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韩国孤立性羊水过少的管理:基于问卷调查的韩国母胎医学会成员临床实践模式研究

Management of isolated oligohydramnios in Korea: a questionnaire-based study of clinical practice patterns among the members of the Korean Society of Maternal Fetal Medicine.

作者信息

Yang Seung Woo, Jin Yihua, Jang Eun Bi, Kim Hee Sun, Sohn In Sook, Kwon Han Sung, Hwang Han-Sung

机构信息

Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.

Department of Obstetrics and Gynecology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.

出版信息

Obstet Gynecol Sci. 2020 Sep;63(5):586-593. doi: 10.5468/ogs.20061. Epub 2020 Jul 21.

Abstract

OBJECTIVE

The aim of this survey was to investigate the recommendations and clinical practice patterns of the Korean Society of Maternal and Fetal Medicine (KSMFM) members, regarding management of isolated oligohydramnios (IO).

METHODS

From December 2018 to February 2019, questionnaires were e-mailed to the KSMFM members at 257 institutes that are listed by the Korean Statistical Information Services (KOSIS) as suitable labor premises. Responses to the seven questions on the management of IO, from diagnosis to treatment, were evaluated.

RESULTS

A total of 72 KSMFM members responded to this survey. Nearly all participants (90.1%) used the amniotic fluid index (AFI) as the primary method for estimating amniotic fluid volume. The majority of the participants (73.6%) believed that IO was a risk factor for adverse pregnancy outcomes, including abnormal fetal heart rate (73.6%), need for cesarean delivery (58.3%), intrauterine fetal demise (52.8%), and meconium aspiration syndrome (50%). Almost 70% of the participants believed that induction of labor might decrease perinatal morbidities, and that late-preterm to early-term period (36-38 gestational weeks) was a suitable timeframe for delivery, if the fetus was sufficiently grown and antenatal testing revealed reassuring results. Less than half of the participants (47.2%) believed that maternal oral or intravenous hydration was a useful intervention for IO management.

CONCLUSIONS

KSMFM members preferred labor induction at late-preterm to early-term, to decrease perinatal morbidity in cases of IO, although it was still uncertain whether labor induction improved the outcomes. Further prospective studies are needed regarding IO management.

摘要

目的

本调查旨在研究韩国母胎医学会(KSMFM)成员关于孤立性羊水过少(IO)管理的建议和临床实践模式。

方法

2018年12月至2019年2月,通过电子邮件向韩国统计信息服务局(KOSIS)列为合适分娩场所的257家机构的KSMFM成员发送问卷。对关于IO管理的七个问题(从诊断到治疗)的回答进行评估。

结果

共有72名KSMFM成员回复了本次调查。几乎所有参与者(90.1%)使用羊水指数(AFI)作为估计羊水量的主要方法。大多数参与者(73.6%)认为IO是不良妊娠结局的危险因素,包括异常胎心(73.6%)、剖宫产需求(58.3%)、宫内胎儿死亡(52.8%)和胎粪吸入综合征(50%)。近70%的参与者认为引产可能会降低围产期发病率,并且如果胎儿发育充分且产前检查结果令人放心,晚期早产至足月期(妊娠36 - 38周)是合适的分娩时间框架。不到一半的参与者(47.2%)认为母体口服或静脉补液是管理IO的有效干预措施。

结论

KSMFM成员倾向于在晚期早产至足月期引产,以降低IO病例的围产期发病率,尽管引产是否能改善结局仍不确定。关于IO管理需要进一步的前瞻性研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b28e/7494768/43ae8c005029/ogs-20061f1.jpg

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