日本医療機能評価機構産科医療補償制度再発防止委員会. 第11回産科医療補償制度再発防止に関する報告書. 日本医療機能評価機構. 2021; p17-18.
Phelan JP, Smith CV, Broussard P, Small M.
Amniotic fluid volume assessment with the four-quadrant technique at 36-42 weeks' gestation.
J Reprod Med. 1987 Jul;32(7):540-2.
Abstract/Text
An ultrasound approach was developed to identify normal amniotic fluid volume. The uterine cavity was divided into four quadrants. With the use of linear-array, real-time B-scanning, the vertical diameter of the largest pocket in each quadrant was measured. The sum of these four quadrants was used to provide a single number for the amniotic fluid volume and termed the amniotic fluid index. This approach is simple, requires little time and gives a semiquantitative estimate of amniotic fluid volume. Based on our observations, the normal amniotic fluid index in term gestation is 12.9 +/- 4.6 cm. Evaluation of the relationship between amniotic fluid volume and fetal outcome is under investigation.
Chamberlain PF, Manning FA, Morrison I, Harman CR, Lange IR.
Ultrasound evaluation of amniotic fluid volume. II. The relationship of increased amniotic fluid volume to perinatal outcome.
Am J Obstet Gynecol. 1984 Oct 1;150(3):250-4. doi: 10.1016/s0002-9378(84)90360-0.
Abstract/Text
Qualitative amniotic fluid volume determination is a routine part of fetal biophysical profile score testing. The relationship between polyhydramnios and poor perinatal outcome has been previously documented. We have undertaken a retrospective chart review which relates qualitative amniotic fluid volume as determined at the time of last biophysical profile score assessment to perinatal outcome in 7562 referred high-risk obstetric patients. Gross and corrected perinatal mortality in association with normal qualitative amniotic fluid volume ranged from 4.65/1000 and 1.97/1000, respectively, to 32.9/1000 and 4.12/1000 in association with increased qualitative amniotic fluid volume, respectively. The incidences of major congenital anomaly and fetal macrosomia were significantly related to qualitative amniotic fluid volume.
Magann EF, Doherty DA, Chauhan SP, Busch FW, Mecacci F, Morrison JC.
How well do the amniotic fluid index and single deepest pocket indices (below the 3rd and 5th and above the 95th and 97th percentiles) predict oligohydramnios and hydramnios?
Am J Obstet Gynecol. 2004 Jan;190(1):164-9. doi: 10.1016/s0002-9378(03)00859-7.
Abstract/Text
OBJECTIVE: This study was undertaken to determine whether the amniotic fluid index (AFI) and single deepest pocket percentiles can reliably identify a dye-determined amniotic fluid volume.
STUDY DESIGN: Ultrasound measurements and dye-determined volumes were prospectively collected. Oligohydramnios predictors included AFI and single deepest pocket below the 3rd and 5th percentiles, and hydramnios predictors were based on AFI and single deepest pocket above the 95th and 97th percentiles.
RESULTS: Two hundred ninety-one women with singleton pregnancies participated, including 75 pregnancies (26%) with oligohydramnios and 31 pregnancies (10%) with hydramnios. The predictive ability of the AFI and single deepest pocket indices (<3rd and 5th percentiles) to identify oligohydramnios was between 11% and 27% and to identify hydramnios (>95th and 97th percentiles) ranged between 33% and 46%. The best prediction was for normal fluid volume with an accuracy of 83% to 94%.
CONCLUSION: Amniotic fluid indices perform best for the identifying normal AF volumes, whereas the identification of oligohydramnios or hydramnios is poor.
Carlson DE, Platt LD, Medearis AL, Horenstein J.
Quantifiable polyhydramnios: diagnosis and management.
Obstet Gynecol. 1990 Jun;75(6):989-93.
