Birmingham Centre for Women's & Children's Health & School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Fetal Medicine Centre, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK.
BJOG. 2014 May;121(6):686-99. doi: 10.1111/1471-0528.12589. Epub 2014 Feb 7.
Measurements of amniotic fluid volume are used for pregnancy surveillance despite a lack of evidence for their predictive ability.
To evaluate the association and predictive value of ultrasound measurements of amniotic fluid volume for adverse pregnancy outcome.
Electronic databases (inception to October 2011), reference lists, hand searching of journals, contact with experts.
Studies comparing measurements of amniotic fluid volume with adverse outcome, excluding pre-labour ruptured membranes or congenital/structural anomalies.
Data on study characteristics, design, quality. Random effects meta-analysis to estimate summary odds ratios (prognostic association) and summary sensitivity, specificity and likelihood ratios (predictive ability).
Forty-three studies (244,493 fetuses) were included demonstrating a strong association between oligohydramnios (varying definitions) and birthweight <10th centile (summary odds ratio [OR] 6.31, 95% confidence interval [95% CI] 4.15-9.58; high-risk population [author definition] n = 6 studies, 28,510 fetuses), and mortality (neonatal death any population summary OR 8.72, 95% CI 2.43-31.26; n = 6 studies, 55,735 fetuses; and perinatal mortality high-risk population summary OR 11.54, 95% CI 4.05-32.9; n = 2 studies, 27;891 fetuses). There was a strong association between polyhydramnios (maximum pool depth >8 cm or amniotic fluid index ≥25 cm) and birthweight >90th centile (OR 11.41, 95% CI 7.09-18.36; n = 1 study, 3960 fetuses). Despite strong associations, predictive accuracy for perinatal outcome was poor.
AUTHOR'S CONCLUSION: Current evidence suggests that oligohydramnios is strongly associated with being small for gestational age and mortality, and polyhydramnios with birthweight >90th centile. Despite strong associations with poor outcome, they do not accurately predict outcome risk for individuals.
尽管羊水体积测量对预测能力缺乏证据，但仍用于妊娠监测。
评估超声测量羊水体积与不良妊娠结局的相关性和预测价值。
电子数据库（从创建到 2011 年 10 月）、参考文献列表、期刊的手工搜索、与专家联系。
比较羊水体积测量与不良结局的研究，排除产前破裂膜或先天性/结构异常。
研究特征、设计、质量的数据。随机效应荟萃分析估计汇总优势比（预后关联）和汇总敏感性、特异性和似然比（预测能力）。
共纳入 43 项研究（244493 例胎儿），表明羊水过少（不同定义）与出生体重<第 10 百分位（汇总优势比[OR]6.31，95%置信区间[95%CI]4.15-9.58；高危人群[作者定义]n=6 项研究，28510 例胎儿）和死亡率（新生儿死亡任何人群汇总 OR 8.72，95%CI 2.43-31.26；n=6 项研究，55735 例胎儿；围产儿死亡率高危人群汇总 OR 11.54，95%CI 4.05-32.9；n=2 项研究，27891 例胎儿）之间存在强烈关联。羊水过多（最大池深度>8cm 或羊水指数≥25cm）与出生体重>第 90 百分位（OR 11.41，95%CI 7.09-18.36；n=1 项研究，3960 例胎儿）之间存在强烈关联。尽管存在强烈关联，但对围产儿结局的预测准确性较差。
目前的证据表明，羊水过少与胎儿小于胎龄和死亡率密切相关，而羊水过多与出生体重>第 90 百分位相关。尽管与不良结局有强烈关联，但它们并不能准确预测个体的结局风险。
