Vikraman Seneesh Kumar, Chandra Vipin, Balakrishnan Bijoy, Batra Meenu, Sethumadhavan Sreeja, Patil Swapneel Neelkanth, Nair Sabila, Kannoly Gopinathan
Department of Fetomaternal Medicine, Centre for Infertility and Assisted Reproduction (CIMAR), Edappal Hospitals Private Limited, Edappal, Malappuram, Kerala 679576, India.
Department of Fetomaternal Medicine, Centre for Infertility and Assisted Reproduction (CIMAR), Edappal Hospitals Private Limited, Edappal, Malappuram, Kerala 679576, India.
Eur J Obstet Gynecol Reprod Biol. 2017 May;212:96-100. doi: 10.1016/j.ejogrb.2017.03.026. Epub 2017 Mar 20.
The primary objective our study was to assess the role of diagnostic antepartum amnioinfusion on the yield from targeted ultrasounds performed in pregnancies with severe oligo- and anhydramnios.
This was a retrospective and descriptive study, conducted in the fetal medicine units of two private tertiary care referral centers in south India. The details of all the cases of diagnostic amnioinfusion performed at these two centers from January 2009 to June 2016 were collected and analyzed. Inclusion criteria were pregnancies between 17 and 26 weeks of gestational age with severe oligo- or anhydramnios. Pregnancies with obvious preterm premature rupture of membranes (PPROM) were excluded. The primary outcome measure was the improvement in diagnostic information pertaining to cause of severe oligo- and anhydramnios, and the nature of such anomalies.
A total of 61 cases of were identified. The median gestational age at performance of the procedure was 22 weeks [IQR, 19.5-23]. The mean volume of normal saline infused was 314±54ml. A significant increase in the single vertical pocket (SVP) was observed following the procedure (pre-procedure SVP=0.6±0.9cm, post procedure SVP=3.4±1.7; paired t test, p<0.001). In 37 cases (37/61, 60.7%), there were no pre-procedure ultrasound findings. There was significant overall detection of abnormalities post procedure (mean pre-procedure findings=0.39±0.49, mean post procedure findings=1.59±1.24; paired t test, p<0.001). The most frequent group of anomalies/abnormalities were renal (36/61, 59%), followed by PPROM (13/61, 21.3%) and finally fetal growth restriction (11/61, 18%).
CONCLUSION(S): Antepartum amnioinfusion is a valuable ancillary technique in prenatal diagnosis as it increases the diagnostic yield from pregnancies presenting with severe oligo- and anhydramnios.
我们研究的主要目的是评估产前诊断性羊膜腔灌注在严重羊水过少和羊水过少孕妇的针对性超声检查结果中的作用。
这是一项回顾性描述性研究，在印度南部两个私立三级医疗转诊中心的胎儿医学科进行。收集并分析了2009年1月至2016年6月在这两个中心进行的所有诊断性羊膜腔灌注病例的详细信息。纳入标准为孕龄在17至26周之间且有严重羊水过少或羊水过少的孕妇。胎膜早破明显的孕妇被排除在外。主要结局指标是与严重羊水过少和羊水过少原因以及此类异常性质相关的诊断信息的改善情况。
共确定了61例病例。进行该操作时的中位孕周为22周[四分位间距，19.5 - 23]。注入的生理盐水平均体积为314±54ml。操作后观察到单一垂直羊水池（SVP）显著增加（操作前SVP = 0.6±0.9cm，操作后SVP = 3.4±1.7；配对t检验，p<0.001）。在37例（37/61，60.7%）病例中，操作前超声检查无发现。操作后总体上显著检测到更多异常（操作前平均发现数 = 0.39±0.49, 操作后平均发现数 = 1.59±1.24；配对t检验，p<0.001）。最常见的异常组是肾脏异常（36/61，59%），其次是胎膜早破（13/61，21.3%），最后是胎儿生长受限（11/61，18%）。
产前羊膜腔灌注是产前诊断中有价值的辅助技术，因为它提高了严重羊水过少和羊水过少孕妇的诊断率。
