| BackroundOligohydramnios is one of the common complications in obstetrics.Poor amniotic fluid can occur in the middle and late pregnancy.The domestic incidence rate is 0.4 to 4%[1].At present,ultrasound examination is an important method for diagnosing oligohydramnios during pregnancy.It is stated in the second edition of?Prenatal Ultrasound Diagnosis of Fetal Malformations"?published by Science Press in 2017.The number of weeks of pregnancy is<37 weeks.,AFI)? 8 cm or weeks of pregnancy? 37 weeks AFI ? 5 cm is oligohydramnios[2].Usually,for term pregnancy with oligohydramnios,the pregnancy should be terminated in time after comprehensive assessment of maternal and fetal conditions;for those with preterm pregnancy with oligohydramnios,clinical treatment is mainly based on intravenous fluid replacement.Prolong the gestational week,but the effect is not good[3].Amnioinfusion(AI)refers to the infusion of saline into the amniotic cavity through the abdomen or the cervix.In recent years,AI has provided another way for the treatment of oligohydramnios,and at the same time which is conducive to finding the cause of oligohydramnios.In this context,through retrospective analysis,this study explored the efficacy and safety of antepartum transabdominal amnioinfusion(APTA)in the treatment of oligohydramnios,and provided reference for clinical treatment.ObjectiveTo study the efficacy and safety of antepartum transabdominal amnioinfusion in the treatment of underterm oligohydramnios.MethodsA retrospective analysis of 166 pregnant women with underterm amniotic fluid who were hospitalized in the Third Affiliated Hospital of Zhengzhou University from January 2012 to December 2019 was divided into groups based on whether APTA was performed.Among them,42 cases in the control group were divided into A1 and A2 subgroups according to the gestational week of intervention:16w?interventional gestational weeks<28w were the A1 group,28w:?interventional gestational weeks<34w were the A2 group;observation group 124 cases In the same way,it is divided into B1 and B2 groups:16w?interventional gestational week<28w is the B1 group,28w?interventional gestational week<34w is the B2 group.Collect and record the age,pregnancy time,previous parity,pre-pregnancy body mass index of pregnant women in the observation group and control group,diagnosis and intervention of oligohydramnios,gestational week and amniotic fluid volume(AFV)value or AFI value,APTA and after fluid replacement AFV or AFI value,umbilical artery S/D value on day 3 and day 7,fetal chromosome delivery status,ultrasound detection status,pregnancy complications(hypertension during pregnancy,gestational diabetes,hypothyroidism,pregnancy Anaemia),reproductive tract microbial results(mycoplasma,chlamydia),vaginal secretion analysis results and group B streptococcus detection results,delivery methods,gestational weeks,labor induction,chorioamnionitis,premature rupture of membranes,and placental abruption Situation,neonatal weight,neonatal transfer to pediatrics,umbilical cord placenta sent for inspection.Compare the differences between the groups,P<0.05 indicates that the differences are statistically significant.Result1.Comparison of general conditions between groupsThere were no statistically significant differences in the A1 and B1 groups,A2 and B2 groups in the age of pregnant women,parity,BMI before pregnancy,AFV,AF1 and umbilical artery S/D values before intervention,intervention gestational week,(P>0.05).2.Comparison of fluid replacement effect between groupsCompared with the A1 group,the increase of AFV on the 3rd and 7th day after APTA in group B1 was not statistically significant(P>0.05);The 7-day AFI growth value(40.55±24.70)mm was significantly greater than the Al group's AFI growth value on the 3rd day(16.88±29.72)mm and the 7th day AFI growth value(21.00±34.20)mm.The increase in AFV and AFI of ultrasound examination on group 3 and 7 days after APTA in group B2 was significantly higher than that in group A2,the difference was statistically significant(P<0.05).There was no statistically significant difference in the umbilical artery S/D values between the B1 and B2 groups and the A1 and A2 groups on the 3rd and 7th days after treatment(P>0.05).3.Comparison of gestational weeks and pregnancy outcomes among groups3.1 There were no statistically significant differences in the diagnosis of gestational weeks,prolonged gestational weeks,and gestational gestational weeks of oligohydramnios in groups A1 and B1(P>0.05);the induced birth rate in group B1 was 44.6%lower than 50.0%in group A1;The vaginal delivery