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目的探究足月妊娠产妇羊水偏少时,阴道试产对围生结局产生的影响。方法对住院分娩的足月妊娠初产妇进行检查,孕周37~42周,产前3D超声诊断为羊水偏少,没有发现其他危险因素,安排引产的128例产妇作为观察组。并选取羊水量正常、没有其他危险诱因的阴道分娩的130例初产妇作为对照组。对上述产妇全部予以密切的产前监测,监测内容有测脐动脉收缩阶段最大血流量与舒张末期血流量的对比参数、胎儿生物物理评分、电子胎心监护等。所有产妇收治入院后,引产前常规予以缩宫素激惹试验(OCT),然后予以宫颈评分,宫颈Bishop<7分,予以普贝生促宫颈成熟,必要时予以缩宫素调整宫缩,宫颈Bishop评分≥7分,则予以缩宫素引产。产程阶段密切监测胎心率改变,胎儿羊水污染以及产程不顺利的产妇,第一时间予以急诊剖宫产。结果产前缩宫素激惹试验(OCT)出现变异减速(VD),无晚期减速(LD)。产时监护缩宫素激惹试验以及宫缩应激试验显示,观察组变异减速(VD)和晚期减速(LD)较产前差异有统计学意义(P<0.01或P<0.05)。上述产妇,其中观察组轻度羊水浑浊的发生率显著超过对照组,两组对比差异有统计学意义(P<0.01)。上述两组产妇胎儿窘迫,羊水粪染的发生率对比,差异无统计学意义(P>0.05)。两组分娩形式对比,观察组急诊剖宫产率明显高于对照组(P<0.01),阴道分娩的成功率超过61.7%,两组对比差异有统计学意义(P<0.05)。两组新生儿预后对比及新生儿体重对比,差异无统计学意义(P>0.05)。观察组新生儿窒息发生率显著超过对照组,差异有统计学意义(P<0.05)。结论超声诊断羊水偏少的足月妊娠产妇,在严密监护下可阴道试产。
Objective To investigate the effect of vaginal trial production on perinatal outcome when partial amniotic fluid in term pregnant women is less than normal. Methods The full-term pregnant primipara was checked in the hospital for delivery. The gestational age ranged from 37 to 42 weeks. Prenatal 3D ultrasound was diagnosed as oligohydramnios. No other risk factors were found and 128 cases of induced labor were assigned as the observation group. And select the normal amount of amniotic fluid, vaginal delivery without other dangerous incentives 130 cases of primipara as a control group. All of the above-mentioned maternal to be closely monitored prenatal monitoring content of the umbilical artery during the measurement of maximum blood flow and end-diastolic blood flow parameters, fetal biophysical scores, electronic fetal heart monitoring. All women admitted to hospital after induction of labor routinely to oxytocin challenge test (OCT), and then to cervical score, cervical Bishop <7, to Probes to promote cervical ripening, if necessary, to adjust uterine contraction contractions, cervical Bishop score ≥ 7 points, then be oxytocin induced labor. Closely monitor the stage of labor during fetal heart rate changes, fetal amniotic fluid contamination and labor process is not successful maternal, the first emergency cesarean section. Results Prenatal oxytocin challenge test (OCT) showed variable decelerations (VD), no late deceleration (LD). Obstetrics and Gynecology Oxytocin provocation test and uterine contraction stress test showed that there were significant differences in observation group (VD) and late deceleration (LD) compared with those before birth (P <0.01 or P <0.05). The incidence of mild amniotic fluid cloudy in the observation group was significantly higher than that in the control group, with significant difference between the two groups (P <0.01). The incidence of fetal distress and meconium-stained amniotic fluid in the two groups was no significant difference (P> 0.05). The cesarean section rate in the observation group was significantly higher than that in the control group (P <0.01). The success rate of vaginal delivery was over 61.7%. The difference between the two groups was statistically significant (P <0.05). The two groups of newborns compared the prognosis and neonatal weight comparison, the difference was not statistically significant (P> 0.05). The incidence of neonatal asphyxia in the observation group was significantly higher than that in the control group, with significant difference (P <0.05). Conclusion Ultrasound diagnosis of oligohydramnios less full-term pregnant women, vaginal trial under close supervision.