Parilla B V, McDermott T M
Department of Obstetrics and Gynecology, Northwestern University Medical School and Northwestern Memorial Hospital, Chicago, Illinois, USA.
Am J Perinatol. 1998;15(12):649-52. doi: 10.1055/s-2007-994085.
The objective of this article is to prospectively investigate the efficacy of amnioinfusion as a means to reduce febrile morbidity in pregnancies complicated by chorioamnionitis. All laboring patients with a temperature > or =100.1 degrees F were approached for study participation. Exclusion criteria included amnionitis diagnosed at greater than 8 cm dilation, multiple gestation, placental abruption, or a nonreassuring fetal heart rate tracing. Consenting patients were randomized to receive antibiotics (ampicillin or penicillin with gentamicin) and acetaminophen with or without amnioinfusion. All patients received intrauterine pressure catheter placement. For study patients, normal saline at room temperature was infused at 10 mL/min for 60 min, then 3 mL/min until delivery. Postpartum endometritis was defined as a temperature = 100.4 degrees F accompanied by uterine tenderness more than 12 hr after delivery. Statistical analysis was performed using the Student's t-test for continuous data and Chi-square for discrete variables. Thirty-six patients were enrolled, and complete data were available for 34 patients (17 in each group). There were no differences between groups with respect to maternal age, gravidity, race, or gestational age. There were also no differences between groups in duration of rupture of membranes, temperature at randomization, interval from randomization to delivery, cesarean section rate, or umbilical cord arterial pH. The mean temperature at the time of delivery was 99.8+/-0.9 degrees F for the amnioinfusion group versus 100.5+/-1.0 degrees F for the control group (p=0.046). Three of 17 amnioinfusion patients and 3 of 17 control patients had postpartum endometritis. There was 1 neonatal infection in the treatment group and no neonatal infections among the control patients. Prophylactic amnioinfusion was associated with a decline in temperature at the time of delivery. No untoward effects from the amnioinfusion were identified.
本文的目的是前瞻性地研究羊膜腔灌注作为降低合并绒毛膜羊膜炎的妊娠发热发病率的一种手段的疗效。所有体温≥100.1华氏度的临产患者均被邀请参与研究。排除标准包括宫口扩张大于8厘米时诊断出的羊膜腔炎、多胎妊娠、胎盘早剥或胎儿心率监护异常。同意参与的患者被随机分为接受抗生素（氨苄青霉素或青霉素加庆大霉素）和对乙酰氨基酚，同时接受或不接受羊膜腔灌注。所有患者均放置了宫内压力导管。对于研究患者，室温下的生理盐水以10毫升/分钟的速度输注60分钟，然后以3毫升/分钟的速度输注直至分娩。产后子宫内膜炎定义为分娩后12小时以上体温≥100.4华氏度并伴有子宫压痛。对于连续数据使用学生t检验，对于离散变量使用卡方检验进行统计分析。共招募了36名患者，34名患者（每组17名）有完整数据。两组在产妇年龄、孕次、种族或孕周方面无差异。两组在胎膜破裂时间、随机分组时的体温、随机分组至分娩的间隔、剖宫产率或脐动脉pH值方面也无差异。羊膜腔灌注组分娩时的平均体温为99.8±0.9华氏度，而对照组为100.5±1.0华氏度（p = 0.046）。17名羊膜腔灌注患者中有3名，17名对照组患者中有3名发生了产后子宫内膜炎。治疗组有1例新生儿感染，对照组无新生儿感染。预防性羊膜腔灌注与分娩时体温下降有关。未发现羊膜腔灌注的不良影响。
