| Objective:To investigate the composition,treatment,choice of delivery mode and outcome of maternal and child in pregnant women with oligohydramnios in different gestational weeks of late pregnancy,so as to provide a reference to select appropriate termination of pregnancy,increase the rate of vaginal delivery and control cesarean section rate.Methods:1.A total of 364 pregnant women who met the diagnostic criteria of oligohydramnios in obstetrics and gynecology——2016.01 to 2020.12 were selected as the subjects,excluding 1)pregnant women that less than 28 weeks;2)pregnant women of premature rupture of membranes;3)pregnant women with incomplete clinical data or failure to cooperate with follow-up to end of delivery.They were grouped according to different gestational weeks and whether they were associated with complications:Group Ⅰ(28 weeks to 36 weeks+6 days):195 cases,including group a(isolated preterm oligohydramnios,24 cases)and group b(complicated preterm oligohydramnios,56 cases);Group Ⅱ(37 weeks to 38 weeks+6 days):124 cases,including group c(isolated early-term oligohydramnios,81 cases)and group d(complicated early-term oligohydramnios,43 cases);Group Ⅲ(39 weeks and above):160 cases,including group e(isolated late-term oligohydramnios,125 cases)and group f(complicated late-term oligohydramnios,35 cases).Collect relevant data separately,general information of pregnant women(including age,gestation times,parity,pre-pregnancy BMI),gestational age at the time of discovery,treatment status,comorbidity composition,gestational week of termination of pregnancy,method of termination of pregnancy,occurrence of adverse events(amniotic fluid fetus)Fecal contamination,abnormal fetal heart rate monitoring,postpartum hemorrhage,puerperal infection),newborn conditions(birth weight,Apgar score,SGA incidence,jaundice,transfer rate,neonatal complications).2.Using SPSS25.0 software to statistically analyze each factor between groups.For measurement data with normal distribution and uniform variance,it is expressed as mean ±standard deviation(x±s),and LSD-t test is used.Measurement data with uniform distribution and uniform variance are expressed as the median(lower quartile～upper quartile),using Kruskal-Wallis test;the counting data is expressed by composition ratio,the counting data is measured by χ2 test or Fisher exact probability test,the difference is statistically significant in p<0.05.Result:1.In the general data of pregnant women,there were no statistically significant differences in age,gestation times,parity times and pre-pregnancy BMI between the 6 groups(p>0.05).The total incidence of oligohydramnios in different gestational weeks was 21.98%,34.07%,and 43.96%,respectively,and the proportion of oligohydramnios occurred after 39 weeks and 39 weeks was the highest.2-Analysing the complications,the proportions of complicated oligohydramnios at different gestational weeks were respectively 15.38%,11.81%,and 9.62%.The complications include:intrauterine growth restriction IUGR,abnormal cord blood flow,gestational diabetes mellitus/pregestational diabetes mellitus GDM/PGDM,hypertensive disorders of pregnancy HDP and other causes.Complications in different groups are different.There was a statistically significant difference in IUGR between the three groups(p<0.05).The combination of preterm complicated oligohydramnios had the highest probability of IUGR,accounting for 48.21%.There was also a statistically significant difference in cord blood flow abnormality between the three groups(p<0.05).The probability of combined preterm complicated oligohydramnios and cord blood flow abnormality was significantly higher than that of the other two groups.There is no statistically significant difference in the incidence of GDM/PGDM,HDP and other causes among pregnant women with complications of oligohydramnios at different gestational weeks(p>0.05).Other causes include:SLE,anticardiolipin antibody syndrome,twisted or knotted umbilical cord,fetal abnormalities,and syphilis.3.Comparing the first gestational weeks that dignosed of oligohydramnios,from 28 weeks to 38 weeks+6 days,the first gestational weeks that dignosed of oligohydramnios with complicated oligohydramnios group was earlier than that of the isolate oligohydramnios group,with an average of 33.63 weeks in groups b and of 37.78 weeks in group d,while group a and group c were 35.37 weeks and 38.37 weeks respectively,the difference was statistically