Abstract/Text
Little has been written regarding the ultrasonographic quantification of polyhydramnios or its subsequent management. Therefore, we designed this study to define polyhydramnios using the amniotic fluid index of greater than 2 SDs above the mean for late second- to third-trimester pregnancies, or 24 cm or greater. One hundred twelve nondiabetic women referred to Women's Hospital, Los Angeles County/University of Southern California Medical Center with the descriptive diagnosis of polyhydramnios made by experienced ultrasonographers were included in the study. There was poor correlation between these descriptions and fetal outcome. Twenty-six were qualitatively described as having severe, 29 as moderate, and 57 as mild polyhydramnios. Forty-nine of the 112 patients met our definition of significant polyhydramnios by having an amniotic fluid index of 24 cm or more. This particular definition allowed the inclusion of all fetuses with serious structural defects and/or death. Seven patients had an amniotic fluid index less than 24 cm, but with the traditional quantitative definition of one pocket of 8 cm or more; none of these patients had poor fetal outcome. These data appear to suggest that the use of descriptive definitions of polyhydramnios or a single fluid pocket of 8 cm or greater should be discarded in favor of using an amniotic fluid index of 24 cm or more. Once the diagnosis of polyhydramnios is made, the patient should have a detailed sonographic evaluation, be offered cytogenetic studies, and have antepartum surveillance.
日本産科婦人科学会編集・監修. 産科婦人科用語集・用語解説集 改訂第4版. 日本産科婦人科学会, 2018.
Sohaey R, Nyberg DA, Sickler GK, Williams MA.
Idiopathic polyhydramnios: association with fetal macrosomia.
Radiology. 1994 Feb;190(2):393-6. doi: 10.1148/radiology.190.2.8284386.
Abstract/Text
PURPOSE: To determine the relationship between idiopathic polyhydramnios and fetal macrosomia in the absence of maternal diabetes.
MATERIALS AND METHODS: Idiopathic polyhydramnios was studied with ultrasound (US) in 99 consecutive normal fetuses of nondiabetic women. Birth weights and estimated fetal weights were compared with those of postnatal and prenatal control groups, respectively.
RESULTS: The mean birth weight for the study (polyhydramnios) group was 3,771 g +/- 572 (standard deviation) compared with 3,476 g +/- 444 for the postnatal control group (P < .001). Birth weights in the 90th percentile or greater occurred in 28.2% of the study group versus 9.3% of the postnatal control group (P < .001) with a relative risk of 3.0 and a 95% confidence interval of 1.9, 4.9. The mean percentile of estimated fetal weight obtained with US was also significantly greater for the study group (79.3 +/- 23.7) than for the prenatal control group (51.5 +/- 32.7) (P < .001).
CONCLUSION: Idiopathic polyhydramnios is associated with large-for-gestational-age fetuses and macrosomia independent of maternal diabetes.
Dorleijn DM, Cohen-Overbeek TE, Groenendaal F, Bruinse HW, Stoutenbeek P.
Idiopathic polyhydramnios and postnatal findings.
J Matern Fetal Neonatal Med. 2009 Apr;22(4):315-20. doi: 10.1080/14767050802531870.
Abstract/Text
OBJECTIVE: Our objective was to investigate the outcome of neonates with idiopathic polyhydramnios in the first year after birth.
METHODS: All patients diagnosed in the Erasmus Medical Centre Rotterdam and the University Medical Centre Utrecht between January 2000 and April 2005 with idiopathic polyhydramnios were studied. The outcome variables included mode of delivery, pre-term delivery, birth weight, macrosomia, large-for-gestational-age (weight > p90), neonatal or infant mortality and infant morbidity at 1 year after delivery. These were related to antenatal findings, including the onset of polyhydramnios and ultrasonographic evidence of macrosomia (estimated fetal weight > p90).
RESULTS: Polyhydramnios was diagnosed at a mean gestational age (+/- s.d.) of 31.0 +/- 4.9 weeks. The mean gestational age at birth (+/- s.d.) was 37.9 +/- 3.7 weeks. Macrosomia at birth was present in 25.3% (22/88). Sixty-three of 88 infants were in good health 1 year after birth; 20 infants had an abnormality and 5 children had died. Macrosomia and detection of polyhydramnios in the third trimester was associated significantly with a good outcome.
CONCLUSION: In neonates with idiopathic polyhydramnios, abnormalities were detected during the first year of life in 28.4%. Detection of polyhydramnios in the second trimester and low or normal birth weight are risk factors for associated abnormalities.
Shipp TD, Bromley B, Pauker S, Frigoletto FD Jr, Benacerraf BR.
