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孤立性羊水过少管理中的实践模式:围产医学专家调查

Practice patterns in the management of isolated oligohydramnios: a survey of perinatologists.

作者信息

Schwartz Nadav, Sweeting Raeshell, Young Bruce K

机构信息

Department of Obstetrics and Gynecology, New York University School of Medicine, 462 First Ave, NB-9E2, New York, NY 10016, USA.

出版信息

J Matern Fetal Neonatal Med. 2009 Apr;22(4):357-61. doi: 10.1080/14767050802559103.

Abstract

OBJECTIVE

Optimal management of isolated oligohydramnios (IO) remains debatable. We surveyed Society for Maternal-Fetal Medicine (SMFM) members regarding their opinions and practice patterns.

STUDY DESIGN

Questionnaires were mailed to perinatologists across the US. IO was defined as sonographic low fluid (per the practitioner's definition) in the absence of intrauterine growth restriction, fetal anomaly or significant maternal comorbidity.

RESULTS

The overall response rate was 35% (n = 632). Ninety-two percent of respondents consider IO to be a risk factor for various adverse outcomes. With a favourable cervix, 34% and 82% would consider inducing labour without documented lung maturity prior to 37 and 39 weeks, respectively. When asked whether induction of labour in cases of IO reduces perinatal morbidity, 45% were unsure and 21.4% thought it would not. Only 33% believe induction could decrease adverse outcomes. Newer members of SMFM (<10 years) and those of private practice were more likely to believe that induction is efficacious in decreasing morbidity.

CONCLUSION

There is significant divergence regarding the management of IO. Despite being unsure of its benefit, most practitioners lean towards intervention. The available literature is insufficient to make firm recommendations supporting intervention for IO.

摘要

目的

孤立性羊水过少(IO)的最佳管理仍存在争议。我们就母胎医学协会(SMFM)成员的意见和实践模式进行了调查。

研究设计

向美国各地的围产医学专家邮寄了调查问卷。IO被定义为超声显示羊水过少(根据从业者的定义),且不存在宫内生长受限、胎儿异常或严重的母体合并症。

结果

总体回复率为35%(n = 632)。92%的受访者认为IO是各种不良结局的危险因素。对于宫颈条件良好的情况,分别有34%和82%的人会考虑在孕37周和39周之前在未记录肺成熟度的情况下引产。当被问及IO病例引产是否能降低围产期发病率时,45%的人不确定,21.4%的人认为不能。只有33%的人相信引产可以减少不良结局。SMFM的新成员(<10年)和私人执业者更有可能认为引产在降低发病率方面是有效的。

结论

关于IO的管理存在显著分歧。尽管不确定其益处,但大多数从业者倾向于干预。现有文献不足以做出支持对IO进行干预的明确建议。

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