Rabie N, Magann E, Steelman S, Ounpraseuth S
Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Ultrasound Obstet Gynecol. 2017 Apr;49(4):442-449. doi: 10.1002/uog.15929.
To evaluate adverse pregnancy outcomes in singleton pregnancies diagnosed with oligohydramnios through a systematic review and meta-analysis of controlled trials.
We searched electronic databases via OVID, EBSCO, Web of Science, Google Scholar and others from 1980 to 2015. Prospective and retrospective studies with a control group were included. Two authors independently reviewed the abstracts from the literature search. Inclusion criteria were: studies in English, singleton pregnancy, normal fetal anatomy, intact membranes and oligohydramnios determined by the amniotic fluid index (AFI) technique. We stratified the meta-analysis into two groups according to risk: high risk including studies of oligohydramnios with comorbid conditions (e.g. hypertension) and low risk including studies of isolated oligohydramnios.
Fifteen trials met the inclusion criteria. Nine were high-risk and six were low-risk studies, including 8067 and 27 526 women, respectively. Compared with women with normal AFI, those with isolated oligohydramnios had significantly higher rates of an infant with meconium aspiration syndrome (relative risk (RR), 2.83; 95% CI, 1.38-5.77), Cesarean delivery for fetal distress (RR, 2.16; 95% CI, 1.64-2.85) and admission to the neonatal intensive care unit (NICU) (RR, 1.71; 95% CI, 1.20-2.42). Patients with oligohydramnios and comorbidities were more likely to have an infant with low birth weight (RR, 2.35; 95% CI, 1.27-4.34). However, rates of 5-min Apgar score < 7 (RR, 1.85; 95% CI, 0.69-4.96), NICU admission (RR, 2.09; 95% CI, 0.80-5.45), meconium-stained amniotic fluid (RR, 1.32; 95% CI, 0.62-2.81) and Cesarean delivery for fetal distress (RR, 1.65; 95% CI, 0.81-3.36) were similar to those for women with normal AFI. Stillbirth rates were too low to analyze in the meta-analysis.
This review helps to delineate which adverse outcomes are increased with oligohydramnios in low-risk pregnancy (NICU admission, Cesarean delivery for fetal distress and meconium aspiration syndrome), but does not provide enough data to determine the optimal timing of delivery in such cases. Oligohydramnios in complicated pregnancy is associated with an increased risk of delivery of an infant with low birth weight, but this may be confounded by the comorbid condition. Therefore, in high-risk pregnancy, management should be dictated by the comorbid condition and not the presence of oligohydramnios. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
通过对对照试验进行系统评价和荟萃分析，评估诊断为羊水过少的单胎妊娠的不良妊娠结局。
我们通过OVID、EBSCO、科学网、谷歌学术等电子数据库检索了1980年至2015年的文献。纳入有对照组的前瞻性和回顾性研究。两名作者独立审查文献检索得到的摘要。纳入标准为：英文研究、单胎妊娠、胎儿解剖结构正常、胎膜完整且通过羊水指数（AFI）技术确定为羊水过少。我们根据风险将荟萃分析分为两组：高风险组包括伴有合并症（如高血压）的羊水过少研究，低风险组包括单纯性羊水过少研究。
15项试验符合纳入标准。9项为高风险研究，6项为低风险研究，分别包括8067名和27526名女性。与AFI正常的女性相比，单纯性羊水过少的女性发生胎粪吸入综合征婴儿的比例显著更高（相对风险（RR）为2.83；95%置信区间为1.38 - 5.77）、因胎儿窘迫行剖宫产的比例（RR为2.16；95%置信区间为1.64 - 2.85）以及入住新生儿重症监护病房（NICU）的比例（RR为1.71；95%置信区间为1.20 - 2.42）。伴有合并症的羊水过少患者更有可能生出低体重婴儿（RR为2.35；95%置信区间为1.27 - 4.34）。然而，5分钟阿氏评分＜7分的比例（RR为1.85；95%置信区间为0.69 - 4.96）、入住NICU的比例（RR为2.09；95%置信区间为0.80 - 5.45）、羊水粪染的比例（RR为1.32；95%置信区间为0.62 - 2.81）以及因胎儿窘迫行剖宫产的比例（RR为1.65；95%置信区间为0.81 - 3.36）与AFI正常的女性相似。死产率过低，无法在荟萃分析中进行分析。
本综述有助于明确低风险妊娠中羊水过少会增加哪些不良结局（入住NICU、因胎儿窘迫行剖宫产和胎粪吸入综合征），但未提供足够数据来确定此类情况下的最佳分娩时机。复杂妊娠中的羊水过少与低体重儿出生风险增加相关，但这可能受到合并症的混淆。因此，在高风险妊娠中，管理应取决于合并症而非羊水过少的存在。版权所有©2016国际妇产科超声学会。由约翰·威利父子有限公司出版。
