羊水过少的不同评估标准与围生儿结局的临床分析

目的:研究不同评估标准诊断的羊水过少指标在预测不同孕周不良围生儿结局临床意义。方法:回顾性收集2007～2011年本院住院分娩孕妇18262例临床资料,对羊水指数(AFI)<5cm、AFI<该胎龄第五位百分位数与正常AFI进行比较,评估新生儿转科人数、早产人数及出生儿体重等妊娠结局。结果:18262例孕妇中,AFI<5cm孕妇中有16.03%(145例)转新生儿科相对风险度(RR)=2.2],AFI<该胎龄第五百分位的孕妇中有16.45%(235例)转新生儿科(RR=2.37)。敏感性和特异性AFI<5cm为10.9%(95%CI:9.3%～12.7%)和95.2%(95%CI:94.9%～95.5%),AFI<该胎龄的第五百分位数为17.6%(95%CI:15.6%～19.8%)和92.5%(95%CI:92.1%～92.9%)。在预测新生儿转科方面,AFI<该胎龄AFI的第五百分位数优于AFI<5cm(P<0.001)。AFI<5cm、<该胎龄AFI的第五百分位数孕妇与正常AFI孕妇比较,孕周、羊水指数、早产及胎儿出生体重等均存在统计学差异。结论:以AFI<该胎龄的第五位百分位数作为评估羊水过少,较AFI<5cm标准可能更能有效预测胎儿不良围生儿结局。

Assessment criteria of oligohydramnios and perinatal outcome

Objective: To compare an amniotic fluid index (AFI) less than 5 cm to an AFI less than the fifth percentile in predicting adverse perinatal outcomes. Methods: A retrospective cohort study was conducted on clinical data of 18 262 pregnant women delivering between 1998 and 2008. Pregnant women with an AFI less than 5 cm and those with an AFI less than the fifth percentile were compared to pregnant women with a normal AFI. The pregnancy outcome such as the number of neonatal intensive care unit (NICU) admission and premature as well as and birth weight were evaluated. Results: There were 145 NICU admissions in pregnant women with an AFI less than 5 cm (RR: 2.2) and 235 in pregnant women with an AFI less than the fifth percentile for gestational age (RR: 2.37). The sensitivity and specificity for NICU admission using an AFI less than 5 cm were 10.9% (95% CI: 9.3%~12.7%) and 95.2% (95% CI:94.9%~95.5%), and those were 17.6% (95% CI: 15.6%~19.8%) and 92.5% (95% CI:92.1%~92.9%) for an AFI less than the fifth percentile (P<0.001). There were statistical differences in the gestational age, AFI, the number of premature and birth weight when comparing an AFI less than 5 cm and that less than the fifth percentile with the normal AFI. Conclusion: Oligohydramnios defined as an AFI less than the fifth percentile would be better for predicting adverse perinatal outcomes.