Sherer D M, Spong C Y, Minior V K, Salafia C M
Perinatal Research Facility, National Institute of Child Health and Human Development, National Institutes of Health, USA.
Am J Perinatol. 1996 Nov;13(8):479-82. doi: 10.1055/s-2007-994431.
The objective of this study was to assess the relationship between amniotic fluid volume (AFV) and fetal movements at < 32 weeks gestation as assessed by routine biophysical profile (BPP). From a database of 465 consecutive nonhypertensive, nondiabetic patients delivering at < 32 weeks gestation, patients with singleton, nonanomalous fetuses with AFV and fetal movements determined as part of a BPP assessment within 24 hours of delivery were studied. Amniotic fluid volume was scored 0 to 2, according to the following criteria: largest pocket in vertical diameter < 1 cm = 0; < 2 but > 1 cm = 1; > or = 2 cm = 2. Fetal movements (FM) were scored over 30 minutes: 0 if absent, 1 if 1 to 2 movements, 2 if > or = 3 gross (limb/trunk) movements. Variables assessed included fetal presentation, gestational age (GA), premature rupture of membranes (PROM) as a principal indication for delivery, clinical chorioamnionitis (diagnosed by previously published criteria), histologic parameters of infection (in amnion and umbilical cord assessed by a single pathologist blinded to clinical data), and neonatal outcome. Statistical analyses included contingency tables and analysis of variance with p < 0.05 considered significant. Three hundred and fifty-two patients met the inclusion criteria. One hundred and sixty-seven patients (47%) had PROM as a primary indication for delivery. Infrequently, decreased fetal well-being manifested by a BPP < 7 of 10 points was an indication for delivery despite prematurity (n = 7). Of the 352 patients, 80 (23%) had AFV = 0, 60 (17%) had AFV = 1, and 212 (60%) had AFV = 2; and 12 (3%) had FM = 0, 30 (9%) FM = 1, and 310 (88%) FM = 2. There was a significant correlation between decreased AFV and decreased fetal movements (p < 0.0001). Fetal presentation and GA were not significantly different between patients based on score of fetal movements. The incidence of clinical chorioamnionitis was significantly greater in patients with FM = 0 (p < 0.005). We conclude that decreased AFV is associated with decreased fetal movements irrespective of fetal presentation or gestational age. Neonatal outcome (umbilical vasculitis, sepsis, intraventricular hemorrhage) is affected only in unusual cases in which otherwise uncompromised (nonhypoxic, nonacidotic) fetuses have low scores on both these antepartum ultrasonographic parameters.
本研究的目的是通过常规生物物理评分（BPP）评估妊娠<32周时羊水体积（AFV）与胎儿运动之间的关系。在一个包含465例妊娠<32周分娩的非高血压、非糖尿病连续病例数据库中，研究了单胎、非畸形胎儿且在分娩后24小时内作为BPP评估一部分测定了AFV和胎儿运动的患者。羊水体积根据以下标准评分为0至2分：垂直直径最大羊水池<1cm = 0分；<2cm但>1cm = 1分；≥2cm = 2分。胎儿运动（FM）在30分钟内评分：无运动为0分；1至2次运动为1分；≥3次大的（肢体/躯干）运动为2分。评估的变量包括胎儿先露、孕周（GA）、胎膜早破（PROM）作为分娩的主要指征、临床绒毛膜羊膜炎（根据先前发表的标准诊断）、感染的组织学参数（由对临床数据不知情的单一病理学家评估羊膜和脐带）以及新生儿结局。统计分析包括列联表和方差分析，p<0.05被认为具有统计学意义。352例患者符合纳入标准。167例患者（47%）以PROM作为分娩的主要指征。尽管早产，但BPP<10分中的7分所表现出的胎儿健康状况下降很少作为分娩指征（n = 7）。在352例患者中，80例（23%）AFV = 0，60例（17%）AFV = 1，212例（60%）AFV = 2；12例（3%）FM = 0，30例（9%）FM = 1，310例（88%）FM = 2。AFV降低与胎儿运动减少之间存在显著相关性（p<0.0001）。根据胎儿运动评分，患者之间的胎儿先露和GA无显著差异。FM = 0的患者临床绒毛膜羊膜炎的发生率显著更高（p<0.005）。我们得出结论，无论胎儿先露或孕周如何，AFV降低都与胎儿运动减少有关。只有在不常见的情况下，即原本未受影响（非缺氧、非酸中毒）的胎儿在这两项产前超声参数上得分都很低时，新生儿结局（脐血管炎、败血症、脑室内出血）才会受到影响。
