1 7. 6 % , X2 = 5. 5 2 , P〈0.01; 30.6% vs15.6%, X2=6. 22,P〈0. 01]. Conclusions For full-term pregnancy with oligohydramnios patients, the risk of vaginal delivery is higher than normal amniotic fluid patients. So, strengthen prenatal care and regular prenatal examination may be good to improve delivery outcome.