羊水异常与围产结局的相关性：一项回顾性队列研究。
Amniotic fluid disorders and the effects on prenatal outcome: a retrospective cohort study.
机构信息
Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
Department of Obstetrics & Gynecology, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.
出版信息
BMC Pregnancy Childbirth. 2021 Jan 22;21(1):75. doi: 10.1186/s12884-021-03549-3.
BACKGROUND
The amniotic fluid is a protective liquid present in the amniotic sac. Two types of amniotic fluid disorders have been identified. First refers to polyhydramnios, which is an immoderate volume of amniotic fluid with an Amniotic Fluid Index (AFI) greater than 24 cm. Second includes oligohydramnios, which refers to decreased AFI i.e., less than 5 cm. This study aims to; a) identify the maternal risk factors associated with amniotic fluid disorders, b) assess the effect of amniotic fluid disorders on maternal and fetal outcome c) examine the mode of delivery in pregnancy complicated with amniotic fluid disorders.
METHODS
A comparative retrospective cohort study design is followed. Sample of 497 pregnant women who received care at King Abdullah bin Abdul-Aziz University Hospital (KAAUH) between January 2017 to October 2019 was included. Data were collected from electronic medical reports, and was analyzed using descriptive statistics. Association of qualitative variables was conducted by Chi-square test, where p-value < 0.05 was considered statistically significant.
RESULTS
Among the collected data, 2.8% of the cases had polyhydramnios and 11.7% patients had oligohydramnios. One case of still born was identified. A statically significant association was found between polyhydramnios and late term deliveries (P = 0.005) and cesarean section (CS) rates (P = 0.008). The rate of term deliveries was equal in normal AFI and oligohydramnios group (P = 0.005). Oligohydramnios was mostly associated with vaginal deliveries (P = 0.008). Oligohydramnios and polyhydramnios were found to be associated with diabetes mellitus patients (P = 0.005), and polyhydramnios with gestational diabetes patients (P = 0.052). Other maternal chronic diseases showed no effect on amniotic fluid index, although it might cause other risks on the fetus.
CONCLUSION
Diabetes mellitus and gestational diabetes are the most important maternal risk factors that can cause amniotic fluid disorders. Maternal and fetal outcome data showed that oligohydramnios associated with gestational age at term and low neonatal birth weight with high rates of vaginal deliveries, while polyhydramnios associated with gestational age at late term and high birth weight with higher rates of CS.
背景
羊水是存在于羊膜囊中的一种保护性液体。已经确定了两种类型的羊水紊乱。第一种是羊水过多，即羊水过多，羊水指数（AFI）大于 24cm。第二种包括羊水过少，即 AFI 减少，即小于 5cm。本研究旨在：a）确定与羊水紊乱相关的产妇危险因素，b）评估羊水紊乱对产妇和胎儿结局的影响 c）检查妊娠合并羊水紊乱的分娩方式。
方法
采用回顾性队列研究设计。纳入 2017 年 1 月至 2019 年 10 月期间在阿卜杜勒-阿齐兹国王大学医院（KAAUH）接受治疗的 497 名孕妇作为样本。数据来自电子病历，并使用描述性统计进行分析。定性变量的关联性采用卡方检验，p 值<0.05 被认为具有统计学意义。
结果
在所收集的数据中，2.8%的病例为羊水过多，11.7%的患者为羊水过少。发现一例死产。羊水过多与晚期分娩（P=0.005）和剖宫产率（P=0.008）之间存在统计学显著关联。正常 AFI 和羊水过少组的足月分娩率相等（P=0.005）。羊水过少与阴道分娩的关联最大（P=0.008）。羊水过多和羊水过少与糖尿病患者相关（P=0.005），羊水过多与妊娠期糖尿病患者相关（P=0.052）。其他产妇慢性疾病对羊水指数没有影响，但可能对胎儿造成其他风险。
结论
糖尿病和妊娠期糖尿病是导致羊水紊乱的最重要产妇危险因素。产妇和胎儿结局数据显示，羊水过少与足月时的胎龄和低新生儿出生体重相关，阴道分娩率较高，而羊水过多与晚期胎龄和高出生体重相关，剖宫产率较高。
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