Outcome of singleton pregnancies with severe oligohydramnios in the second and third trimesters.
Ultrasound Obstet Gynecol. 1996 Feb;7(2):108-13. doi: 10.1046/j.1469-0705.1996.07020108.x.
Abstract/Text
We evaluated the significance of severe oligohydramnios, or anhydramnios, in the second and third trimesters, by determining the range of etiologies as well as the differences in fetal and neonatal outcome. All prenatal ultrasound results on pregnancies found to have severe oligohydramnios over a 7.5-year period at 13-42 weeks' gestation were retrospectively collected. Follow-up results were obtained from review of medical records, autopsies and pathology reports. A total of 250 singleton pregnancies met the criteria of having severe oligohydramnios. A bimodal distribution in gestational age at diagnosis was seen, with more cases diagnosed at 13-21 weeks and at 34-42 weeks. Fetal abnormalities were present in 50.7% of those diagnosed with severe oligohydramnios in the second trimester and in 22.1% of those in the third trimester. There were 10.2% and 85.3% survivors when severe oligohydramnios was diagnosed in the second and third trimesters, respectively. The rate of aneuploidy was at least 4.4% for the entire singleton population. A bimodal distribution of pregnancies presenting with severe oligohydramnios represents two different naturally occurring populations in terms of both etiology and prognosis.
Gold RB, Goyert GL, Schwartz DB, Evans MI, Seabolt LA.
Conservative management of second-trimester post-amniocentesis fluid leakage.
Obstet Gynecol. 1989 Nov;74(5):745-7.
Abstract/Text
During a 32-month period, 603 genetic amniocenteses were performed in our institution, and seven patients (1.2%) experienced fluid leakage within 24 hours of the procedure. All seven patients were hospitalized for strict bed rest and expectant management. Cessation of amniotic fluid leakage and reaccumulation of normal amniotic fluid occurred within 7 days in all cases. Six patients were delivered at term of appropriately grown infants without complication. One patient experienced an intrauterine death at 25 weeks' gestation (6 weeks after the occurrence of fluid leakage secondary to genetic amniocentesis). Although limited by the small number of patients, our experience suggests the following: 1) Appropriate respect for potential complications of genetic amniocentesis is still warranted; 2) expectant management of patients who experience membrane rupture after genetic amniocentesis may be associated with a good perinatal outcome; and 3) membrane rupture after genetic amniocentesis may represent a fundamentally different etiologic entity than spontaneous rupture of the membranes in the second trimester not associated with genetic amniocentesis.
Ogoyama M, Takahashi H, Kobayashi Y, Usui R, Matsubara S.
Ritodrine-induced rhabdomyolysis, infantile myotonic dystrophy, and maternal myotonic dystrophy unveiled.
J Obstet Gynaecol Res. 2017 Feb;43(2):403-407. doi: 10.1111/jog.13211. Epub 2016 Dec 17.
Abstract/Text
A primiparous pregnant woman in remission of myositis suffered very acute-onset ritodrine-induced rhabdomyolysis. At 29 gestational weeks, ritodrine was administered for threatened preterm labor. Just 3 h later, she complained of severe limb muscle pain, with serum creatinine phosphokinase elevated to 32 019 U/L and myoglobinuria. The muscle pain disappeared immediately after ceasing administration of ritodrine. At 31 weeks, premature rupture of the membranes occurred, necessitating cesarean section, yielding a baby with weak tonus, and the presence of infantile muscle diseases was suspected. Genetic analysis of the infant confirmed myotonic dystrophy (dystrophia myotonica, DM), which prompted us to perform maternal genetic analysis, confirming maternal DM. Ritodrine can induce rhabdomyolysis even in the prodromal phase with a mild phenotype of DM. A literature review suggested that ritodrine-induced rhabdomyolysis may be likely to occur more acutely after ritodrine administration in DM compared with non-DM mothers.
© 2016 Japan Society of Obstetrics and Gynecology.
Hofmeyr GJ, Gülmezoglu AM.
Maternal hydration for increasing amniotic fluid volume in oligohydramnios and normal amniotic fluid volume.
Cochrane Database Syst Rev. 2002;(1):CD000134. doi: 10.1002/14651858.CD000134.
