羊水过少单胎妊娠羊膜腔灌注术管理及妊娠结局分析

Management of amnioinfusion and analysis of pregnancy outcome in single pregnancy with oligohydramnios

目的探讨羊水过少单胎妊娠进行羊膜腔灌注术的治疗作用。方法回顾性研究广东省妇幼保健院医学遗传中心2015年1月至2018年12月诊断为羊水过少单胎孕妇391例,排除染色体异常及胎膜早破导致的羊水过少病例,共纳入45例患者进行了羊膜腔灌注,分析手术方法、并发症和妊娠结局。结果共有45例羊水过少孕妇进行了50次羊膜腔灌注术,进行首次羊膜腔灌注术时的平均孕周24周(18~34周),每次灌注量平均为112ml(40~250ml),在首次羊膜腔灌注后延长的平均孕周为6周(1~17周),分娩的平均孕周为36周(29~40周)。在45例中有27例特发性羊水过少,占60%。胎儿异常超声表现有胎儿宫内生长受限、脐动脉血流异常及肠管回声增强。45例羊水过少胎儿有10例(22.2%)因无羊水、FGR、脐动脉血流缺失引产,4例(6.7%)分别出现了术后流产、胎膜早破、胎死宫内和早产等并发症,2例(4.4%)新生儿出生后因早产死亡。胎儿总的存活率为64.4%(29/45),其中特发性羊水过少存活率40%(18/45)。当羊水暗区≤1cm时,存活率为8.9%(4/45),21例在孕28周前出现羊水过少的存活率为22.2%(10/45),有13例同时合并FGR,其中7例在孕28周前出现FGR,术后存活率为15.6%(7/45)。出生后随访中有1例胎儿出生后肠梗阻进行手术治疗,目前生长发育良好。5例生长发育迟缓,智力发育可,其中3例为FGR。结论羊膜腔灌注术可有效延长孕周,是治疗羊水过少的有效方法,但妊娠结局与胎儿羊水过少的严重程度、过早出现羊水过少及是否合并FGR有关。

Objective Study on the therapeutic effect of amnioinfusion in singleton pregnancy with oligohydramnios.Method A retrospective study was conducted on 391 single pregnant women with oligohydramnios diagnosed by the Medical Genetics Center of Guangdong Maternal and Child Health Hospital from January 2015 to December 2018,excluding cases of oligohydramnios caused by chromosome abnormalities and premature rupture of membranes.amnioinfusion was performed in 45 patients,and the surgical methods,complications and pregnancy outcomes were analyzed.Results A total of 45 pregnant women with oligohydramnios underwent amnioinfusion for 50 times.The average gestational week at the time of the first amnioinfusion was 24(18 to 34)weeks,and the average perfusion volume was 112(40 to 250)milliliters.After the first amnioinfusion,the average gestational weeks were 6(1 to 17)weeks and 36(29 to 40)weeks,respectively.the average gestational weeks after the first amnioinfusion were 6(1 to 17)weeks and 36(29 to 40)weeks,respectively.Of the 45 cases,27 cases were idiopathic oligohydramnios(60%).The abnormal ultrasound findings of fetus included fetal growth restriction,abnormal blood flow of umbilical artery and enhanced echo of intestine.In 45 cases of oligohydramnios,10 cases(22.2%)were induced labor due to absence of amniotic fluid,FGR and umbilical artery blood flow,and 4 cases(6.7%)had complications such as postoperative abortion,premature rupture of membranes,fetal death and preterm delivery,respectively.2 cases(4.4%)died of preterm birth.The overall fetal survival rate was 64.4%(29/45),of which the survival rate of idiopathic oligohydramnios was 40%(18/45).When amniotic fluid dark area≤1cm,the survival rate was 8.9%(4/45).The survival rate of 21 patients with oligohydramnios before 28 weeks of gestation was 22.2%(10/45).There were 13 patients with FGR,7 of them had FGR,before 28 weeks of gestation.The postoperative survival rate was 15.6%(7/45).During the follow-up after birth,1 case of fetal intestinal obstruction underwent surgical treatment,and the growth and development is good at present.There were 5 cases of growth retardation and intellectual development,of which 3 cases were FGR.Conclusions amnioinfusion can effectively prolong the gestational weeks and is an effective method for the treatment of oligohydramnios,but the pregnancy outcome is related to the severity of fetal oligohydramnios,premature occurrence of oligohydramnios and FGR.