经腹羊膜腔内灌注术扩充羊水后母儿围产结局研究

The study of perinatal outcome after transabdominal infusion of amniotic fluid

目的 研究经腹羊膜腔内灌注扩充羊水的安全性、有效性、可行性 ,为羊水过少的孕妇创造阴道分娩的条件 ,降低剖宫产率 ,改善母儿围产结局。 方法 选择B超提示羊水过少或偏少、有阴道分娩适应证、要求阴道分娩并愿意接受经腹羊膜腔内灌注的头位妊娠孕妇 33例 ,腹部B超穿刺探头定位 ,经穿刺孔一次注入预热至 37℃左右的灭菌生理盐水 ,最多 380ml。灌注术中观察母儿不良反应 ,术后观察相关并发症、母儿分娩结局等直至出院。 结果 33例中 32例穿刺灌注成功 ,占 96 .97% ;发生 1例胎膜早破 ,占 3.0 3% ,无胎盘早剥、羊水栓塞、穿刺感染等并发症发生 ;阴道分娩 2 5例 ,占 75 .76 % ;剖宫产 8例 ,分别为头盆不称 4例 ,脐带脱垂胎儿窘迫 1例 ,要求改变分娩方式2例 ,穿刺失败 1例 ,占 2 4 .2 4 %。无一例新生儿发生重度或轻度窒息。 结论 经腹羊膜腔内灌注可有效扩充羊水 ,为羊水过少的晚期妊娠孕妇创造阴道分娩的条件 ,能有效降低剖宫产率 ,方法简便、安全、有效、可行。

Objective To study the safety,efficiency and feasibility of increase the aminotic fluid volume by transabdominal amnioinfusion(AI). Methods Thirty-three patients were selected according to the following criteria: oligohydramnios or borderline oligohydramnios found by B ultrasound ,indications of vaginal delivery and with cephalic presentation,and who is ready to receive AI. After located by puncture bougie,at most 380 ml saline solution at 37℃ were infused into the amniotic cavity. Results AI was accomplished in 32 of 33 cases (96.97%). Premature rupture of membrane occurred in one case (3 03%). No placental abruption and infection or other complications happened. Twety-five patients (75.76%)successed in vaginal delivery. Cesarean sections were performed in 8 cases (24 24%) because of encephalopelvic disproportion,cord prolapse and fetal distress. No neonatal asphyxia happened. Conclusion Amnioinfusion can effectively increase amniotic fluid volume,create favorable conditions of vaginal delivevy for oligohydramnios and decrease the incidence of cesarean section as well as improve perinatal outcome.