Coolen Jillian, Kabayashi Koichi, Wong Karen, Mayes Damon C, Bott Nancy, Demianczuk Nestor
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, AB.
Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, AB; Department of Obstetrics and Gynaecology, Social Insurance Chuo General Hospital, Tokyo, Japan.
J Obstet Gynaecol Can. 2010 Nov;32(11):1030-1034. doi: 10.1016/S1701-2163(16)34709-0.
to evaluate the influence of initial oligohydramnios on the prognosis of women with preterm premature rupture of the membranes (PPROM) at 30 to 36 weeks' gestation.
the Royal Alexandra Hospital ultrasound database was used to identify singleton pregnancies at 30 to 36 weeks' gestation with an ultrasound performed for confirmed PPROM from January 1992 to December 2006. Records were linked to the electronic provincial delivery record to perform a retrospective cohort study comparing the outcomes of pregnancies with an initial amniotic fluid index (AFI) < 5 cm with the outcomes of pregnancies with an AFI of 5 to 10 cm. Logistic and linear regression were used to analyze the association between binary outcome and explanatory variables.
the maternal and perinatal outcomes of 438 pregnancies were analyzed. Univariate analysis suggested statistically significant associations between initial oligohydramnios and decreased latency (P < 0.001), increased histologically proven chorioamnionitis (P = 0.01), neonatal length of stay in hospital (P = 0.002), and NICU (P = 0.003); however, after controlling for confounding variables (gestational age at delivery, parity, presentation, and antenatal antibiotic and corticosteroid administration), only latency remained significant (P = 0.004). No association was found between initial oligohydramnios and any other outcomes assessed, including mode of delivery, postpartum endometritis, maternal length of stay, non-reassuring fetal status, and neonatal morbidity and mortality.
initial oligohydramnios is associated with decreased latency in singleton pregnancies complicated by PPROM at 30 to 36 weeks' gestation; however, it does not appear to influence maternal or neonatal infectious morbidity, and it may not be useful to determine candidacy for expectant management or intentional delivery.
评估妊娠30至36周胎膜早破（PPROM）女性患者初始羊水过少对预后的影响。
利用皇家亚历山德拉医院超声数据库，识别1992年1月至2006年12月期间妊娠30至36周因确诊PPROM而进行超声检查的单胎妊娠。将记录与省级电子分娩记录相链接，进行回顾性队列研究，比较初始羊水指数（AFI）<5 cm的妊娠结局与AFI为5至10 cm的妊娠结局。采用逻辑回归和线性回归分析二元结局与解释变量之间的关联。
分析了438例妊娠的母婴结局。单因素分析表明，初始羊水过少与潜伏期缩短（P<0.001）、组织学证实的绒毛膜羊膜炎增加（P=0.01）、新生儿住院时间延长（P=0.002）和新生儿重症监护病房（NICU）入住率增加（P=0.003）之间存在统计学显著关联；然而，在控制混杂变量（分娩时的孕周、产次、胎位以及产前抗生素和皮质类固醇的使用）后，仅潜伏期仍具有统计学显著性（P=0.004）。未发现初始羊水过少与其他评估结局之间存在关联，包括分娩方式、产后子宫内膜炎、产妇住院时间、胎儿窘迫、新生儿发病率和死亡率。
妊娠30至36周合并PPROM的单胎妊娠中，初始羊水过少与潜伏期缩短有关；然而，它似乎不影响母婴感染性发病率，对于确定期待治疗或计划性分娩的候选资格可能并无帮助。