Abstract/Text
BACKGROUND: Oligohydramnios (reduced amniotic fluid) may be responsible for malpresentation problems, umbilical cord compression, concentration of meconium in the liquor, and difficult or failed external cephalic version. Simple maternal hydration has been suggested as a way of increasing amniotic fluid volume in order to reduce some of these problems.
OBJECTIVES: The objective of this review was to assess the effects of maternal hydration on amniotic fluid volume and measures of pregnancy outcome.
SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: September 2001.
SELECTION CRITERIA: Randomised trials comparing maternal hydration with no hydration in pregnant women with reduced or normal amniotic fluid volume.
DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by both reviewers.
MAIN RESULTS: Two studies of 77 women were included. The women were asked to drink two litres of water before having a repeat ultrasound examination. Maternal hydration in women with and without oligohydramnios was associated with an increase in amniotic volume (weighted mean difference for women with oligohydramnios 2.01, 95% confidence interval 1.43 to 2.56; and weighted mean difference for women with normal amniotic fluid volume 4.5, 95% confidence interval 2.92 to 6.08). Intravenous hypotonic hydration in women with oligohydramnios was associated with an increase in amniotic fluid volume (weighted mean difference 2.3, 95% confidence interval 1.36 to 3.24). Isotonic intravenous hydration had no measurable effect. No clinically important outcomes were assessed in any of the trials.
REVIEWER'S CONCLUSIONS: Simple maternal hydration appears to increase amniotic fluid volume and may be beneficial in the management of oligohydramnios and prevention of oligohydramnios during labour or prior to external cephalic version. Controlled trials are needed to assess the clinical benefits and possible risks of maternal hydration for specific clinical purposes.
Kramer WB, Van den Veyver IB, Kirshon B.
Treatment of polyhydramnios with indomethacin.
Clin Perinatol. 1994 Sep;21(3):615-30.
Abstract/Text
Polyhydramnios detected in a pregnancy should always be investigated thoroughly. We believe chromosomal abnormalities should be excluded, but that determination need not delay therapy. Indomethacin has been shown to reduce amniotic fluid volume in certain cases, but a strict monitoring schedule should be followed whenever it is administered. At our institution, we are investigating the effect on the fetus of newer, more selective prostaglandin synthetase inhibitors that should have beneficial effects similar to indomethacin, but be devoid of its unwanted side effects.
Moise KJ Jr.
Polyhydramnios.
Clin Obstet Gynecol. 1997 Jun;40(2):266-79. doi: 10.1097/00003081-199706000-00004.
Abstract/Text
Hofmeyr GJ, Lawrie TA.
Amnioinfusion for potential or suspected umbilical cord compression in labour.
Cochrane Database Syst Rev. 2012 Jan 18;1(1):CD000013. doi: 10.1002/14651858.CD000013.pub2. Epub 2012 Jan 18.
Abstract/Text
BACKGROUND: Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity.
OBJECTIVES: To assess the effects of amnioinfusion for potential or suspected umbilical cord compression on maternal and perinatal outcome .
SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2011).
SELECTION CRITERIA: Randomised trials of amnioinfusion compared with no amnioinfusion in women with babies at risk of umbilical cord compression in labour.
DATA COLLECTION AND ANALYSIS: The original review had one author only (Justus Hofmeyr (GJH)). For this update, two authors (GJH and T Lawrie) assessed 13 additional trial reports for eligibility and quality. We extracted data and checked for accuracy.
MAIN RESULTS: We have included 19 studies, with all but two studies having fewer than 200 participants. Transcervical amnioinfusion for potential or suspected umbilical cord compression was associated with the following reductions: caesarean section overall (13 trials, 1493 participants; average risk ratio (RR) 0.62, 95% confidence interval (CI) 0.46 to 0.83); fetal heart rate (FHR) decelerations (seven trials, 1006 participants; average RR 0.53, 95% CI 0.38 to 0.74); Apgar score less than seven at five minutes (12 trials, 1804 participants; average RR 0.47, 95% CI 0.30 to 0.72); meconium below the vocal cords (three trials, 674 participants, RR 0.53, 95% CI 0.31 to 0.92); postpartum endometritis (six trials, 767 participants; RR 0.45, 95% CI 0.25 to 0.81) and maternal hospital stay greater than three days (four trials, 1051 participants; average RR 0.45, 95% CI 0.25 to 0.78). Transabdominal amnioinfusion showed similar trends, though numbers studied were small.Mean cord umbilical artery pH was higher in the amnioinfusion group (seven trials, 855 participants; average mean difference 0.03, 95% CI 0.00 to 0.06) and there was a trend toward fewer neonates with a low cord arterial pH (less than 7.2 or as defined by trial authors) in the amnioinfusion group (eight trials, 972 participants, average RR 0.58, 95% CI 0.29 to 1.14).
