Odibo Imelda N, Newville Trista M, Ounpraseuth Songthip T, Dixon Mandi, Lutgendorf Monica A, Foglia Lisa M, Magann Everett F
University of Arkansas for Medical Sciences, Little Rock, AR, United States.
Madigan Army Medical Center, Tacoma, WA, United States.
Eur J Obstet Gynecol Reprod Biol. 2016 Apr;199:175-8. doi: 10.1016/j.ejogrb.2016.02.018. Epub 2016 Feb 21.
To investigate the likelihood of resolution of idiopathic polyhydramnios in pregnant women and compare outcomes between resolved and persistent cases.
One hundred and sixty-three women with idiopathic polyhydramnios who delivered at two medical centers during a 3 year period (January 2012-January 2015) were included in the study. Exclusion criteria included congenital fetal anomalies, maternal diabetes, isoimmunization, fetal infection, placental tumors or anomalies, and multiple gestation. Polyhydramnios was defined as SDP≥8cm or AFI≥24cm. Resolved cases were defined as those with AFI and/or SDP falling and remaining below 24cm and 8cm respectively. Pregnancy outcomes were compared between resolved and persistent cases. Two-sample t-test or Wilcoxon rank-sum test was used for continuous variables while chi-square test or Fisher's exact test was used for categorical measures.
Resolution was noted in 61 of 163 (37%) patients. There were no differences in maternal age, gravidity or parity between resolved and persistent cases. Mean gestational age at diagnosis of polyhydramnios and overall mean AFI were significantly lower in the cases that resolved (29.7±4.5 weeks vs 33.4±4.1 weeks, p<0.0001; 23.3±3.5cm vs 25.8 23.3±4.0cm, p=0.0002). Similar to AFI measurements, mean SDP was also lower in cases with resolution (p=0.002). There was no difference in induction rates, mode of delivery, amnioinfusion rates, meconium staining of amniotic fluid and fetal heart rate abnormalities influencing intrapartum management between the two groups. Induction of labor for fetal indication and rupture of membranes were significantly more common in the persistent group. Cesarean delivery for abnormal lie and fetal distress did not differ between the groups. There was an increased risk of macrosomia (>4000g) and preterm delivery (<37 weeks) in the persistent group (p<0.05).
Resolution rate was approximately 37% and more likely in cases diagnosed earlier in pregnancy and with lower mean amniotic fluid volume. Preterm delivery and macrosomia were more common in cases that persisted across gestation.
探讨孕妇特发性羊水过多自行消退的可能性，并比较消退病例与持续存在病例的结局。
本研究纳入了在3年期间（2012年1月至2015年1月）于两个医疗中心分娩的163例特发性羊水过多的妇女。排除标准包括先天性胎儿畸形、母体糖尿病、血型不合、胎儿感染、胎盘肿瘤或畸形以及多胎妊娠。羊水过多定义为单一最大羊水深度（SDP）≥8cm或羊水指数（AFI）≥24cm。消退病例定义为AFI和/或SDP下降并分别保持在24cm和8cm以下的病例。比较消退病例与持续存在病例的妊娠结局。连续变量采用两样本t检验或Wilcoxon秩和检验，分类变量采用卡方检验或Fisher精确检验。
163例患者中有61例（37%）羊水过多自行消退。消退病例与持续存在病例在产妇年龄、孕次或产次方面无差异。羊水过多诊断时的平均孕周以及总体平均AFI在消退病例中显著更低（29.7±4.5周对33.4±4.1周，p<0.0001；23.3±3.5cm对25.8±4.0cm，p=0.0002）。与AFI测量结果相似，消退病例的平均SDP也更低（p=0.002）。两组在引产率、分娩方式、羊膜腔灌注率、羊水胎粪污染以及影响产时管理的胎儿心率异常方面无差异。因胎儿指征引产和胎膜破裂在持续存在组中明显更常见。两组因胎位异常和胎儿窘迫行剖宫产的情况无差异。持续存在组巨大儿（>4000g）和早产（<37周）的风险增加（p<0.05）。
消退率约为37%，在妊娠早期诊断且平均羊水量较低时更有可能出现消退。在整个妊娠期持续存在羊水过多的病例中，早产和巨大儿更为常见。
