羊水过多和小于胎龄是新生儿死亡和孕产妇发病的独立危险因素。

Hydramnios and small for gestational age are independent risk factors for neonatal mortality and maternal morbidity.

作者信息

Erez Offer, Shoham-Vardi Ilana, Sheiner Eyal, Dukler Doron, Bashiri Asher, Mazor Moshe

机构信息

Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.

出版信息

Arch Gynecol Obstet. 2005 Apr;271(4):296-301. doi: 10.1007/s00404-004-0656-4. Epub 2004 Jul 9.

DOI:10.1007/s00404-004-0656-4

PMID:15243757

Abstract

OBJECTIVE

The objective was to evaluate the contribution of hydramnios and small for gestational age (SGA) as a combined pathology to maternal and neonatal morbidity and mortality.

METHODS

The study population consisted of 192 SGA neonates with hydramnios, 5,515 SGA neonates with a normal amount of amniotic fluids, 3,714 appropriate for gestational age (AGA) neonates with polyhydramnios and 83,763 AGA neonates with a normal amount of amniotic fluid. A cross-sectional population based study was designed between the four study groups. Multiple logistic regression analysis was used to assess the contribution of these abnormalities and different risk factors to maternal and perinatal complications.

RESULTS

The combination of hydramnios/SGA was found to be an independent risk factor for perinatal mortality (OR 20.55; CI 12.6-33.4). Congenital anomalies, prolapse of cord, hydramnios, SGA and grand multiparity were also independent risk factors for perinatal mortality. Independent risk factors for neonatal complications were prolapse of umbilical cord (OR 4.13; 95% CI 1.48-11.5), hydramnios/SGA (OR 2.72; 95% CI 1.81-4.07), chronic hypertension (OR 2.45; 95% CI 1.02-5.9), congenital malformations (OR 1.93; 95% CI 1.14-3.24) and SGA (OR 1.47; 95% CI 1.07-2). Significant independent risk factors for medical interventions during labor were fetal distress (OR 198.46; 95% CI 47.27-825.27), GDM Class B-R (OR 21.22; 95% CI 2.34-192.25), GDM class A (OR 4.64; 95% CI 2.62-8.21), severe pregnancy-induced hypertension (PIH; OR 7.74; 95% CI 2.35-25.42), hydramnios (OR 1.95; 95% CI 1.3-2.91), hydramnios/SGA (OR 1.84; 95% CI 1.12-3.02) and malpresentation (OR 1.56; 95% CI 1.32-1.84).

CONCLUSION

The combination of hydramnios and SGA is an independent risk factor for perinatal mortality and maternal complications. We suggest that the growth restriction of these fetuses is responsible for the neonatal complications, while the hydramnios contributes mainly to maternal complications.

摘要

目的

评估羊水过多与小于胎龄儿（SGA）合并症对孕产妇及新生儿发病和死亡的影响。

方法

研究人群包括192例伴有羊水过多的SGA新生儿、5515例羊水正常的SGA新生儿、3714例伴有羊水过多的适于胎龄（AGA）新生儿以及83763例羊水正常的AGA新生儿。在这四个研究组之间开展了一项基于人群的横断面研究。采用多因素logistic回归分析来评估这些异常情况和不同风险因素对孕产妇及围产期并发症的影响。

结果

发现羊水过多/SGA合并症是围产期死亡的独立危险因素（比值比[OR]20.55；可信区间[CI]12.6 - 33.4）。先天性异常、脐带脱垂、羊水过多、SGA及多产也是围产期死亡的独立危险因素。新生儿并发症的独立危险因素包括脐带脱垂（OR 4.13；95%CI 1.48 - 11.5）、羊水过多/SGA（OR 2.72；95%CI 1.81 - 4.07）、慢性高血压（OR 2.45；95%CI 1.02 - 5.9）、先天性畸形（OR 1.93；95%CI 1.14 - 3.24）及SGA（OR 1.47；95%CI 1.07 - 2）。分娩期间医疗干预的显著独立危险因素包括胎儿窘迫（OR 198.46；95%CI 47.27 - 825.27）、B - R级妊娠期糖尿病（GDM；OR 21.22；95%CI 2.34 - 192.25）、A级GDM（OR 4.64；95%CI 2.62 - 8.21）、重度妊娠高血压综合征（PIH；OR 7.74；95%CI 2.35 - 以上是完整翻译内容，你可按需查看使用。25.42）、羊水过多（OR 1.95；95%CI 1.3 - 2.91）、羊水过多/SGA（OR 1.84；

95%CI 1.12 - 3.02）及胎位异常（OR 1.56；95%CI 1.32 - 1.84）。