AUTHORS' CONCLUSIONS: The use of amnioinfusion for potential or suspected umbilical cord compression may be of considerable benefit to mother and baby by reducing the occurrence of variable FHR decelerations, improving short-term measures of neonatal outcome, reducing maternal postpartum endometritis and lowering the use of caesarean section, although there were methodological limitations to the trials reviewed here. In addition, the trials are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion. More research is needed to confirm the findings, assess longer-term measures of fetal outcome, and to assess the impact on caesarean section rates when the diagnosis of fetal distress is more stringent. Trials should assess amnioinfusion in specific clinical situations, such as FHR decelerations, oligohydramnios or prelabour rupture of membranes.
Fraser WD, Hofmeyr J, Lede R, Faron G, Alexander S, Goffinet F, Ohlsson A, Goulet C, Turcot-Lemay L, Prendiville W, Marcoux S, Laperrière L, Roy C, Petrou S, Xu HR, Wei B; Amnioinfusion Trial Group.
Amnioinfusion for the prevention of the meconium aspiration syndrome.
N Engl J Med. 2005 Sep 1;353(9):909-17. doi: 10.1056/NEJMoa050223.
Abstract/Text
BACKGROUND: It is uncertain whether amnioinfusion (infusion of saline into the amniotic cavity) in women who have thick meconium staining of the amniotic fluid reduces the risk of perinatal death, moderate or severe meconium aspiration syndrome, or both.
METHODS: We performed a multicenter trial in which 1998 pregnant women in labor at 36 or more weeks of gestation who had thick meconium staining of the amniotic fluid were stratified according to the presence or absence of variable decelerations in fetal heart rate and then randomly assigned to amnioinfusion or to standard care. The composite primary outcome measure was perinatal death, moderate or severe meconium aspiration syndrome, or both.
RESULTS: Perinatal death, moderate or severe meconium aspiration syndrome, or both occurred in 44 infants (4.5 percent) of women in the amnioinfusion group and 35 infants (3.5 percent) of women in the control group (relative risk, 1.26; 95 percent confidence interval, 0.82 to 1.95). Five perinatal deaths occurred in the amnioinfusion group and five in the control group. The rate of cesarean delivery was 31.8 percent in the amnioinfusion group and 29.0 percent in the control group (relative risk, 1.10; 95 percent confidence interval, 0.96 to 1.25).
CONCLUSIONS: For women in labor who have thick meconium staining of the amniotic fluid, amnioinfusion did not reduce the risk of moderate or severe meconium aspiration syndrome, perinatal death, or other major maternal or neonatal disorders.
Copyright 2005 Massachusetts Medical Society.
Golan A, Wolman I, Sagi J, Yovel I, David MP.
Persistence of polyhydramnios during pregnancy--its significance and correlation with maternal and fetal complications.
Gynecol Obstet Invest. 1994;37(1):18-20. doi: 10.1159/000292513.
Abstract/Text
One hundred and thirteen cases of polyhydramnios diagnosed by repeated ultrasonic examinations in singleton pregnancies were divided into two groups according to the trend of change in the amniotic fluid volume between the first and the second ultrasonic examination. Group A patients (65 cases) showed an increase or no change in amniotic fluid volume, and in group B (48 cases) a reduction in amniotic fluid volume to mild polyhydramnios or to normal amniotic fluid volume was observed. A significantly increased rate (p < 0.05) of maternal complications such as diabetes mellitus, pregnancy-induced hypertension, urinary tract infections, premature rupture of membranes and premature delivery was observed in group A. More abdominal deliveries and an increased rate of fetal anomalies, fetal abnormal presentations, intrauterine fetal death and neonatal death also occurred in this group. Group B patients, most of whom were idiopathic, showed a very favorable outcome.
