[分娩期间的预防性羊膜腔灌注。关于195例病例]

De Meeus J B, Magnin G, Vequeau V, Bascou V, d'Halluin G

Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Jean-Bernard, CHU La Milétrie, Poitiers.

J Gynecol Obstet Biol Reprod (Paris). 1997;26(6):610-6.

OBJECTIVE

To show that intrapartum prophylactic amnioinfusion in case of oligohydramnios or particulate meconium-stained amniotic fluid could be beneficial.

STUDY DESIGN

From March 1st, 1993 until December 31st, 1996, 6845 women were delivered at the University Hospital of Poitiers. Patients presenting with oligohydramnios (G1) (118 patients with an amniotic fluid index below 5 cm) or a particulate meconium-stained amniotic fluid (G2)(77 patients) were included. Each group was compared with a historical control group constituted retrospectively according to the following criteria: oligohydramnios (CG1), particulate meconium-stained amniotic fluid (CG2)), age, parity, gestational age, and duration of labor. Statistical analysis was performed using the Student's t test and the Fisher's exact test when appropriate with a level of significance of p < 0.05.

RESULTS

The mean infused volume was 883 ml in G1 and 751 ml in G2. A significant difference was found in terms of cesarean section between G1 and CG1 (14% versus 25%, p < 0.05) and of assisted deliveries for fetal distress between G2 and CG2 (5% versus 18%, p < 0.02). No other significant difference was found between the study groups and their control for all other studied criteria. When considering more specifically the presence of meconium below the vocal cords we also find a difference between G2 and CG2 (5% versus 14%) which was not significant. No neonatal or maternal adverse effects happened in this short study.

COMMENT

Amnioinfusion is easy to perform during labor in case of oligohydramnios or particulate meconium-stained amniotic fluid. In case of oligohydramnios, a decreased rate of cesarean sections has been observed in the infused group. Considering patients with particulate meconium-stained amniotic fluid, less interventions for fetal distress and neonates with meconium below the vocal cords has been found in the infused group. Further prospective evaluation is needed to confirm these results in case of particulate meconium-stained amniotic fluid and to compare the advantage of prophylactic versus therapeutic amnioinfusion performed in case of oligohydramnios and abnormal fetal heart rate.

目的

证明在羊水过少或羊水粪染呈颗粒状的情况下，产时预防性羊膜腔灌注可能有益。

研究设计

1993年3月1日至1996年12月31日期间，6845名妇女在普瓦捷大学医院分娩。纳入羊水过少（G1组）（118名羊水指数低于5厘米的患者）或羊水粪染呈颗粒状（G2组）（77名患者）的患者。根据以下标准，将每组与回顾性构建的历史对照组进行比较：羊水过少（CG1组）、羊水粪染呈颗粒状（CG2组）、年龄、产次、孕周和产程。在适当情况下，使用学生t检验和费舍尔精确检验进行统计分析，显著性水平为p<0.05。

结果

G1组平均灌注量为883毫升，G2组为751毫升。G1组与CG1组在剖宫产方面存在显著差异（14%对25%，p<0.05），G2组与CG2组在因胎儿窘迫而行助产方面存在显著差异（5%对18%，p<0.02）。在所有其他研究标准方面，研究组与其对照组之间未发现其他显著差异。当更具体地考虑声带以下胎粪的存在情况时，我们也发现G2组与CG2组之间存在差异（5%对14%），但不显著。在这项短期研究中未发生新生儿或产妇不良反应。

在羊水过少或羊水粪染呈颗粒状的情况下，产时羊膜腔灌注易于实施。在羊水过少的情况下，灌注组剖宫产率有所降低。对于羊水粪染呈颗粒状的患者，灌注组中因胎儿窘迫的干预措施较少，且声带以下有胎粪的新生儿也较少。需要进一步的前瞻性评估来证实羊水粪染呈颗粒状情况下的这些结果，并比较羊水过少和胎儿心率异常时预防性与治疗性羊膜腔灌注的优势。