足月妊娠原发性羊水过少与妊娠并发症的关系及对妊娠结局的影响

The Influence of Primary Oligohydramnios on Full-Term Pregnancy Complications and on Pregnancy Outcome

目的探讨足月妊娠原发性羊水过少与妊娠并发症的相关性及对妊娠结局的影响。方法选取2017年1月-2018年3月于本院妇产科住院的足月原发性羊水过少产妇150例(观察组),选取同期于本院分娩的羊水量正常的足月产妇100例(对照组),对两组妊娠并发症、分娩方式、剖宫产手术指征、妊娠结局进行比较;并将观察组按有无并发症分为两个亚组,比较两亚组围生儿的情况。结果观察组HDCP、ICP、FGR、延期妊娠的发生率均高于对照组(P<0.05);观察组合并1种、合并≥2种并发症的发生率均高于对照组(P<0.05);观察组自然分娩率低于对照组,剖宫产率及引产率高于对照组,差异均有统计学意义(P<0.05);观察组以胎儿窘迫及引产失败为剖宫产手术指征的比例均较对照组高(P<0.05);观察组产后出血、产后感染、脐带异常、胎儿窘迫、羊水Ⅱ°粪染、羊水Ⅲ°粪染、新生儿疾病、入住NICU的发生率均高于对照组,观察组新生儿出生体重低于对照组,均有统计学差异(P<0.05)。无妊娠并发症组胎儿窘迫、羊水Ⅱ°粪染、羊水Ⅲ°粪染、新生儿肺炎、新生儿黄疸的发生率均低于伴妊娠并发症组,差异具有统计学意义(P<0.05)。结论原发性羊水过少与妊娠并发症密切相关,可作为临床不良妊娠结局预测信号;伴妊娠并发症原发性羊水过少孕妇,应及时终止妊娠;无妊娠并发症原发性羊水过少孕妇,应严密监测产程及胎心变化,进行综合评估,首先选择阴道试产,避免盲目剖宫产。

Objective To explore the influence of primary oligohydramnios on full-term pregnancy complications and on pregnancy outcome Methods 250 full-term pregnant women during the period from Jan, 2017 to Mar, 2018 were divided into 2 groups: observation group (150 cases with primary oligohydramnios) and control group (100 cases with normal amniotic fluid);comparison was conducted between the cases of both groups on the occurrence of pregnancy complications, delivery modes, cesarean section indications and pregnancy outcomes;the observation group was divided into 2 subgroups: complication group and non-complication group, and the perinatal outcomes of the cases in 2 subgroups were compared. Results The HDCP, ICP, FGR, and the incidence of delayed pregnancy in the cases of observation group were higher than those in control group ( P <0.05);cases in observation group were more susceptible to both single and multiple complications than those in control group ( P <0.05);observation group was of lower rate of natural childbirth and of higher rate of cesarean section and induced labor than control group ( P <0.05);The proportion of taking fetal distress and induced labor failure as cesarean section indication in observation group was higher than that in control group ( P <0.05);The rates of postpartum hemorrhage, postpartum infection, abnormal umbilical cord, fetal distress, meconium-stained amniotic fluid (II° to III°), neonatal diseases and neonatal intensive care were higher in cases of observation group than those in control group, while the birth weights of cases in observation group was lower than those in control group ( P <0.05);the rates of fetal distress, meconium-stained amniotic fluid (II° to III°), neonatal pneumonia and neonatal jaundice in the cases of complication group were higher than those of non-complication group ( P <0.05). Conclusions Primary oligohydramnios is involved with pregnancy complication and serves as a indicator for adverse pregnancy outcome;women with primary oligohydramnios and pregnancy complications should make timely abortion;women with primary oligohydramnios and without pregnancy complications require intensive monitor of the variation of fetal heart rate during their birth process, and they should make a trial of labor first rather than taking cesarean section without deliberation.