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Abstract：
BACKGROUND: Treatment of oligohydramnios in the mid-trimester is challenging, because of the high incidence of adverse perinatal outcomes mainly due to bronchopulmonary dysplasia. Antenatal amnioinfusion has been proposed as a possible treatment for oligohydramnios with intact amnions, but there are few relevant studies. This study aimed to evaluate the effectiveness of transabdominal amnioinfusion in the management of oligohydramnios without fetal lethal malformations in the second and early third trimesters.
METHODS: It is a historical cohort study. A total of 79 patients diagnosed with oligohydramnios at 18-32 weeks gestation were enrolled. In the amnioinfusion group (n = 39), patients received transabdominal amnioinfusion with the assistance of real-time ultrasound guidance. In the expectant group (n = 41), patients were treated with 3000 mL of intravenous isotonic fluids daily. The perioperative complications and perinatal outcomes were analyzed.
RESULTS: Compared with the expectant group, the delivery latency was significantly prolonged, and the rate of cesarean delivery was significantly reduced in the amnioinfusion group (p < 0.05). Although the rate of intrauterine fetal death was significantly reduced, the incidence of spontaneous miscarriage, premature rupture of membranes (PROMs), and threatened preterm labor were significantly higher in the amnioinfusion group than in the expectant group (p < 0.05). There was no significant difference in terms of perinatal mortality (28.9% vs. 41.4%, p > 0.05). Multivariate logistic regression revealed that amnioinfusion (odds ratio [OR] 0.162, 95% confidence interval [CI] 0.04-0.61, p = 0.008) and gestational age at diagnosis (OR 0.185, 95% CI 0.04-0.73, p = 0.016) were independently associated with neonatal adverse outcomes. Further subgrouping showed that amnioinfusion significantly reduced the frequency of bronchopulmonary hypoplasia for patients ≤26 weeks (26.7% vs. 75.0%, p = 0.021). The rates of other neonatal complications were similar in both groups.
CONCLUSIONS: Amnioinfusion has no significant effect on improving the perinatal mortality of oligohydramnios in the second and early third trimesters. It may lead to a relatively high rate of PROM and spontaneous abortion. However, amnioinfusion may significantly improve the latency period, the rate of cesarean delivery, and neonatal outcomes of oligohydramnios, especially for women ≤26 weeks with high risk of neonatal bronchopulmonary hypoplasia.
METHODS: It is a historical cohort study. A total of 79 patients diagnosed with oligohydramnios at 18-32 weeks gestation were enrolled. In the amnioinfusion group (n = 39), patients received transabdominal amnioinfusion with the assistance of real-time ultrasound guidance. In the expectant group (n = 41), patients were treated with 3000 mL of intravenous isotonic fluids daily. The perioperative complications and perinatal outcomes were analyzed.
RESULTS: Compared with the expectant group, the delivery latency was significantly prolonged, and the rate of cesarean delivery was significantly reduced in the amnioinfusion group (p < 0.05). Although the rate of intrauterine fetal death was significantly reduced, the incidence of spontaneous miscarriage, premature rupture of membranes (PROMs), and threatened preterm labor were significantly higher in the amnioinfusion group than in the expectant group (p < 0.05). There was no significant difference in terms of perinatal mortality (28.9% vs. 41.4%, p > 0.05). Multivariate logistic regression revealed that amnioinfusion (odds ratio [OR] 0.162, 95% confidence interval [CI] 0.04-0.61, p = 0.008) and gestational age at diagnosis (OR 0.185, 95% CI 0.04-0.73, p = 0.016) were independently associated with neonatal adverse outcomes. Further subgrouping showed that amnioinfusion significantly reduced the frequency of bronchopulmonary hypoplasia for patients ≤26 weeks (26.7% vs. 75.0%, p = 0.021). The rates of other neonatal complications were similar in both groups.
CONCLUSIONS: Amnioinfusion has no significant effect on improving the perinatal mortality of oligohydramnios in the second and early third trimesters. It may lead to a relatively high rate of PROM and spontaneous abortion. However, amnioinfusion may significantly improve the latency period, the rate of cesarean delivery, and neonatal outcomes of oligohydramnios, especially for women ≤26 weeks with high risk of neonatal bronchopulmonary hypoplasia.
摘要：
背景：妊娠中期羊水过少的治疗具有挑战性，主要由于支气管肺发育不良导致围产期不良结局发生率高。已提出产前羊膜输注作为羊膜完整的羊水过少的可能治疗方法。但相关研究很少。这项研究旨在评估经腹羊膜灌注在妊娠中期和晚期早期无胎儿致命性畸形的羊水过少治疗中的有效性。
方法：这是一项历史队列研究。共纳入79例妊娠18-32周诊断为羊水过少的患者。在羊膜灌注组（n=39），患者在实时超声引导下接受经腹羊膜灌注.在期待组(n=41)中，患者每天接受3000mL静脉等渗液体治疗.分析围手术期并发症及围生儿结局。
结果：与预期组相比，交付延迟显著延长，羊膜灌注组剖宫产率显着降低（p<0.05）。尽管胎儿宫内死亡率显著降低,自发性流产的发生率，胎膜早破（PROMs），羊膜灌注组的先兆早产明显高于期待组（p<0.05）。围产期死亡率无显著差异(28.9%vs.41.4%,p>0.05)。多因素logistic回归分析显示，羊膜输注（比值比[OR]0.162，95％置信区间[CI]0.04-0.61，p=0.008）和诊断时的胎龄（OR0.185，95％CI0.04-0.73，p=0.016）与新生儿不良结局独立相关。进一步的分组显示，羊膜灌注显着降低≤26周患者支气管肺发育不全的频率（26.7％vs.75.0%,p=0.021)。两组其他新生儿并发症的发生率相似。
结论：羊膜灌注对改善第二和妊娠早期羊水过少的围产期死亡率无显著影响。它可能导致相对较高的PROM和自然流产率。然而,羊膜灌注可以显着改善潜伏期，剖宫产率，羊水过少的新生儿结局，尤其是≤26周的新生儿支气管肺发育不全高危女性。
方法：这是一项历史队列研究。共纳入79例妊娠18-32周诊断为羊水过少的患者。在羊膜灌注组（n=39），患者在实时超声引导下接受经腹羊膜灌注.在期待组(n=41)中，患者每天接受3000mL静脉等渗液体治疗.分析围手术期并发症及围生儿结局。
结果：与预期组相比，交付延迟显著延长，羊膜灌注组剖宫产率显着降低（p<0.05）。尽管胎儿宫内死亡率显著降低,自发性流产的发生率，胎膜早破（PROMs），羊膜灌注组的先兆早产明显高于期待组（p<0.05）。围产期死亡率无显著差异(28.9%vs.41.4%,p>0.05)。多因素logistic回归分析显示，羊膜输注（比值比[OR]0.162，95％置信区间[CI]0.04-0.61，p=0.008）和诊断时的胎龄（OR0.185，95％CI0.04-0.73，p=0.016）与新生儿不良结局独立相关。进一步的分组显示，羊膜灌注显着降低≤26周患者支气管肺发育不全的频率（26.7％vs.75.0%,p=0.021)。两组其他新生儿并发症的发生率相似。
结论：羊膜灌注对改善第二和妊娠早期羊水过少的围产期死亡率无显著影响。它可能导致相对较高的PROM和自然流产率。然而,羊膜灌注可以显着改善潜伏期，剖宫产率，羊水过少的新生儿结局，尤其是≤26周的新生儿支气管肺发育不全高危女性。
