| BackgroundThe reduction of amniotic fluid volume is considered to be a sign of placental dysfunction[1].The incidence of oligohydramnios is approximately0.4%to 4%,and the perinatal mortality is significantly higher.The mortality of pregnancies with severe oligohydramnios is 47 times higher,so early termination of pregnancy for them is more common[2].Borderline oligohy-dramnios is the transitional period of oligohydramnios,which has also been reported to have a high rate of perinatal morbidity[3],and the termination of pregnancy for them in advance is also advocated.Recent studies have shown that isolated oligohydramnios?IO?or isolated borderline oligohydramnios?IBO?have no significant correlation with adverse perinatal outcomes,but associated with high induced labor rate and cesarean section rate[4,5].Therefore,how to manage pregnancies with IO or IBO is one of the problems needed to be solved in clinical practice.ObjectivesTo explore the maternal and perinatal outcomes of pregnancies at term with IO and IBO,and to analyze the related factors affecting their maternal and perinatal outcomes.Materials and methodsMaterials:Retrospective collection of pregrancies with a singleton at term who gave birth in our hospital from December 2017 to April 2019.Inclusion criteria were as follows:gestational week of 37-42 weeks,singleton and cephalic presentation,non-scar uterus,no pelvic stenosis,no macrosomia estimated at prenatal,and with complete obstetric inpatient medical records,pregnant women aged 20-45 years;Exclusion criteria:preeclampsia,chronic hypertension,cardio-cerebrovascular disease,fetus with abnormal chromosom-e or fetal malformation,intrauterine growth restriction,hydramnios and multip-le pregnancies.In the end,a total of 1037 maternal cases were included,and collected their general materials,delivery mode and neonatal materials.This study was approved by the Ethics Committee of the Third Affiliated Hospital of Xinxiang Medical University.Methods:According to amniotic fluid index?AFI?,all materials of pregnancies were divided into three groups:IO group?n=143?,IBO group?n=256?and normal amniotic fluid group?NAF group,n=658?.General materials:gestational week,age,AFI,and the rate of nullipara.Maternal observation indexes:elective induced labor rate,delivery mode,and the reason for cesarean section.Perinatal observation indexes:the Apgar scores at 5 minutes,the neonatal weight?kg?,the rate of meconium-stained amniotic fluid,the rate of admission to intensive care and death rate.To compare maternal and perinatal general materials and outcomes between the three groups,and the related factors affecting maternal and perinatal outcomes were analyzed.Statistical methods:using SPSS 22.0 for statistical analysis,variance analysis,Chi-square exact test and logistic regression analysis were used for statistical analysis.Each P value was two-tailed,and the significance level was set at P=0.05.But Bonferroni correction was used for comparisons between the three groups,each P value was two-tailed and the significance level was set at P=0.016?0.05/3?.Reasults?1?Genernal materials of pregnanciesWe did not find any clinically significanct differences between the three groups in the gestational weeks?P=0.397?.The mean age:IO group?27.3±4.4?,IBO group?27.8±3.8?,NAF group?29.0±4.5?,the mean age?year?of IO group and IBO group was lower than that of NAF group?all P<0.016?,but there were no significanct difference between IO group and IBO group?P>0.016?.The rate of nullipara:IO group 96?67.1%?,IBO group 134?56.8%?,NAF group 288?43.7%?,the rates in IO group and IBO group were higher than that in NAF group?all P<0.016?,but there was no significanct difference between IO group and IBO group?P=0.045?.?2?Maternal outcomesThere was no maternal death in the three groups.The rates of induction:IO group 48?33.6%?,IBO group 82?34.7%?,NAF group 126?19.1%?,the rates in IO group and IBO group were higher than that in NAF group?all P<0.016?,but there were no significanct difference between IO group and IBO group?P=0.815?.The cesarean section rate:IO group?49.6%?,IBO group?29.2%?,NAF group?21.2%?,the cesarean section rate of IBO group was lower than that of IO group but higher than that of NAF group,and the differences between the three were all statistically significant?all P<0.016?.The main causes of cesarean section in the three groups were nonreassuring fetal heart rate monitoring?NRFHR?and elective cesarean section,with higher rate of elective cesarean section in IO group?53.5%?and higher rate of NRFHR in IBO group?47.8%?.?2?Perinatal outcomesThere was no perinatal death in the three groups,and there was no significant difference in the proportions of low-birth-weight infants?P=0.114?,the rates of meconium-stained amniotic fluid?P=0.758?,the proportions of Apgar<7 points at 5 minutes?P=0.893?and the rates of admission to neonatal intensive care unit?P=0.054?among groups.Neonatal weight?kg?:group IO?3.20±0.39?,group IBO?3.36±0.39?,group NAF?3.44±0.40?,the mean weight of group IBO is higher than that of group IO but lower than that of group NAF,and the differences were all statistically significant?P<0.05?.?3?The correlation analysisPearson test analysis showed a positive correlation between AFI and neonatal weight?r=0.224,P<0.001?.?5?Analysis for relevant factors of cesarean section rateThe binary logistic regression analysis showed that the factors of age,nullipara,IO and elective induced labor were all correlated with the rate of cesarean section?all P<0.001?,but the factors of gestational week and IBO were not significantly correlated with the rate of cesarean section?all P>0.05?.The multivariate logistic regression analysis showed that the factor of elective induced labor was correlated with NRFHR?P<0.001?,but the factors of gestational weeks,maternal age,nullipara,IO and IBO were not correlated with NRFHR?all P>0.05?.Conclusions?1?IO or IBO was not significantly associated with adverse perinatal outcomes,but correlated with excessively high induction rate and cesarean section rate.?2?There was a positive correlation between neonatal weight and amniotic fluid volume.?3?Both IO and elective induced labor increased the rate of cesarean section,while elective induced labor increased NRFHR thereby increasing the rate of cesarean section. |
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