Garzetti G G, Ciavattini A, De Cristofaro F, La Marca N, Arduini D
Institute of Obstetrics and Gynecology, Ancona University, Italy.
Gynecol Obstet Invest. 1997;44(4):249-54. doi: 10.1159/000291538.
This study was designed to: (i) evaluate the effect of amnioinfusion on the latency period in patients with oligohydramnios for preterm premature rupture of membranes, and (ii) to investigate the relationship between changes in the amniotic fluid index and fetal heart rate short-term variability by computerized Hewlett-Packard cardiotocography, longitudinally estimated before and after prophylactic amnioinfusion.
All singleton pregnancies with prolonged premature rupture of membranes after 25 weeks of gestation and seen at the Institute of Obstetrics and Gynecology, University of Ancona (Italy), between January 1994 and June 1995 were included in the study. Transabdominal amnioinfusion with 150-350 ml warmed normal saline (25-50 ml/min) was performed at weekly intervals. Amniotic fluid volume was assessed ultrasonographically by means of the four-quadrant technique on a weekly basis before and after each amnioinfusion, as well as the short-term variability by a Hewlett-Packard computerized cardiotocographic system.
18 women were enrolled and underwent prophylactic transabdominal amnioinfusion at weekly intervals until delivery. Eighteen controls, who did not undergo prophylactic amnioinfusion, were recruited from our 1992-1993 series and included in the study. The median interval between premature rupture of membranes and delivery was 3.0 weeks (range 1-8 weeks), with an average delivery age of 33.0 weeks (range 27-36 weeks). The latency period was significantly longer in patients who underwent prophylactic amnioinfusion (mean +/- SD, 4.1 +/- 1.7 weeks) than in controls(1.7 +/- 1.0 weeks; p < 0.001). An increase in both the weekly amniotic fluid index (linear regression analysis r = 0.8, p = 0.03) and the weekly short-term variability (linear regression analysis r = 0.82, p = 0.02) was observed among patients who underwent prophylactic amnioinfusion. A direct relationship was observed between the amniotic fluid index and short-term variability (linear regression analysis r = 0.54, p = 0.04). The mean values of fetal movements recorded by computerized tomography during the 20 min of observation significantly increased after amnioinfusion in comparison with those before it (2.6 +/- 0.9 and 0.9 +/- 0.7 respectively; p = 0.001).
The present study has shown a positive effect of prophylactic transabdominal amnioinfusion on the latency period in patients with preterm premature rupture of membranes and oligohydramnios. Among the patients who underwent amnioinfusion, an interesting improvement in fetal heart rate short-term variability was associated with the progressive increase in amniotic fluid volume, as an expression of fetal well-being.
本研究旨在：（i）评估羊膜腔灌注对羊水过少合并胎膜早破早产患者潜伏期的影响，以及（ii）通过惠普计算机化胎心监护，纵向评估预防性羊膜腔灌注前后羊水指数变化与胎儿心率短期变异性之间的关系。
纳入1994年1月至1995年6月间在意大利安科纳大学妇产科就诊的所有妊娠25周后胎膜早破延长的单胎妊娠。每周间隔进行一次经腹羊膜腔灌注150 - 350 ml温热生理盐水（25 - 50 ml/分钟）。在每次羊膜腔灌注前后每周通过四象限技术超声评估羊水量，以及通过惠普计算机化胎心监护系统评估短期变异性。
18名妇女入组并接受每周一次的预防性经腹羊膜腔灌注直至分娩。从我们1992 - 1993年的病例系列中招募了18名未接受预防性羊膜腔灌注的对照者并纳入研究。胎膜早破至分娩的中位间隔时间为3.0周（范围1 - 8周），平均分娩孕周为33.0周（范围27 - 36周）。接受预防性羊膜腔灌注的患者潜伏期显著长于对照组（均值±标准差，4.1±1.7周比1.7±1.0周；p < 0.001）。在接受预防性羊膜腔灌注的患者中观察到每周羊水指数（线性回归分析r = 0.8，p = 0.03）和每周短期变异性（线性回归分析r = 0.82，p = 0.02）均增加。观察到羊水指数与短期变异性之间存在直接关系（线性回归分析r = 0.54，p = 0.04）。与灌注前相比，灌注后20分钟计算机断层扫描记录的胎儿平均胎动次数显著增加（分别为2.6±0.9和0.9±0.7；p = 0.001）。
本研究表明预防性经腹羊膜腔灌注对胎膜早破合并羊水过少患者的潜伏期有积极影响。在接受羊膜腔灌注的患者中，胎儿心率短期变异性的有趣改善与羊水量的逐渐增加相关，这是胎儿健康状况的一种表现。
