妊娠34周及以后单纯羊水过多与妊娠结局的关联。
Association of isolated polyhydramnios at or beyond 34 weeks of gestation and pregnancy outcome.
作者信息
Aviram Amir, Salzer Liat, Hiersch Liran, Ashwal Eran, Golan Gilad, Pardo Joseph, Wiznitzer Arnon, Yogev Yariv
机构信息
Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.
出版信息
Obstet Gynecol. 2015 Apr;125(4):825-832. doi: 10.1097/AOG.0000000000000740.
OBJECTIVE
To evaluate pregnancy outcome among women with isolated polyhydramnios at admission for labor at or beyond 34 weeks of gestation.
METHODS
Retrospective cohort study at a tertiary medical center between 2007 and 2012. Isolated polyhydramnios was defined as amniotic fluid index (AFI) greater than 25 cm at admission in the absence of gestational or pregestational diabetes mellitus or fetal structural or chromosomal anomalies. Women with isolated polyhydramnios were compared with women with a normal AFI (5-25 cm).
RESULTS
Overall, 31,376 women were eligible for analysis, of whom 215 (0.7%) had isolated polyhydramnios and 31,161 normal AFI. Women with isolated polyhydramnios had higher rates of labor induction (7.9% compared with 4.8%, P=.04) and cesarean delivery (12.1% compared with 5.1%, P<.001). They also had higher rates of placental abruption (0.9% compared with 0.2%, P=.02), abnormal or intermediate fetal heart rate (FHR) tracings (7.0% compared with 3.2%, P=.002), and prolonged first stage of delivery (6.0% compared with 1.4%, P<.001). Isolated polyhydramnios was also associated with higher rates of shoulder dystocia (1.9% compared with 0.3%, P<.001) and respiratory distress syndrome (0.5% compared with 0.03%, P=.001). On a multiple logistic regression model, isolated polyhydramnios was an independent risk factor for labor induction (adjusted odds ratio [OR] 1.7, 95% confidence interval [CI] 1.01-2.8), cesarean delivery (adjusted OR 2.6, 95% CI 1.7-4.0), prolonged first stage of delivery (adjusted OR 3.6, 95% CI 1.97-6.7), abnormal or intermediate FHR tracings (adjusted OR 2.6, 95% CI 1.6-4.5), placental abruption (adjusted OR 8.4, 95% CI 2.00-35.4), shoulder dystocia (adjusted OR 3.4, 95% CI 1.2-9.7), and respiratory distress syndrome (adjusted OR 38.9, 95% CI 4.6-332.6). Mild isolated polyhydramnios (AFI 25.1-30.0) was independently associated with cesarean delivery, prolonged first stage of delivery, placental abruption, abnormal or intermediate FHR tracings, and shoulder dystocia.
CONCLUSION
Isolated polyhydramnios at admission for labor at or beyond 34 weeks of gestation is associated with adverse obstetric and neonatal outcomes.
目的
评估妊娠34周及以后入院分娩时单纯羊水过多的孕妇的妊娠结局。
方法
2007年至2012年在一家三级医疗中心进行的回顾性队列研究。单纯羊水过多定义为入院时羊水指数（AFI）大于25 cm，且无妊娠期或孕前糖尿病、胎儿结构或染色体异常。将单纯羊水过多的孕妇与羊水指数正常（5 - 25 cm）的孕妇进行比较。
结果
总体而言，31376名女性符合分析条件，其中215名（0.7%）为单纯羊水过多，31161名羊水指数正常。单纯羊水过多的孕妇引产率较高（7.9% 对比4.8%，P = 0.04）和剖宫产率较高（12.1% 对比5.1%，P < 0.001）。她们胎盘早剥率也较高（0.9% 对比0.2%，P = 0.02）、胎儿心率（FHR）异常或中等异常的发生率较高（7.0% 对比3.2%，P = 0.002）以及第一产程延长率较高（6.0% 对比1.4%，P < 0.001）。单纯羊水过多还与肩难产率较高（1.9% 对比0.3%，P < 0.001）和呼吸窘迫综合征发生率较高（0.5% 对比0.03%，P = 0.001）相关。在多因素逻辑回归模型中，单纯羊水过多是引产（调整优势比[OR] 1.7，95%置信区间[CI] 1.01 - 2.8）、剖宫产（调整OR 2.6，95% CI 1.7 - 4.0）、第一产程延长（调整OR 3.6，95% CI 1.97 - 6.7）、FHR异常或中等异常（调整OR 2.6，95% CI 1.6 - 4.5）、胎盘早剥（调整OR 8.4，95% CI 2.00 - 35.4）、肩难产（调整OR 3.4，95% CI 1.2 - 9.7）和呼吸窘迫综合征（调整OR 38.9，95% CI 4.6 - 332.6）的独立危险因素。轻度单纯羊水过多（AFI 25.1 - 30.0）与剖宫产、第一产程延长、胎盘早剥、FHR异常或中等异常以及肩难产独立相关。
结论
妊娠34周及以后入院分娩时单纯羊水过多与不良的产科和新生儿结局相关。
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