Ross M G, Cedars L, Nijland M J, Ogundipe A
Department of Obstetrics and Gynecology, Harbor-University of California, Los Angeles Medical Center, Torrance, CA 90509, USA.
Am J Obstet Gynecol. 1996 May;174(5):1608-13. doi: 10.1016/s0002-9378(96)70615-4.
Maternal 1-deamino-[8-D-arginine] vasopressin (a selective antidiuretic agonist) and oral water loading decrease maternal and fetal plasma osmolality and markedly increase fetal urine flow in sheep. We hypothesized that a titrated reduction in maternal plasma osmolality would increase human amniotic fluid volume.
Pregnant women (n = 5) with oligohydramnios at term were administered oral water loading (20 ml/kg) and intravenous 1-deamino-[8-D-arginine] vasopressin (2 micrograms) to induce antidiuresis. Maternal plasma and urine osmolality and urine production were measured hourly, and water replacement was titrated for 8 hours to reduce plasma osmolality by 15 to 20 mOsm/kg. The amniotic fluid index determined by ultrasonography was measured at baseline, 8 hours, and 24 hours. A control group of pregnant women (n = 5) with oligohydramnios at term was observed for 8 hours with maintenance intravenous hydration.
In 1-deamino-[8-D-arginine] vasopressin-treated women, maternal urine flow increased with oral water loading, decreased with 1-deamino-[8-D-arginine] vasopressin administration, and remained reduced for 8 hours. Maternal plasma osmolality significantly decreased (285 +/- 4 to 265 +/- 4 mOsm/kg) and the amniotic fluid index significantly increased (4.1 +/- 0.6 to 8.2 +/- 1.5 cm) at 8 hours. Although maternal urine osmolality returned to basal values at 24 hours, plasma osmolality was reduced and the amniotic fluid index remained significantly increased (8.2 +/- 1.3 cm). There was no change in the amniotic fluid index (4.3 +/- 0.4 to 4.7 +/- 0.7 cm) in control patients observed with maintenance intravenous hydration.
Maternal 1-deamino-[8-D-arginine] vasopressin and oral water administration can reduce and stabilize plasma osmolality and increase amniotic fluid volume. 1-Deamino-[8-D-arginine] vasopressin therapy has potential for the prevention and treatment of oligohydramnios.
母体注射1-去氨基-[8-D-精氨酸]加压素（一种选择性抗利尿激动剂）并口服水负荷可降低母羊和胎儿的血浆渗透压，并显著增加胎儿尿流量。我们假设，逐步降低母体血浆渗透压会增加人类羊水体积。
对5名足月羊水过少的孕妇给予口服水负荷（20 ml/kg）和静脉注射1-去氨基-[8-D-精氨酸]加压素（2微克）以诱导抗利尿。每小时测量母体血浆和尿液渗透压以及尿量，并在8小时内逐步补充水分以将血浆渗透压降低15至20 mOsm/kg。在基线、8小时和24小时通过超声测量羊水指数。对5名足月羊水过少的孕妇组成的对照组进行8小时的静脉补液维持观察。
在接受1-去氨基-[8-D-精氨酸]加压素治疗的女性中，母体尿量随口服水负荷增加，随1-去氨基-[8-D-精氨酸]加压素给药而减少，并在8小时内持续减少。8小时时，母体血浆渗透压显著降低（从285±4降至265±4 mOsm/kg），羊水指数显著增加（从4.1±0.6增至8.2±1.5 cm）。尽管母体尿液渗透压在24小时时恢复到基础值，但血浆渗透压仍降低，羊水指数仍显著增加（8.2±1.3 cm）。接受静脉补液维持观察的对照组患者羊水指数无变化（从4.3±0.4增至4.7±0.7 cm）。
母体注射1-去氨基-[8-D-精氨酸]加压素并口服水可降低并稳定血浆渗透压，增加羊水量。1-去氨基-[8-D-精氨酸]加压素疗法在预防和治疗羊水过少方面具有潜力。
