足月妊娠合并特发性羊水过多的分娩结局

Delivery outcomes of term pregnancy complicated by idiopathic polyhydramnios.

作者信息

Zeino S, Carbillon L, Pharisien I, Tigaizin A, Benchimol M, Murtada R, Boujenah J

机构信息

Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93000 Bobigny, France.

出版信息

J Gynecol Obstet Hum Reprod. 2017 Apr;46(4):349-354. doi: 10.1016/j.jogoh.2017.02.014. Epub 2017 Feb 24.

DOI:10.1016/j.jogoh.2017.02.014

PMID:28643663

Abstract

OBJECTIVE

Polyhydramnios is associated with an increased risk of cesarean section. The aetiology of polyhydramnios and the characteristics of the labour may be confounding factors. The objective was to study the characteristics and mode of delivery in case of pregnancy complicated with idiopathic polyhydramnios.

METHODS

This retrospective matched and controlled study included all pregnant women with idiopathic polyhydramnios (amniotic index>25cm or single deepest pocket>8cm) diagnosed at the 2nd or 3rd trimester and persistent at term delivery (>37weeks of pregnancy) in our institution. We excluded pregnancies in which the polyhydramnios could be explained by infection, gestational diabetes, congenital malformation, abnormal karyotype, placental anomalies, alloimmunization as well as pregnancies in which an amniocentesis for the purpose of diagnosis had not been performed. Data were gathered from a tertiary care university hospital register from 1998-2015. Cases of polyhydramnios were matched with the following two women who presented for labour management with spontaneous cephalic presentation, matching for delivery date, maternal age, parity, body mass index. The main outcome measure was the risk of cesarean section. Univariate and multivariate adjusted analysis were performed.

RESULTS

We identified 108 women with idiopathic polyhydramnios and compared them with 216 matched women. Among them, 94 and 188 attempted a trial of labour. Maternal age, mean term delivery and birthweight were 31 years, 39+5weeks gestation and 3550 g. We did not observe differences in maternal characteristics, epidural analgesia and rate of abnormal fetal heart tracing. Induced labour and non-vertex presentations (forehead, bregma, face) were more frequent in the polyhydramnios group (respectively 57.9% versus 27.8%, P<0.05 and 7.8% versus 1%, P<0.05). Cesarean section rate was higher in the case of polyhydramnios in the overall population (45.4% versus 8%, P<0.05) and remained higher after exclusion of cases of induced labour and non-vertex presentation (38.4% versus 3.8%, P<0.05). Amniotomy was more frequent in pregnancies with polyhydramnios (55.8% versus 39.1%, P<0.05). After adjustment for matching and confounding variables, polyhydramnios was found to be a risk factor for cesarean section (OR 21.02; CI 95% 8.004-55.215, P<0.01).

CONCLUSION

Idiopathic polyhydramnios increased the risk of prolonged first stage of labour, non-vertex presentation and cesarean section.

摘要

目的

羊水过多与剖宫产风险增加相关。羊水过多的病因及分娩特征可能是混杂因素。本研究旨在探讨妊娠合并特发性羊水过多的特征及分娩方式。

方法

本回顾性配对对照研究纳入了所有在我院孕中期（孕2期或孕3期）诊断为特发性羊水过多（羊水指数>25cm或单个最深羊水池>8cm）且足月分娩（妊娠>37周）时仍持续存在的孕妇。我们排除了羊水过多可由感染、妊娠期糖尿病、先天性畸形、染色体异常、胎盘异常、同种免疫引起的妊娠，以及未进行诊断性羊膜腔穿刺的妊娠。数据收集自1998年至2015年的一家三级护理大学医院登记册。羊水过多病例与以下两名自然头先露分娩的孕妇配对，匹配分娩日期、产妇年龄、产次、体重指数。主要结局指标是剖宫产风险。进行单因素和多因素调整分析。

结果

我们确定了108例特发性羊水过多的妇女，并将她们与216例配对妇女进行比较。其中，94例和188例尝试经阴道分娩。产妇年龄、平均足月分娩孕周和出生体重分别为31岁、妊娠39+5周和3550g。我们未观察到产妇特征、硬膜外镇痛和胎儿心率异常率的差异。引产和非头先露（额头、前囟、面部）在羊水过多组中更常见（分别为57.9%对27.8%，P<0.05；7.8%对1%，P<0.05）。总体人群中羊水过多病例的剖宫产率更高（45.4%对8%，P<0.05），排除引产和非头先露病例后仍更高（38.4%对3.8%，P<0.05）。羊水过多的妊娠中人工破膜更常见（55.8%对39.1%，P<0.05）。在对匹配和混杂变量进行调整后，发现羊水过多是剖宫产的一个危险因素（OR 21.02；95%CI 8.004-55.215，P<0.01）。