足月妊娠羊水偏少孕妇阴道分娩的临床处理探讨  

Clinical treatment of vaginal delivery in full-term pregnant women with borderline oligohydramnios

作　　者：王孝贤[1] 高洁[1] 张茗[1] 丁浩[1] WANG Xiao-xian;GAO Jie;ZHANG Ming;DING Hao(Fourth Maternity Wards,Maternal And Child Care Hospital of Dalian,Dalian Liaoning 116033,P.R.China)

机构地区：[1]大连市妇产医院产四病房,辽宁大连116033

出　　处：《中国计划生育和妇产科》2019年第2期62-65,共4页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨足月妊娠羊水偏少选择阴道分娩的孕妇给予积极引产的可行性,并探寻合适的引产时机。方法回顾性分析2016年1～10月足月妊娠因羊水偏少入住大连市妇产医院产科,有阴道分娩意愿并符合阴道分娩条件的625例初产妇的临床资料。将给予引产的320例作为引产组(A组:<孕40周为A 1组,≥孕40周为A 2组),将给予补液、等待自然临产的305例作为对照组(B组:同法分为B 1组、B 2组),对各组妊娠结局进行分析比较。结果①阴道分娩成功率比较:A 2组> A 1组、B 2组,B 1组> B 2组(P <0. 05)。②中转剖宫产原因比较:a.复查B超羊水过少:B 2组> B 1组、A 2组,A组<B组(P <0. 05)。b.胎儿窘迫:各组间比较差异无统计学意义(P> 0. 05)。c.产程异常:A 1组> A 2组,B 1组<B 2组,A 1组> B1组,A 2组<B 2组(P <0. 05)。③分娩结局比较:a.羊水Ⅱ°～Ⅲ°混浊:A 1+B 1组<A 2+B 2组,A组> B组,差异均有统计学意义(P <0. 05)。b.新生儿窒息:各组间比较差异均无统计学意义(P> 0. 05)。结论积极引产对于羊水偏少的孕妇是一种可行的处理方式。对于≥孕40周引产可提高阴道分娩成功率,降低剖宫产率;对于<孕40周可予补液期待疗法,并不降低阴道分娩率,可降低因过早引产导致发生产程异常中转剖宫产的概率。Objective To investigate the feasibility of active induction of labor for full-term pregnant women with borderline oligohydramnios choosing the vaginal delivery,and explore suitable induction timing.Methods Retrospective analysis of clinical data of 625 primiparas from Department of Obstetrics of Maternal And Child Care Hospital of Dalian from January to October 2016 due to borderline oligohydramnios,who in line with singleton, head position, full term pregnancy, no pregnancy complications and comorbidities,had vaginal delivery willing and vaginal delivery conditions.320 patients who were given labor induction were enrolled in the induction group( group A:<40 weeks gestation for A 1 group,≥40 weeks gestation for group A 2),and 305 patients who were given fluid replacement and waited for natural labor were set as control group( Group B: same method for group B 1 and group B 2),the pregnancy outcomes of each group were analyzed and compared.Results ① Comparison of the success rate of vaginal delivery:group A 2>A 1 and B 2,group B 1>B 2( P<0.05).② Comparison the reasons of transit cesarean delivery: a.A review of ultrasound oligohydramnios: group B 2>B 1,group A 2<B 2,group A<group B( P<0.05).b.Fetal distress: There was no statistically significant difference between the groups(P<0.05).c.Abnormal labor: group A 1>group A 2,group B 1<group B 2,group A 1>group B 1,group A 2<group B 2( P<0.05).③ Comparison of birth outcomes: a.Amniotic fluid II ~ III turbidity: group A 1 + B 1<group A 2 + B 2,group A>group B,the difference was statistically significant( P<0.05).b.Neonatal asphyxia: there was no statistically significant difference between the groups(P>0.05).Conclusion Active induction of labor is a viable treatment for pregnant women with borderline oligohydramnios.For women ≥ 40 weeks of gestation,induction of labor can increase the success rate of vaginal delivery,reduce the rate of cesarean section;for women less than 40 weeks of geatation,rehydration expectation therapy can not reduce the vaginal delivery

关 键 词：羊水偏少 阴道分娩 积极引产 引产时机 

分 类 号：R714.2[医药卫生—妇产科学]