孕晚期单纯羊水过少分娩方式的选择

Selection of modes of delivery in the oligohydramnios patients

目的：探讨羊水过少者分娩方式的选择，降低不必要的剖宫产率。方法回顾性分析2013年9月至2015年12月我院羊水过少患者的临床资料，入选研究对象148例，其中阴道试产74例，成功阴道分娩组54例，因引产或产程过程中胎心异常或引产失败行急诊剖宫产术（试产转急诊剖宫产组）20例；直接行选择性剖宫产74例。比较3种分娩方式的围生儿结局，并对阴道分娩及急诊剖宫产孕周、产次、宫颈评分、羊水最大暗区垂直深度（ AFV）、羊水指数（ AFI）、胎儿大小、水化治疗和引产情况进行统计学比较。结果试产转急诊剖宫产组胎心异常和羊水Ⅲ度发生率均为80．00％（16／20），阴道分娩组分别为11．11％（6／54）、29．63％（16／54），选择性剖宫产组分别为0和9．50％（7／74），3组间两两比较差异均有统计学意义（ P均＜0．05）。阴道试产成功分娩组及中转急诊剖宫产组孕龄分别为（39．33±0．13）、（40．20±0．2）周，产次0次分别为45例、20例，产次1次分别为9例、0例；AFV分别为（2．14±0．06）、（1．86±0．08） cm；水化治疗率分别为66．67％（36／74）、30．00％（6／20）；两组间比较差异均有统计学意义（ P均＜0．05）。引产情况比较：阴道分娩组24例自然临产未引产，12例予米索前列醇促宫颈成熟后阴道分娩，12例缩宫素引产阴道分娩，6例米索前列醇促宫颈成熟后予缩宫素静脉滴注引产后阴道分娩；急诊剖宫产组自然临产未引产2例，缩宫素引产8例，米索前列醇促宫颈成熟后缩宫素引产10例。两组引产方法比较差异有统计学意义（ P＜0．001）。结论低危妊娠、胎儿宫内储备能力良好羊水过少者阴道试产是可行的，水化治疗、孕周＜40周、产次≥1次、AFV＞2 cm、对引产敏感的孕妇阴道分娩率高。

Objective To explore the prognosis of children under different modes of delivery in the oli-gohydramnios patients,in order to reduce unnecessary cesarean section rate. Methods One hundred and forty-eight cases of oligohydramnios from September 2013 to October 2015 in the First Affiliated Hospital of Tsinghua University were reviewed,including 74 cases of vaginal delivery,54 cases of vaginal delivery group,20 cases for fetal heart abnormalities in the induction of labor or labor in the process or abortion failure emergency caesarean＆amp;nbsp;birth operation（ pilot transfer of emergency cesarean section delivery group）;direct line selective cesarean section in 74 cases. The delivery surround unripe ending of three kinds of delivery mode was compared,and gestational weeks,estate, cervical score, maximal amniotic fluid dark area vertical depth （ AFV）, amniotic fluid index （ AFI） ,fetal size,water treatment and abortion case of the vaginal delivery and emergency caesarean birth were statistically compared. Results Both fetal heart abnormality and amniotic fluid of third degree incidence of trial production of emergency cesarean section group was 80. 00%（ 16/20） ,of vaginal delivery group was respectively 11. 11%（ 6/54） ,29. 63 （ 16/54） ,and of selective cesarean section delivery group was 0 and 9. 50%（ 7/74） re-spectively,the difference between the 3 groups was statistically significant（ P〈0. 05） . The gestational age of vagi-nal trial production successfully delivery group and transfer of emergency cesarean section production group was respectively （39. 33＋0. 13）,（40. 20＋0. 2） weeks, the parity was 0 were 45 cases,20 cases respectively,the parity was 1 were 9 cases,0 case respectively;AFV was （ 2. 14＋0. 06） cm,（ 1. 86＋0. 08） cm respectively;the water treatment rates were 66. 67%（ 36/74） and 30%（ 6/20） respectively;the difference between the two groups was statistically significant（P〈0. 05）. Induction：in vaginal delivery group,there were 24 cases of spontaneous labor without induction,12 cases treated with misoprostol for cervical mature after vaginal delivery,12 cases of contraction oxytocin induction of labor with vaginal delivery,6 cases of misoprostol for cervical ripening after va-ginal delivery;in emergency cesarean section group,there were 2 cases of natural labor,8 cases of oxytocin,miso-prostol after oxytocin in 10 cases. There was significant difference between the two groups （ P〈0. 001 ） . Conclusion Low risk pregnancy, fetal reserve ability of oligohydramnios in vaginal delivery is feasible. Water treatment,gestational age 〈 40 weeks, the parity more than 1 times,AFV〉2 cm,the high rate of abortion sensi-tive pregnant women with high rate of vaginal delivery.