足月妊娠羊水过少对围产结局的影响

The affects on perinatal period outcome caused by oligohydramnios of full-term pregnancy

目的 :分析足月妊娠孕产妇羊水过少对围产结局的影响。方法 :应用 B超羊水最大深度法及羊水指数法估测羊水量 ,并测定脐动脉收缩期最大血流速度 (S)和舒张末期血流速度 (D)的比值 (S/D) ,比较分析 2 4 0例羊水过少 (观察组 )和 2 4 0例羊水正常的足月妊娠妇女 (对照组 ) B超测量羊水量与实际过少的符合率、分娩情况及新生儿预后。结果 :AFI小于 3.5 cm时 ,B超测量羊水量与实际羊水过少符合率为 10 0 % ;AFI为 3.5～ 5 .0 cm时为 80 % ;AFI为 5～ 8cm时为 5 8% ;观察组择期剖宫产和急诊剖宫产率均显著高于对照组 (P<0 .0 1) ;阴道分娩的成功率明显低于对照组 (P<0 .0 1) ;胎儿宫内窘迫与羊水轻度混浊的发生率明显高于对照组 (P<0 .0 1) ;新生儿轻度窒息发生率明显高于对照组 (P<0 .0 1) ;重度窒息率两组间差异无显著性 (P>0 .0 5 )。结论 :加强对羊水过少的产前及产时监护 ,对重度羊水过少者不予试产 ,对试产的孕产妇产程中出现异常及时行急诊剖宫产而不过度试产。对于羊水过少 ,同时又合并其它高危因素者 ,应禁止试产 ,以剖宫产结束妊娠。

Objective:To analyse the affects on perinatal period outcome caused by oligohydramnios of full-term pregnancy. Methods: The amount of amniotic fluid was measured by estimating maximum depth and indexes with ultrasonic B; the systolic/diastolic ratio of the blood flow in fetal umbilical arteries were measured to compare and analyze the amniotic amount measured by ultrasonic B and its coincidence rate of actual oligohydramnios, delivery and newborns' prognosis between the observation group (240 cases with oligohydramnios) and the control group (240 cases with normal amniotic fluid and full-term pregnancy). Results:The value of AFI less than 3.5cm was regarded as 100%, 3.5~5.0 cm as 80%, and 5~8 cm as 58%. The rates of time-selecting caesarean section and emergent were significantly higher than that of controls (P<0.01). The successful rate of vaginal delivery was significantly lower than that of controls (P<0.01). The incidence of fetal distress in uterus and mild opacity of amniotic fluid was significantly higher than that of controls (P<0.01). The incidence of mild asphyxia of newborns was also significantly higher than that of controls (P<0.01). There was no difference in the incidence of severe neonatal asphyxia between the two groups. Conclusion: Prenatal and perinatal monitoring of oligohydramnios should be strengthened. Trial of labor is not recommended for severe oligohydramnios. To those women who presented abnormal phenomenon during the trial of labor, emergent caesarean section have to be done in time instead of trial of labor and to those who have oligohydramnios as well as high-risk factors, trial of labor is forbidden and the pregnancy is ended with caesarean section.