Souza Alex Sandro Rolland, Patriota Adriane Farias, Guerra Gláucia Virgínia de Queiroz Lins, Melo Brena Carvalho Pinto de
Instituto de Medicina Integral Professor Fernando Figueira, Instituto de Medicina Integral Prof. Fernando Figueira, Fetal Medicine, Recife PE , Brazil, PhD in Maternal and Child Health - Sector Supervisor and Medical Residency Supervisor, Fetal Medicine/Instituto de Medicina Integral Prof. Fernando Figueira (Imip). Adjunct Professor, Maternal and Child Health Department/Universidade Federal de Pernambuco, Recife, PE, Brazil.
Instituto Materno Infantil de Pernambuco, Imip, Recife PE , Brazil, MSc in Intensive Care - Nurse at the Imip, Recife, PE, Brazil.
Rev Assoc Med Bras (1992). 2016 May-Jun;62(3):269-75. doi: 10.1590/1806-9282.62.03.269.
To determine the association between amniotic fluid index (AFI) and perinatal outcomes in preterm premature rupture of membranes (PPROM).
A retrospective cohort study was conducted between 2008 and 2012. 86 pregnant women were included, with a diagnosis of PPROM and gestational age from 24 to 35 weeks. Women who presented hypertensive disorders, diabetes, fetuses with birth defects and infection at admission were excluded. To determine the association between AFI and perinatal outcomes, chi-square and Fisher's exact test were used if necessary, as well as risk ratio (RR) and 95% confidence intervals (95CI). Correlation between AFI and perinatal outcomes was determined by using simple linear regression, and AFI progression during pregnancy was analyzed by Z-test.
When comparing newborns presenting ultrasound with AFI<5cm and AFI>5cm, there was a higher frequency of perinatal mortality when the AFI was lower than 5 cm. However, when the oligohydramnios was diagnosed as severe (AFI<3cm), there was a higher frequency of Apgar scores less than seven at 1 minute, neonatal sepsis and early neonatal mortality compared to those presenting AFI>3cm. There was a positive correlation between AFI and gestational age at delivery, birth weight and Apgar scores at minutes 1 and 5. There was also a decrease in amniotic fluid volume with increased gestational age.
The presence of severe oligohydramnios after PPROM contributed to a higher frequency of perinatal complications and death.
确定胎膜早破（PPROM）时羊水指数（AFI）与围产期结局之间的关联。
进行一项2008年至2012年的回顾性队列研究。纳入86例诊断为PPROM且孕周在24至35周之间的孕妇。排除入院时患有高血压疾病、糖尿病、胎儿有出生缺陷及感染的妇女。为确定AFI与围产期结局之间的关联，必要时采用卡方检验和Fisher精确检验，以及风险比（RR）和95%置信区间（95CI）。采用简单线性回归确定AFI与围产期结局之间的相关性，并通过Z检验分析孕期AFI的变化。
比较超声显示AFI<5cm和AFI>5cm的新生儿时，AFI低于5cm时围产期死亡率更高。然而，当羊水过少被诊断为严重（AFI<3cm）时，与AFI>3cm的新生儿相比，1分钟时Apgar评分低于7分、新生儿败血症和早期新生儿死亡率的发生率更高。AFI与分娩时的孕周、出生体重以及1分钟和5分钟时的Apgar评分呈正相关。随着孕周增加羊水量也减少。
PPROM后出现严重羊水过少会导致围产期并发症和死亡的发生率更高。