rate was 21.4%higher than 16.7%in the A1 group;A1 and B1 groups had similar cesarean section rates,and the difference was not statistically significant(P>0.05).3.2 The gestational age of oligohydramnios diagnosed in group B2 was significantly smaller than that in group A2,the difference was statistically significant(P<0.05),the extended gestational week of B2 was(4.66 ± 3.10)w was greater than that of group A2(3.63 ± 2.58)w,B2 delivery gestational week(35.54 ± 2.86)w is greater than A2 component delivery gestational week(35.23±2.94)w;A2 and B2 group induced labor rate is similar,the difference is not statistically significant(P>0.05);B2 group vaginal delivery The rate was 20.6%higher than 10.0%in group A2,and the rate of cesarean section in group B2 was 73.5%lower than 86.7%in group A2.3.3 Excluding the number of induced labor cases,the premature birth rate of the B1 and B2 groups was higher than that of the A1 and A2 groups,and the difference was statistically significant(P<0.05);the birth weights of the newborns in the B1 and B2 groups were the same as the A1,A2 group is similar,the difference is not statistically significant(P>0.05);A1 and B1 group Apagar score 1 minute,5 minutes,the difference is not statistically significant(P>0.05);A2 and B2 group Apagar 1 minute,5-minute score,the difference was not statistically significant(P>0.05);the rate of neonatal transfer in groups B1 and B2 was lower than that in groups A1 and A2,and the difference was not statistically significant(P>0.05).4.Partial fetal appendages in the each group4.1 The incidence of chorioamnionitis(10.7%)and premature rupture of membranes(19.6%)in group B1 were higher than those in group A1(8.3%and 0.0%,respectively).There was no significant difference in the incidence of placental abruption between groups B1 and A1(P>0.05);the incidence of chorioamnionitis(5.9%)and the incidence of premature rupture of membranes in group B2(11.8%)were higher than 0.0%and 6.7%of group A2,respectively,and the difference was not statistically significant(P>0.05),in which 6 cases in group B2 had fetuses within 3 days after infusion Membrane premature rupture;there was no statistically significant difference in the incidence of placental abruption between the B2 and A2 groups(P>0.05).Pearson correlation analysis by statistical method showed that mycoplasma genitalium infection,genital chlamydia infection,vaginal inflammation(trichomonas vaginitis,bacterial vaginosis,vulvovaginal candidiasis in groups B1 and B2 and group A1 and A2 respectively Disease)and reproductive tract group B streptococcal infections were not associated with chorioamnionitis and premature rupture of membranes,respectively,and the difference was not statistically significant(P>0.05).4.2 The number of samples submitted to the umbilical cord placenta in the observation group(B1,B2)was 22,and the number of samples submitted to the control group(A1,A2)was 5.It is calcification,infarction,cellulose-like changes,villous bleeding,followed by formation and increase of concomitant nodules,inflammatory cell infiltration,and thrombosis;the most common fetal membrane lesions are cellulose-like changes,inflammatory cell infiltration,and edema,followed by Bleeding and calcification;umbilical cord lesions are commonly edema and interstitial bleeding,followed by inflammatory cell infiltration and thrombosis.5.Prenatal diagnosis of the each groupThe chromosome detection rate of group B1 was 83.93%,and the chromosome detection rate was 42.55%.The fetal chromosomes were not detected due to social psychological factors in group A1.The ultrasound detection rate of group B1 after APTA was 42.86%higher than that of group A1 after the improvement of amniotic fluid volume The detection rate is 40.00%;the chromosome detection rate of group B2 is 60.29%,and the detection rate of chromosomes is 2.44%.The fetal chromosomes are not detected in group A2 due to social and psychological factors.The ultrasound detection rate of group B2 after APTA is 40.00%The ultrasound detection rate was 33.33%higher than the A2 group after the amniotic fluid volume improved.Conclusion1.Transabdominal amniotic cavity infusion can significantly increase the amount of amniotic fluid,prolong the gestational week,reduce the rate of cesarean section,and improve the mother and infant outcome to a certain extent.2.Transabdominal amniotic cavity perfusion has certain risks,but the incidence is relatively low and it is relatively safe.3.Transabdominal amniotic cavity perfusion provides convenience for prenatal diagnosis. |
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