足月特发性羊水过少妊娠结局的多中心回顾性队列研究
A Multicenter Retrospective Cohort Study of Pregnancy Outcomes in Idiopathic Oligohydramnios at Term.
作者信息
Gao Hui, Tao Hui, Zou Li, Luo Qing-Qing, Zhang Wei-Yuan
机构信息
Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, People's Republic of China.
出版信息
Int J Womens Health. 2025 Jun 5;17:1665-1672. doi: 10.2147/IJWH.S508609. eCollection 2025.
OBJECTIVE
The effect of idiopathic oligohydramnios or isolated oligohydramnios on perinatal outcomes at term pregnancies is understudied. This study aimed to show the current epidemiological status of idiopathic oligohydramnios in mainland China, evaluate the pregnancy outcomes, and discuss the optimal delivery opportunity and mode.
METHODS
We conducted a retrospective cohort study of 106,225 term pregnancies from 37 hospitals in mainland China. All cases that delivered a non-anomalous singleton fetus between 37 and 41 weeks were collected. Perinatal outcomes of different gestational weeks and different delivery modes were compared between the idiopathic oligohydramnios group and the control group.
RESULTS
The incidence of idiopathic oligohydramnios in singleton pregnancies at term was 2.6%. Compared with control pregnancies, the idiopathic oligohydramnios group was characterized by lower birth weights and higher cesarean section rates (P <0.01, respectively). From early-term and full-term to late-term, a pregnancy with idiopathic oligohydramnios exhibited the trend of lower risk of cesarean delivery and neonatal intensive care unit (NICU) admission but a higher risk of meconium-stained amniotic fluid, non-reassuring fetal heart rate status (NRFHRS), and emergency cesarean delivery (P <0.01, respectively). Notably, the rate of Apgar score <7 at 5 min and cesarean section was the lowest when delivery occurred during the 39 to 40 weeks. There was a higher incidence of NRFHRS in the idiopathic oligohydramnios vaginal delivery group when compared to the selective cesarean section group (2.6% vs 1.2%, P=0.05), but with no significant differences in postpartum hemorrhage, low Apgar score, or NICU admission.
CONCLUSION
The incidence of adverse pregnancy outcomes is higher in the idiopathic oligohydramnios group than in the control group. Adverse outcomes seem lowest in the group of vaginal delivery during the 39 to 40 weeks, but close intrapartum surveillance and active intervention still need to be applied.
目的
特发性羊水过少或孤立性羊水过少对足月妊娠围产期结局的影响研究较少。本研究旨在展示中国大陆特发性羊水过少的当前流行病学状况，评估妊娠结局，并探讨最佳分娩时机和方式。
方法
我们对中国大陆37家医院的106,225例足月妊娠进行了一项回顾性队列研究。收集所有在37至41周分娩出正常单胎胎儿的病例。比较特发性羊水过少组和对照组不同孕周及不同分娩方式的围产期结局。
结果
足月单胎妊娠中特发性羊水过少的发生率为2.6%。与对照妊娠相比，特发性羊水过少组的特点是出生体重较低和剖宫产率较高（分别为P<0.01）。从早期、足月到晚期，特发性羊水过少的妊娠表现出剖宫产和新生儿重症监护病房（NICU）入院风险较低，但羊水粪染、胎儿心率异常（NRFHRS）和急诊剖宫产风险较高的趋势（分别为P<0.01）。值得注意的是，当在39至40周分娩时，5分钟时Apgar评分<7和剖宫产的发生率最低。特发性羊水过少阴道分娩组的NRFHRS发生率高于选择性剖宫产组（2.6%对1.2%，P=0.05），但在产后出血、低Apgar评分或NICU入院方面无显著差异。
结论
特发性羊水过少组不良妊娠结局的发生率高于对照组。在39至40周进行阴道分娩的组中不良结局似乎最低，但仍需要严密的产时监测和积极干预。
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