Abdel-Aleem H, Amin A F, Shokry M, Radwan R A
Department of Obstetrics and Gynecology, Assiut University Hospital, Assiut, Egypt.
Int J Gynaecol Obstet. 2005 Aug;90(2):94-8. doi: 10.1016/j.ijgo.2005.03.027.
To evaluate the role of therapeutic amnioinfusion using a pediatric feeding tube in cases of intrapartum fetal distress.
A randomized clinical trial including 438 women admitted in labor at Assiut University Hospital with nonreassuring fetal heart rate tracing. Using sealed opaque envelopes, the women were randomized to 2 groups. In the amnioinfusion group they underwent transcervical amnioinfusion (1000 mL of warmed sterile saline solution) in addition to conventional treatment. In the control group they received conventional treatment only. The primary outcome was cesarean section rate for fetal distress. The secondary outcomes were neonatal and maternal complications.
The amnioinfusion group showed a significant reduction in the rate of cesarean section for fetal distress (relative risk [RR], 0.7; 95% confidence interval [CI], 0.6-0.83), and a 30% reduction in abnormal fetal heart rate patterns (RR, 0.7; 95% CI, 0.6-0.83). Significantly fewer newborns had Apgar scores less than 7 at 1 and 5 min in the amnioinfusion group than in the control group (RR, 0.38; 95% CI, 0.26-0.55 and RR, 0.31; 95% CI, 0.15-0.64, respectively). Significantly fewer newborns had meconium below the vocal cords in the amnioinfusion group than in the control group (RR, 0.36; 95% CI, 0.13-0.97). Moreover, 14 newborns in the amnioinfusion group needed admission to the intensive care unit vs. 31 newborns in the control group. There were no significant differences between the 2 groups regarding the incidence rates of uterine hypertonus and maternal temperature higher than 38 degrees C.
Therapeutic amnioinfusion is a simple and effective intervention that reduces the rates of cesarean section for intrapartum nonreassuring fetal heart tracing. In under-resourced settings, it can be performed using inexpensive catheters.
评估使用小儿喂食管进行治疗性羊膜腔灌注在产时胎儿窘迫病例中的作用。
一项随机临床试验，纳入了438名在阿斯尤特大学医院分娩时出现胎儿心率监护异常的妇女。使用密封不透明信封将这些妇女随机分为两组。羊膜腔灌注组在接受常规治疗的基础上，接受经宫颈羊膜腔灌注（1000毫升温热无菌盐溶液）。对照组仅接受常规治疗。主要结局是因胎儿窘迫而行剖宫产的比率。次要结局是新生儿和母亲并发症。
羊膜腔灌注组因胎儿窘迫而行剖宫产的比率显著降低（相对危险度[RR]，0.7；95%置信区间[CI]，0.6 - 0.83），异常胎儿心率模式减少30%（RR，0.7；95%CI，0.6 - 0.83）。与对照组相比，羊膜腔灌注组在出生后1分钟和5分钟时阿氏评分低于7分的新生儿明显更少（RR分别为0.38；95%CI，0.26 - 0.55和RR，0.31；95%CI，0.15 - 0.64）。与对照组相比，羊膜腔灌注组声带以下有胎粪的新生儿明显更少（RR，0.36；95%CI，0.13 - 0.97）。此外，羊膜腔灌注组有14名新生儿需要入住重症监护病房，而对照组有31名新生儿。两组在子宫过度收缩发生率和母亲体温高于38摄氏度方面无显著差异。
治疗性羊膜腔灌注是一种简单有效的干预措施，可降低产时胎儿心率监护异常时的剖宫产率。在资源匮乏地区，可使用廉价导管进行该操作。
