Locatelli A, Vergani P, Di Pirro G, Doria V, Biffi A, Ghidini A
Divisione di Ostetricia e Ginecologia, Istituto di Scienze Biomediche San Gerardo, Università di Milano-Bicocca, Monza, Italy.
Am J Obstet Gynecol. 2000 Oct;183(4):878-82. doi: 10.1067/mob.2000.108873.
We sought to evaluate whether serial amnioinfusions for persistent oligohydramnios can affect the perinatal and long-term outcomes in extreme cases of preterm premature rupture of membranes.
All singleton pregnancies with preterm premature rupture of membranes at <26 weeks' gestation and lasting >4 days between January 1991 and June 1998 were included. Amniotic fluid volume was assessed as the maximum cord-free pocket with serial ultrasonographic examinations. Consenting women with persistent (>4 days) oligohydramnios (amniotic fluid </=2 cm) received serial transabdominal amnioinfusions to maintain an amniotic fluid pocket >2 cm. The pregnancy, neonatal, and long-term neurologic outcomes of the cases that spontaneously maintained a median amniotic fluid pocket >2 cm (amnioinfusion-not-necessary group) were compared with those of women with oligohydramnios who underwent amnioinfusion but continued to have a median amniotic fluid pocket after preterm premature rupture of membranes </=2 cm (persistent oligohydramnios group) and with those of women in whom oligohydramnios was alleviated by the procedure for at least 48 hours (successful amnioinfusion group). Statistical analysis included the Wilcoxon rank-sum test and the Fisher exact test, with a 2-tailed P <.05 considered significant.
Among the 49 women included in the study, 13 (26.5%) did not have oligohydramnios, the neonatal survival rate was 92%, and normal fetal lung development and neurologic outcome were achieved in all survivors. The remaining 36 women had oligohydramnios, and all underwent serial amnioinfusions, which successfully restored a median amniotic fluid pocket >2 cm for >/=48 hours in 11 (30%) patients. This successful amnioinfusion group was comparable with the persistent oligohydramnios group (n = 25) in gestational age at first amnioinfusion (median, 20.2 weeks; range, 16-25.6 weeks; vs median, 20.3 weeks; range, 16.5-24.2 weeks; P =.4), number of amnioinfusions (median, 3; range, 1-9; vs median, 3; range, 1-5; P =.4), and interval between amnioinfusions (median, 6 days; range, 4-14 days; vs median, 8 days; range, 6-43 days; P =. 1). However, patients in the persistent oligohydramnios group had a significantly shorter interval to delivery, lower neonatal survival (20%), and higher rates of pulmonary hypoplasia (62%) and abnormal neurologic outcomes (60%) than the patients in the groups in which amnioinfusion was not necessary or was successful (all P </=.01).
Pregnancies with preterm premature rupture of membranes-related oligohydramnios at <26 weeks' gestation in which serial amnioinfusions successfully alleviate oligohydramnios have a perinatal outcome that is significantly better than the outcome in those with persistent oligohydramnios and is comparable with gestations with preterm premature rupture of membranes in which oligohydramnios never develops.
我们试图评估对于胎膜早破极端病例中持续性羊水过少进行系列羊膜腔灌注是否会影响围产期及长期结局。
纳入1991年1月至1998年6月间所有孕龄小于26周且胎膜早破持续超过4天的单胎妊娠。通过系列超声检查将羊水体积评估为最大无脐带羊水暗区。同意参与研究的持续性（超过4天）羊水过少（羊水指数≤2cm）的孕妇接受系列经腹羊膜腔灌注以维持羊水暗区大于2cm。将自然维持羊水暗区中位数大于2cm的病例（无需羊膜腔灌注组）的妊娠、新生儿及长期神经学结局与胎膜早破后羊水过少且接受羊膜腔灌注但羊水暗区中位数仍≤2cm的孕妇（持续性羊水过少组）以及羊膜腔灌注使羊水过少缓解至少48小时的孕妇（成功羊膜腔灌注组）进行比较。统计分析包括Wilcoxon秩和检验及Fisher确切概率检验，双侧P<0.05被认为具有统计学意义。
在纳入研究的49名女性中，13名（26.5%）无羊水过少，新生儿存活率为92%，所有存活者均实现了正常胎儿肺发育及神经学结局。其余36名女性有羊水过少，均接受了系列羊膜腔灌注，其中11名（30%）患者成功使羊水暗区中位数大于2cm并维持≥48小时。该成功羊膜腔灌注组与持续性羊水过少组（n = 25）在首次羊膜腔灌注时的孕龄（中位数20.2周；范围16 - 25.6周；对比中位数20.3周；范围16.5 - 24.2周；P = 0.4）、羊膜腔灌注次数（中位数3次；范围1 - 9次；对比中位数3次；范围1 - 5次；P = 0.4）及羊膜腔灌注间隔时间（中位数6天；范围4 - 14天；对比中位数8天；范围6 - 43天；P = 0.1）方面具有可比性。然而，持续性羊水过少组患者的分娩间隔时间显著更短，新生儿存活率更低（20%），肺发育不全发生率（62%）及神经学异常结局发生率（60%）高于无需羊膜腔灌注组或成功羊膜腔灌注组患者（所有P≤0.01）。
孕龄小于26周的胎膜早破相关羊水过少妊娠中，系列羊膜腔灌注成功缓解羊水过少者的围产期结局显著优于持续性羊水过少者，且与胎膜早破但从未发生羊水过少的妊娠结局相当。
