Спасибо! Я смотрела, но вопрос показаний к индукции при изолированном маловодии там как-то не слишком раскрыт.
Management of oligohydramnios in late pregnancy depends on the clinical situation. Initially, an evaluation for fetal anomalies and growth is critical. In a pregnancy complicated by oligohydramnios and fetal-growth restriction, close fetal surveillance is important because of associated morbidity. In many cases, evidence for fetal or maternal compromise will override potential complications from preterm delivery. However, oligohydramnios detected before 36 weeks in the presence of normal fetal anatomy and growth may be managed expectantly in conjunction with increased fetal surveillance (see Chap. 15, Antepartum Assessment).
То есть что делать с маловодием, обнаруженным, скажем, в 38 недель и без признаков fetal or maternal compromise, остается неясным.
The outcomes of pregnancies with intrapartum oligohydramnios are conflicting. Chauhan and associates (1999) performed meta-analysis of 18 studies comprising more than 10,500 pregnancies in which the intrapartum AFI was less than 5 cm. Compared with controls whose index was greater than 5 cm, women with oligohydramnios had a significantly increased 2.2-fold risk for cesarean delivery for fetal distress and a 5.2-fold increased risk for a 5-minute Apgar score of less than 7. Cord compression during labor is common with oligohydramnios. Baron and colleagues (1995) reported a 50-percent increase in variable decelerations during labor and a sevenfold increased cesarean delivery rate in these women. Divon and associates (1995) studied 638 women with a postterm pregnancy in labor and observed that only those whose amnionic fluid index was 5 cm or less had fetal heart rate decelerations and meconium. Interestingly, Chauhan and colleagues (1995) showed that diminished amnionic fluid index increased the cesarean delivery rate only in women whose labor attendants were made aware of the findings!
Conversely, using the RADIUS trial database, Zhang and colleagues (2004) reported that oligohydramnios of this degree was not associated with adverse perinatal outcomes. Similarly, Magann and co-workers (1999) did not find that associated oligohydramnios increased risks for intrapartum complications. Casey and co-workers (2000) showed a 25-percent increase in nonreassuring fetal heart rate patterns when women with oligohydramnios were compared with normal controls. Despite this, the cesarean delivery rate for pregnancies with this finding increased only from 3 to 5 percent (see Table 21-5).
Это о том, что происходит _в родах_ (и кстати без различения, спонтанные это роды или индуцированнные). А далее там еще абзац про амниоинфузию, это мы делаем в родах, да, но когда рожать-то, вот вопрос
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В общем, Вильямса пересмотрела, но не могу сказать, что у меня прояснилось.