Vergani P, Locatelli A, Strobelt N, Mariani S, Cavallone M, Arosio P, Ghidini A
Department of Obstetrics and Gynecology, University of Milan, Ospedale S. Gerardo, Monza, Italy.
Am J Perinatol. 1997 Jul;14(6):325-9. doi: 10.1055/s-2007-994154.
We conducted a study to evaluate the feasibility and benefits of transabdominal amnioinfusion in preterm premature rupture of membranes with persistent oligohydramnios for the prevention of pulmonary hypoplasia. To this purpose, we designed a cohort study in which the pregnancy outcome of women with rupture of membranes at < or = 25 weeks and persistent (> or = 4 days) oligohydramnios managed with serial amnioinfusions (n = 18) was compared with that of a historic cohort group (controls) with similar characteristics but managed expectantly (n = 16). Pulmonary hypoplasia was diagnosed at birth in the presence of strict radiological and pathological criteria. No amnioinfusion-related complications occurred. The prevalence of pulmonary hypoplasia was significantly lower among the amnioinfused cases compared with the controls (46% [6 of 13] vs 86% [12 of 14], odds ratio [OR] = 0.4, 95% confidence interval [CI] 0.2-0.9), despite a lower gestational age at rupture of membranes in the treated group. Within the group undergoing amnioinfusions, those in which the infused solution was rapidly lost had a higher rate of pulmonary hypoplasia compared with those in which amnioinfusion alleviated oligohydramnios for > 48 hours (considered successful) (0 of 4 vs. 6 of 9, OR = 2.3, 95% CI 1-5.5). Cases of successful amnioinfusion had a longer interval between membrane rupture and appearance of oligohydramnios than those in which the procedure failed to correct oligohydramnios, even though both groups had similar gestational age at appearance of oligohydramnios. This suggests that the rate of loss of amniotic fluid after membrane rupture may predict the rate of loss of the infused solution, and therefore identify a subset of patients who may benefit from the procedure.
我们开展了一项研究，以评估经腹羊膜腔灌注术用于胎膜早破合并持续性羊水过少的早产患者预防肺发育不全的可行性和益处。为此，我们设计了一项队列研究，将孕周小于或等于25周且胎膜早破合并持续性（大于或等于4天）羊水过少并接受系列羊膜腔灌注术治疗的女性（n = 18）的妊娠结局，与具有相似特征但采用期待治疗的历史队列组（对照组，n = 16）进行比较。肺发育不全根据严格的放射学和病理学标准在出生时诊断。未发生与羊膜腔灌注相关的并发症。与对照组相比，接受羊膜腔灌注术的病例中肺发育不全的发生率显著更低（46% [13例中的6例] 对86% [14例中的12例]，比值比[OR] = 0.4，95%置信区间[CI] 0.2 - 0.9），尽管治疗组胎膜破裂时的孕周更小。在接受羊膜腔灌注术的组内，与羊膜腔灌注缓解羊水过少超过48小时（视为成功）的患者相比，灌注液迅速流失的患者肺发育不全发生率更高（4例中的0例对9例中的6例，OR = 2.3，95% CI 1 - 5.5）。羊膜腔灌注术成功的病例与该操作未能纠正羊水过少的病例相比，胎膜破裂至羊水过少出现的间隔时间更长，尽管两组羊水过少出现时的孕周相似。这表明胎膜破裂后羊水流失的速率可能预测灌注液的流失速率，因此可识别出可能从该操作中获益的一部分患者。
