孤立性早发性胎儿肾性羊水过少的系列羊膜腔灌注策略比较

Comparison of Serial Amnioinfusion Strategies for Isolated Early-Onset Fetal Renal Anhydramnios.

作者信息

Cheng Joyce M, Baschat Ahmet A, Atkinson Meredith A, Rosner Mara, Kush Michelle L, Wolfson Denise, Olson Sarah, Voegtline Kristin, Goodman Lindsey, Jelin Angie C, Miller Jena L

机构信息

Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

出版信息

Fetal Diagn Ther. 2025;52(2):155-163. doi: 10.1159/000539732. Epub 2024 Jun 10.

DOI:10.1159/000539732

PMID:38857574

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11628636/

Abstract

INTRODUCTION

The optimal protocol for serial amnioinfusions to maintain amniotic fluid in pregnancies with early-onset fetal renal anhydramnios before 22 weeks is not known. We compared the performance of two different approaches.

METHODS

A secondary analysis was conducted of serial amnioinfusions performed by a single center during the external pilot and feasibility phases of the Renal Anhydramnios Fetal Therapy (RAFT) trial. During the external pilot, higher amnioinfusion volumes were given less frequently; in the feasibility study, smaller volume amnioinfusions were administered more frequently. Procedural details, complications, and obstetric outcomes were compared between the two groups using Pearson's χ2 or Fisher's exact tests for categorical variables and Student's t tests or Wilcoxon rank-sum tests for continuous variables. The adjusted association between procedural details and chorioamniotic separation was obtained through a multivariate repeated measure logistic regression model.

RESULTS

Eleven participants underwent 159 amnioinfusions (external pilot: 3 patients, 21 amnioinfusions; feasibility: 8 patients, 138 amnioinfusions). External pilot participants had fewer amnioinfusions (7 vs. 19.5 in the feasibility group, p = 0.04), larger amnioinfusion volume (750 vs. 500 mL, p < 0.01), and longer interval between amnioinfusions (6 [4-7] vs. 4 [3-5] days, p < 0.01). In the external pilot, chorioamniotic separation was more common (28.6% vs. 5.8%, p < 0.01), preterm prelabor rupture of membranes (PPROM) occurred sooner after amnioinfusion initiation (28 ± 21.5 vs. 75.6 ± 24.1 days, p = 0.03), and duration of maintained amniotic fluid between first and last amnioinfusion was shorter (38 ± 17.3 vs. 71 ± 19 days, p = 0.03), compared to the feasibility group. While delivery gestational age was similar (35.1 ± 1.7 vs. 33.8 ± 1.5 weeks, p = 0.21), feasibility participants maintained amniotic fluid longer.

CONCLUSION

Small volume serial amnioinfusions performed more frequently maintain normal amniotic fluid volume longer because of delayed occurrence of PPROM.

摘要

引言

对于在孕22周前出现早发性胎儿肾性羊水过少的妊娠，维持羊水量的最佳连续羊膜腔灌注方案尚不清楚。我们比较了两种不同方法的效果。

方法

对在单中心进行的肾性羊水过少胎儿治疗（RAFT）试验的外部预试验和可行性阶段进行的连续羊膜腔灌注进行二次分析。在外部预试验中，较高的羊膜腔灌注量给药频率较低；在可行性研究中，较小剂量的羊膜腔灌注给药频率较高。使用Pearson卡方检验或Fisher精确检验对分类变量进行两组间的程序细节、并发症和产科结局比较，使用Student t检验或Wilcoxon秩和检验对连续变量进行比较。通过多变量重复测量逻辑回归模型获得程序细节与绒毛膜羊膜分离之间的校正关联。

结果

11名参与者接受了159次羊膜腔灌注（外部预试验：3名患者，21次羊膜腔灌注；可行性研究：8名患者，138次羊膜腔灌注）。外部预试验参与者的羊膜腔灌注次数较少（可行性组为7次 vs. 19.5次，p = 0.04），羊膜腔灌注量较大（750 vs. 500 mL，p < 0.01），羊膜腔灌注间隔时间较长（6 [4 - 7]天 vs. 4 [3 - 5]天，p < 0.01）。在外部预试验中，绒毛膜羊膜分离更常见（28.6% vs. 5.8%，p < 0.01），羊膜腔灌注开始后早产胎膜早破（PPROM）发生得更早（28 ± 21.5天 vs. 75.6 ± 24.1天，p = 0.03），首次和最后一次羊膜腔灌注之间维持羊水的持续时间较短（38 ± 17.3天 vs. 71 ± 19天，p = 0.03），与可行性组相比。虽然分娩孕周相似（35.1 ± 1.7周 vs. 33.8 ± 1.5周，p = 0.21），但可行性研究参与者维持羊水量的时间更长。