Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer).
Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer).
Am J Obstet Gynecol MFM. 2023 Dec;5(12):101192. doi: 10.1016/j.ajogmf.2023.101192. Epub 2023 Oct 18.
The rate of polyhydramnios is higher in pregnancies complicated by congenital anomalies. These pregnancies have higher rates of peripartum complications. Amnioreduction is offered to relieve maternal symptoms such as dyspnea, abdominal and respiratory discomfort, and other issues like satiety.
This study aimed to report the rates of amnioreduction and its associated complications in pregnancies with moderate to severe polyhydramnios secondary to fetal anomalies. We also sought to determine if amnioreduction provided additional benefits, including prolongation of pregnancy and a decrease in the rates of peripartum morbidities associated with moderate to severe polyhydramnios.
This was a retrospective review of anomalous singleton pregnancies with moderate to severe polyhydramnios that were evaluated and delivered at a single center between 2013 and 2021. Peripartum outcomes were compared between pregnancies that underwent amnioreduction and those that were expectantly managed. Mann-Whitney U tests were used to compare continuous variables and Fisher's exact tests were used for categorical variables. A multiple regression model was created to understand the effects of amnioreduction on gestational age at delivery.
A total of 218 singleton pregnancies met the inclusion criteria of moderate to severe polyhydramnios in the study period. Of those, 110 patients (50.5%) underwent amnioreduction and 108 patients (49.5%) opted for expectant management. A total of 147 procedures were performed at a median gestational age of 32.5 weeks and a median of 1900 mL of amniotic fluid was removed per procedure. Complications occurred in 10.9% (n=16) of procedures, including preterm delivery within 48 hours in 5.4% cases (n=8). The median amniotic fluid index was higher in the amnioreduction group than in the expectant group (38.9 cm vs 35.5 cm; P<.0001). Patients who underwent amnioreduction had an earlier median gestational age at delivery (36.3 weeks vs 37.0 weeks; P=.048), however, the rates of spontaneous preterm delivery were similar. A higher percentage of women in the amnioreduction group had vaginal delivery (49.4% vs 30.5%; P=.01) and lower rates of uterine atony (2.4% vs 13.7%; P=.006). In the multiple linear regression analysis, the gestational age at delivery positively correlated with gestational age at amnioreduction after controlling for amniotic fluid volume (P<.0001; 95% confidence interval, 0.34-0.71). In addition, the patients in the amnioreduction group were twice as likely to have a vaginal delivery (P=.02).
Amnioreduction in the setting of moderate-severe polyhydramnios has a reasonably low rate of complications but does not provide any benefits in terms of prolonging the pregnancy. The procedure may increase the likelihood of vaginal delivery and lower the rates of uterine atony.
在伴有先天性异常的妊娠中，羊水过多的发生率较高。这些妊娠的围产期并发症发生率较高。羊水减量术用于缓解孕妇呼吸困难、腹部和呼吸不适以及其他饱胀等症状。
本研究旨在报告在因胎儿异常而导致中重度羊水过多的妊娠中羊水减量术的发生率及其相关并发症。我们还试图确定羊水减量术是否提供了额外的益处，包括延长妊娠时间和降低与中重度羊水过多相关的围产期发病率。
这是一项对 2013 年至 2021 年在单一中心接受评估和分娩的伴有中重度羊水过多的异常单胎妊娠的回顾性研究。将行羊水减量术的妊娠与行期待治疗的妊娠的围产期结局进行比较。采用 Mann-Whitney U 检验比较连续变量，采用 Fisher 确切概率法比较分类变量。创建了一个多元回归模型，以了解羊水减量术对分娩时胎龄的影响。
在研究期间，共有 218 例单胎妊娠符合中重度羊水过多的纳入标准。其中，110 例患者（50.5%）行羊水减量术，108 例患者（49.5%）行期待治疗。共进行了 147 次手术，中位孕龄为 32.5 周，每次手术平均去除 1900 毫升羊水。10.9%（n=16）的手术发生并发症，包括 5.4%（n=8）的 48 小时内早产。羊水减量组的羊水指数中位数高于期待治疗组（38.9 cm 比 35.5 cm；P<.0001）。行羊水减量术的患者中位分娩时胎龄较早（36.3 周比 37.0 周；P=.048），但自发性早产发生率相似。羊水减量组中阴道分娩的比例较高（49.4%比 30.5%；P=.01），宫缩乏力的比例较低（2.4%比 13.7%；P=.006）。在多元线性回归分析中，在校正羊水体积后，分娩时胎龄与羊水减量时的胎龄呈正相关（P<.0001；95%置信区间，0.34-0.71）。此外，羊水减量组患者阴道分娩的可能性增加了一倍（P=.02）。
在中重度羊水过多的情况下，羊水减量术的并发症发生率相当低，但在延长妊娠时间方面没有任何益处。该操作可能增加阴道分娩的可能性，并降低宫缩乏力的发生率。