significant(p<0.05).After 39 weeks and 39 weeks,the gestational age of the isolate oligohydramnios group and the complicated oligohydramnios group was similar at the time of first discovery,and the difference was not statistically significant(p>0.05).4.The total cesarean section rate(including transit cesarean section and direct cesarean section)in this study was 71.43%,69.14%,65.60%,83.93%,76.74%,74.29%,which were significantly higher than that of the hospital’s average cesarean section rate.Among pregnant women with isolated oligohydramnios,there was a statistically significant difference in the induction rate of balloon catheter and/or oxytocin(p<0.05),Among pregnant women with complicated oligohydramnios:there were statistically significant differences in the rate of natural labor,balloon catheter and/or oxytocin induction rate,and direct cesarean section rate among the groups(p<0.05).After the 6 groups used balloon and/or oxytocin to induce labor,the probability of transition to cesarean section due to the failure of labor induction was more than 40%.The transition cesarean section rate of pregnant women with complicated oligohydramnios was higher than that of pregnant women with isolated oligohydramnios.Transition to cesarean section is mainly due to signs of fetal distress during induction of labor,followed by social factors.5.The main adverse events that occurred during labor/delivery were amniotic fluid meconium contamination,abnormal fetal heart rate monitoring,postpartum hemorrhage and puerperal infection.Within different gestational weeks,there was no statistically significant difference in the adverse events of pregnant women with isolated oligohydramnios during labor and delivery(p>0.05),and the incidence of postpartum hemorrhage and puerperal infection was low.In different gestational weeks,the differences in the adverse events of pregnant women with complicated oligohydramnios are mainly in the rate of meconium contamination of amniotic fluid and abnormal rate of fetal heart rate monitoring.The rate of meconium contamination of complicated oligohydramnios in the late term group is higher.The abnormal rate of fetal heart rate monitoring in the preterm complicated oligohydramnios group was higher,reaching 39.29%,but the incidence of postpartum hemorrhage and puerperal infection was also lower.6.In the neonatal outcome,the birth weight of newborns in the preterm complicated oligohydramnios group was significantly lower than that of the preterm isolate oligohydramnios group,and the difference was statistically significant(p<0.05);The 1-minute Agpar score of newborns in the term complicated oligohydramnios group was the lowest,and the incidence of neonatal asphyxia was 17.86%.In the isolated oligohydramnios group,the incidence of neonatal SGA in the late term group was the highest,which was 13.60%;in the complicated oligohydramnios group,the incidence of neonatal SGA was higher in the preterm and early term groups,48.21%and 44.19%respectively.Whether it is isolated oligohydramnios or complicated oligohydramnios,the transfer rate of neonates in the preterm group was significantly higher than that of the other two groups.Comparing the incidence of complications in newborns whose mothers were isolated oligohydramnios,the difference between the three groups was not statistically significant(p>0.05),while the incidence of complications in newborns whose mothers were comorbid oligohydramnios was not significant.The term group was the highest,33.93%.Conclusion:1.The oligohydramnios in full-term pregnant women are mainly isolate oligohydramnios,while the oligohydramnios in pre-term pregnant women are mainly complicated oligohydramnios that intrauterine growth restriction and gestational hypertension are the two main complications.2.Oligohydramnios is not an absolute indication for cesarean section,especially for pregnant women with isolate oligohydramnios at full-term.The success rate of cervical ripening by balloon catheter and/or oxytocin induction is higher,so these pregnant women should be delivered strictly monited to reduce the rate of cesarean section.3.Newborns of pregnant women with pre-term complicated oligohydramnios have a greater risk of neonatal complications after birth.Therefore,attention should be paid to the management of these pregnant women during pregnancy,and the gestational week should be extended as much as possible to reduce the adverse prognosis. |
PDF Full Text Request