Shrem G, Nagawkar SS, Hallak M, Walfisch A.
Isolated Oligohydramnios at Term as an Indication for Labor Induction: A Systematic Review and Meta-Analysis.
Fetal Diagn Ther. 2016;40(3):161-173. doi: 10.1159/000445948. Epub 2016 May 4.
Abstract/Text
OBJECTIVE: To investigate whether isolated oligohydramnios at term is associated with increased rates of perinatal morbidity and mortality and whether induction of labor in term pregnancies with isolated oligohydramnios is superior to conservative management in reducing perinatal morbidity and mortality.
STUDY DESIGN: We searched databases from inception to May 2015. We included studies that evaluated isolated oligohydramnios at term and perinatal outcome. Each outcome was analyzed separately, performing a comparative analysis between the study and control groups.
RESULTS: Twelve studies were included with 35,999 women: 2,414 (6.7%) with isolated oligohydramnios and 33,585 (93.29%) with normal amniotic fluid index. Patients with isolated oligohydramnios had significantly higher rates of labor induction [odds ratio (OR) 7.56, confidence interval (CI) 4.58-12.48] and Cesarean sections (OR 2.07, CI 1.77-2.41). There were higher rates of an Apgar score <7 at 1 and 5 min (OR 1.53, CI 1.03-2.26, and OR 2.01, CI 1.3-3.09, respectively) and admission to the neonatal intensive care unit (OR 1.47, CI 1.17-1.84). There were no significant differences in cord pH <7.1 and meconium-stained amniotic fluid. In the single randomized trial comparing induction of labor with expectant management, no differences were found in any significant maternal or neonatal outcomes.
CONCLUSION: Isolated oligohydramnios at term is associated with significantly higher rates of labor induction, Cesarean sections, and short-term neonatal morbidity.
© 2016 S. Karger AG, Basel.
Brzezinski-Sinai NA, Stavsky M, Rafaeli-Yehudai T, Yitshak-Sade M, Brzezinski-Sinai I, Imterat M, Andrea Mastrolia S, Erez O.
Induction of labor in cases of late preterm isolated oligohydramnios: is it justified?
J Matern Fetal Neonatal Med. 2019 Jul;32(14):2271-2279. doi: 10.1080/14767058.2018.1430134. Epub 2018 Feb 1.
Abstract/Text
OBJECTIVES: To analyze in a retrospective cohort study the outcomes of pregnancies with isolated oligohydramnios at the late preterm period (34-36.6 weeks of gestation).
STUDY DESIGN: This retrospective cohort study included three groups of women: (1) Women with isolated oligohydramnios whose pregnancy was managed conservatively (n = 33 births); (2) women with isolated oligohydramnios who were managed actively (i.e. induction of labor) (n = 111 births); and (3) a control group including women with normal amount of amniotic fluid who had a spontaneous late preterm delivery (n = 10,445 births). Maternal and fetal characteristics and obstetrics outcomes were collected from a computerized database of all deliveries at Soroka University Medical Center during the study period.
RESULTS: Our cohort included 10,589 births. The rate of inducing labor was higher in the oligohydramnios groups compared to the controls (p < .001). There was an increase in the rate of cesarean section (CS) in the conservative treatment group (p < .001), compared with the other groups. Conservative management was associated with higher rates of maternal infection (p = .026), chorioamnionitis (p = .01), and transitory tachypnea of the newborn (p = .02). After controlling for confounding factors, mal presentation (OR = 19.9), and a prior CS (OR = 2.4) were independently associated with an increased risk for CS, while induction of labor was associated with a reduced risk for CS (OR = 0.28).
CONCLUSIONS: Women with late preterm isolated oligohydramnios had a higher rate of induction of labor than women with a normal amount of amniotic fluid. Induction of labor seems to be beneficial to both the neonate and the mother as seen by a lower rate of CS conducted in this group, as well as lower maternal and neonatal morbidity in comparison to the conservative group. Therefore, women with oligohydramnios at late preterm may benefit from induction of labor.
