足月妊娠不同时期合并羊水偏少引产 142 例临床分析

医学研究与教育 ›› 2014, Vol. 31 ›› Issue (6): 10-15.

足月妊娠不同时期合并羊水偏少引产 142 例临床分析

武红利，张惠，梁玲，康文丽

河北大学附属医院产科，河北保定 071000

收稿日期:2015-06-03 修回日期:2015-06-03 出版日期:2014-12-25 发布日期:2014-12-25
作者简介:武红利（1968—），女，河北保定人，主任医师，硕士，硕士生导师，主要从事产科临床工作。E-mail: fyckwhl@163.com

Clinical analysis induction time of 142 full-term pregnancy at different periods with oligohydramnios

WU Hongli, ZHANG Hui, LIANG Ling, KANG Wenli

Obstetrics Department, Affiliated Hospital of Hebei University, Baoding 071000, China

Received:2015-06-03 Revised:2015-06-03 Online:2014-12-25 Published:2014-12-25

摘要/Abstract

摘要： 目的探讨足月妊娠不同时期（37～41^+6,周）合并羊水偏少的合理分娩方式。方法选择 2010 年 1 月至 2013 年 6 月足月妊娠住院阴道试产孕妇，B 超提示羊水偏少（5+6周）、中期羊水偏少组（39～40⁺⁶周）、晚期羊水偏少组（41～41⁺⁶周），并随机抽取同期超声检查羊水量正常，无其他高危因素的孕足月孕产妇作为对照组。观察阴道分娩成功率、胎儿窘迫、急诊剖宫产率和新生儿窒息的发生率。结果（1）阴道分娩成功率：中期羊水偏少组大于晚期羊水偏少组，晚期羊水偏少组大于早期羊水偏少组，差异有统计学意义，各期羊水偏少组与同期对照组比较，差异均无统计学意义。（2）引产失败继续妊娠率：早期羊水偏少组与同期对照组差异无统计学意义，中期羊水偏少组、晚期羊水偏少组与同期对照组比较差异均有统计学意义，早期羊水偏少组大于中期羊水偏少组和晚期羊水偏少组，差异有统计学意义。（3）急诊剖宫产率：晚期羊水偏少组大于早期羊水偏少组，早期羊水偏少组大于中期羊水偏少组，差异有统计学意义，3 组与同期对照组比较，差异均无统计学意义。（4）NST无反应型：早、中、晚期羊水偏少组间比较差异均无统计学意义。（5）新生儿轻度窒息：早、中、晚期羊水偏少组间比较差异均无统计学意义。结论中、晚期足月妊娠羊水偏少，若胎心良好，可给予小剂量米索前列醇促宫颈成熟引产，但要掌握好阴道分娩指征，产程中需严密监测胎儿情况，及时给予恰当的处理，阴道分娩是安全可行的；而早期足月妊娠羊水偏少选择阴道分娩需谨慎，如胎心良好，可给予补液等期待治疗，如胎心监测提示胎儿窘迫等则应适当放宽剖宫指征。

关键词: 足月妊娠, 羊水偏少, 引产时机

Abstract: Objective To investigate the reasonable delivery way during different periods (37-41⁺⁶ weeks) of uterogestation accompanying with oligohydramnios. Methods From January 2010 to June 2013, 142 full-term gravidas were selected as research objects, which were diagnosed as oligohydramnios (5+6 weeks), the interim group (39-40⁺⁶ weeks) and the advanced group (41-41^{+6,/sup> weeks), were divided. Full-term gravidas with normal amniotic fluid diagnosed by hameochronous ultrasonography and without other high risk factors were randomly selected as control group. The success rate of vaginal delivery, fetal distress, emergency caesarean section rate and
asphyxia neonatorum were observed respectively. Results (1) The success rate of vaginal delivery showed a significant tendency of interim group>advanced group>early group, but the significance between the research group and control group was not obvious. (2) Compared with the control group, the failure rate
of odinopoeia showed a tendency of early group>interim group=advanced group, in which the significance between the early group and control group was not obvious, while the opposite was true among the interim group, advanced group and control group. (3) The emergency caesarean section rate showed a significant
tendency of advanced group>early group>interim group, but the significance was not obvious between the three research groups and control group. (4) The significance of non-stress test adiaphoria was not obvious between the research groups and control group. (5) The significance of mild asphyxia neonatorum between the early group and control group was not obvious, while the opposite was true among the interim group, advanced group and control group. Conclusions Oligohydramnios occurred among the interim and advanced cases. By this time, low doses of misoprostol could be used to promote the cervical ripening and labor induction in case the fetus possesses a fine fetal heart. However, the vaginal delivery indication should be well controlled, and during the whole delivery process, the fetus’s condition must be closely monitored in order to provide appropriate measures. During the early period, vaginal delivery should be carefully adopted if the oligohydramnios occurs. Fluid infusion could be used only when the fetus possesses a fine fetal heart. On the contrary, if the fetal distress occurs, the indications for cesarean section should be relaxed.}

Key words: full-term pregnancy, oligohydramnios, induction time

中图分类号:

武红利，张惠，梁玲，康文丽. 足月妊娠不同时期合并羊水偏少引产 142 例临床分析[J]. 医学研究与教育, 2014, 31(6): 10-15.

WU Hongli, ZHANG Hui, LIANG Ling, KANG Wenli. Clinical analysis induction time of 142 full-term pregnancy at different periods with oligohydramnios[J]. Medical Reserch and Education, 2014, 31(6): 10-15.

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