Ashwal Eran, Hiersch Liran, Melamed Nir, Aviram Amir, Wiznitzer Arnon, Yogev Yariv
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petah Tiqwa, Israel.
Arch Gynecol Obstet. 2014 Nov;290(5):875-81. doi: 10.1007/s00404-014-3292-7. Epub 2014 Jun 13.
As conflicting data exist concerning the implications of isolated oligohydramnios on pregnancy outcome at term, we aimed to assess this association in low-risk pregnancies.
A retrospective cohort study of term pregnancies with sonographic finding of isolated oligohydramnios (amniotic fluid index (AFI) <5 cm) between 2007 and 2012. Outcome was compared to a control group of pregnancies with normal AFI (5-25 cm). Pregnancies complicated by thrombophilia, hypertension, diabetes, deviant fetal growth or chromosomal/structural abnormalities were excluded. Composite adverse outcome included CS/operative delivery due to non-reassuring heart rate (NRFHR), low Apgar score, umbilical artery pH < 7.10, neonatal intensive care admission, meconium aspiration syndrome, intubation or hypoxic-ischemic encephalopathy.
Overall, 987 pregnancies complicated by isolated oligohydramnios were compared to 22,280 low-risk pregnancies with normal AFI. Isolated oligohydramnios was associated with a higher rate of induction of labor (27.7 vs. 3.7 %, p < 0.001), CS due to NRFHR (2.3 vs. 1.1 %, p < 0.01) and composite adverse outcome (9.7 vs. 7.1 %, p < 0.01). However, after adjusting for potential confounders as induction of labor and nulliparity using multivariable logistic regression analysis, isolated oligohydramnios was not found to be independently associated with increased risk for composite adverse outcome (OR 1.01, 95 % CI 0.80-1.27, p = 0.93).
Isolated oligohydramnios at term by itself is not associated with increased obstetrical morbidity.
由于关于足月孤立性羊水过少对妊娠结局的影响存在相互矛盾的数据，我们旨在评估低风险妊娠中的这种关联。
对2007年至2012年间超声检查发现孤立性羊水过少（羊水指数（AFI）<5 cm）的足月妊娠进行回顾性队列研究。将结局与羊水指数正常（5 - 25 cm）的对照组妊娠进行比较。排除合并血栓形成倾向、高血压、糖尿病、胎儿生长异常或染色体/结构异常的妊娠。复合不良结局包括因胎心异常（NRFHR）行剖宫产/手术分娩、低Apgar评分、脐动脉pH<7.10、新生儿重症监护病房入院、胎粪吸入综合征、插管或缺氧缺血性脑病。
总体而言，将987例合并孤立性羊水过少的妊娠与22,280例羊水指数正常的低风险妊娠进行了比较。孤立性羊水过少与引产率较高（27.7%对3.7%，p<0.001）、因NRFHR行剖宫产（2.3%对1.1%，p<0.01）以及复合不良结局（9.7%对7.1%，p<0.01）相关。然而，在使用多变量逻辑回归分析对引产和初产等潜在混杂因素进行校正后，未发现孤立性羊水过少与复合不良结局风险增加独立相关（OR 1.01，95%CI 0.80 - 1.27，p = 0.93）。
足月时孤立性羊水过少本身与产科发病率增加无关。
