Park J S, Yoon B H, Romero R, Moon J B, Oh S Y, Kim J C, Jun J K
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, and the Laboratory of Fetal Medicine Research, Clinical Research Institute, Seoul National University Hospital, Korea.
Am J Obstet Gynecol. 2001 Feb;184(3):459-62. doi: 10.1067/mob.2001.109398.
The objective of this study was to determine whether a reduced amniotic fluid volume was associated with the onset of preterm parturition in patients with preterm premature rupture of membranes.
An amniotic fluid index was determined before transabdominal amniocentesis in 129 patients with preterm premature rupture of membranes (gestational age < or = 35 weeks). Amniotic fluid was cultured for aerobic and anaerobic bacteria, as well as for mycoplasmas. Survival techniques were used for analysis.
Amniotic fluid index was < or = 5 cm in 29% of patients (38/129). Patients with an amniotic fluid index of < or = 5 cm had a significantly higher rate of positive amniotic fluid culture than those with an amniotic fluid index of >5 cm (42% [16/38] vs 18% [16/91]; P<.01). Spontaneous preterm delivery within 24 hours and 48 hours was more frequent among patients with an amniotic fluid index of < or = 5 cm than those with an amniotic fluid index of >5 cm (for 24 hours, 29% vs 12%; for 48 hours, 42% vs 21%; P<.05 for each). The amniocentesis-to-delivery interval was significantly shorter in patients with an amniotic fluid index of < or = 5 cm than in patients with an amniotic fluid index of >5 cm (median, 38 hours; range, 0.2-1310 hours; vs median, 100 hours; range 0.1-2917 hours; P<.01). Moreover, Cox proportional hazards model analysis indicated that an amniotic fluid index of < or = 5 cm was a significant predictor of the duration of the pregnancy after adjustment for gestational age and the results of amniotic fluid culture (odds ratio, 2.4; 95% confidence interval, 1.4-3.9; P<.001).
Patients with preterm premature rupture of membranes and an amniotic fluid index of < or = 5 cm are at increased risk for a shorter interval to delivery.
本研究的目的是确定羊水量减少是否与胎膜早破患者早产的发生有关。
对129例胎膜早破（孕周≤35周）患者在经腹羊膜腔穿刺术前测定羊水指数。羊水进行需氧菌、厌氧菌及支原体培养。采用生存分析技术进行分析。
29%（38/129）的患者羊水指数≤5cm。羊水指数≤5cm的患者羊水培养阳性率显著高于羊水指数>5cm的患者（42%[16/38]对18%[16/91]；P<0.01）。羊水指数≤5cm的患者在24小时和48小时内自然早产的发生率高于羊水指数>5cm的患者（24小时时，分别为29%对12%；48小时时，分别为42%对21%；各P<0.05）。羊水指数≤5cm的患者羊膜腔穿刺至分娩的间隔时间显著短于羊水指数>5cm的患者（中位数为38小时；范围为0.2 - 1310小时；相比之下，中位数为100小时；范围为0.1 - 2917小时；P<0.01）。此外，Cox比例风险模型分析表明，在调整孕周和羊水培养结果后，羊水指数≤5cm是妊娠持续时间的显著预测因素（优势比为2.4；95%置信区间为1.4 - 3.9；P<0.001）。
胎膜早破且羊水指数≤5cm的患者分娩间隔时间缩短的风险增加。
