Prophylactic amnioinfusion in oligohydramnios

Background: Oligohydramnios causes many intrapartum maternal and fetal complications. Intrapartum amnioinfusion effectively increases amniotic fluid volume and thereby decreases FH decelerations. The objective of this study was to compare the frequency of fetal heart decelerations and its perinatal outcome with and without amnioinfusion in patients with oligohydramnios and the cesarean rates for fetal distress between them.Methods: In study group, 100 patients in labour with AFI < 5 cm, oligohydramnios and IUGR with normal doppler, postdated pregnancies with AFI ≤ 5 cm with normal doppler were selected and prophylactic amnioinfusion with 300 ml lukewarm saline is given aseptically for 15 minutes after amniotomy. Continuous CTG monitoring done till delivery. If FH decelerations occur, the bolus was repeated up to 3 times. 100 age matched controls managed with conventional methods without amnioinfusion were selected retrospectively from labour room case records.Results: Incidence of FH decelerations was lower in study group (59% versus 84%). Cesarean section for fetal distress was reduced (20.9% versus 79.1%) Perinatal outcome was better. Babies with normal 1-minute Apgar was 86% compared to 75% in controls. Frequency of FH decelerations was reduced (20% versus 73%). Occurrence of 2 FH decelerations were 13% versus 33%, 3 FH decelerations were 7% versus 27% and > 3 times was 0% versus 13%.Conclusions: Prophylactic amnioinfusion can easily and effectively reduce the FH decelerations and caesarean section rate for fetal distress in oligohydramnios improving both maternal and fetal outcomes with negligible risks.

Role of Intrapartum Transcervical Amnioinfusion in Meconium Stained Liquor

Background: Pregnancy is associated with several risks toboth mother and fetus. Meconium staining of amniotic fluid isone of the important risk factors associated with neonatalmortality. Thus the aim of this study was to assess theeffectiveness of amnioinfusion in treatment of thick meconiumstained amniotic fluid and compare the results with controlgroup.Materials and Methods: It was a prospective case controlstudy conducted from October 2015 to September 2017, in thedepartment of Obstetrics and Gynaecology, at Indira GandhiInstitute of Medical Sciences (IGIMS), Patna. We included 100cases of thick meconium complicated deliveries. The patientswere categorized as study group who received amnioinfusionand control group who received standard treatment. Eachgroup contained 50 patients.Results: We found that the need for caesarean section waslow in study group. The Apgar score also effectively improvedin the study group compared to the control group at 1 minute, 5minute and 10 minutes interval. Amnioinfusion reduced theincidence of meconium below the vocal cord and meconiumaspiration syndrome. There was also reduction in admission ofinfants to NICU in those cases who received amnioinfusioncompared to control groups.Conclusion: We concluded that transcervical amnioinfusion issimple and effective method that aids in improvement ofperinatal outcomes of those cases complicated with thickmeconium.

Evaluation of the Success Rate Following Amnioinfusion in Pregnant Women Undergoing External Cephalic Version after Initial Failure

PURPOSE: To evaluate the success rate following amnioinfusion in pregnant women undergoing external cephalic version (ECV) after initial failure. METHODS: This prospective study enrolled 17 consecutive pregnant women from October 2013 to May 2015. ECV was performed with amnioinfusion after initial failure. The success rates of ECV and vaginal delivery, including pregnancy outcomes, were analyzed. RESULTS: ECV was performed at an average of 37.3±0.6 weeks of gestational age. Eight of seventeen patients were nulliparous. The estimated fetal weight was 2,688±279 g, and the amniotic fluid index was 6.4±2.6 cm. The overall success rate of ECV was 70.6% (12/17), and the success rates in nulliparous and multiparous women were 75.0% (6/8) and 66.7% (6/9), respectively. The rate of emergent cesarean section within 24 hours was 11.8% (2/17). Excluding one women who were lost to follow-up, the rate of normal vaginal delivery was 81.8% (9/11) among the women who had successful ECV. We did not observe any complications such as uterine rupture, placental abruption, or intrauterine fetal death. CONCLUSION: Although ECV with amnioinfusion after initial failure might help increase the success rate of ECV, it needs to be further evaluated in larger studies.

Effect of amnioinfusion on outcome of neonates born with meconium stained amniotic fluid.

Background & Objective: Meconium stained amniotic fluid (MSAF) is associated with significant morbidity and mortality. Amnioinfusion can decrease complications of MSAF. The objective was to study role of Amnioinfusion on outcome of babies born with MSAF. Methods: Design: Prospective Interventional Study Setting: Medical college and SSG Hospital, Baroda, Gujarat. Study Period: from 1st March 2003 to 31st December 2003 Inclusion criteria: evidence of Thick MSAF AND station of the head is zero or above. Patients were grouped randomly in to two groups. In Group A amnioinfusion was performed while in Group B amnioinfusion was not done. Amnioinfusion was done by inserting foley catheter transcervically and infusing normal saline or ringer lactate at the rate of 100ml/min till the coming liquor became clear. Outcome was studied. Results: Out of total 227 babies with thick MSAF amnioinfusion was performed in 52 patients (Group A), rest 175 patients were controls (Group B). Incidence of MAS was significantly lower 7.7% in Group A compared to 25.7% of Group B (P < 0.005). There was significantly lower incidence of birth asphyxia 1.92% in Group A compared to 34.8% in Group B (P value < 0.0001). Incidence of HIE was significantly lower in group A. Incidence of Air leaks and PPHN was similar in both groups. Rate of NICU admission was significantly lower in group A (13.4%) compared to group (51.4%), P value < 0.001. Mortality in Group A was much lower 5.8% compared to 14.85% in Group B (p =0.08). Amnioinfusion did not increase risk of maternal or neonatal sepsis. Conclusion: Amnioinfusion significantly decreases complications of MSAF and improves perinatal survival.

The applied value of abnormalities of fetus with oligohydramnios in mid-pregnancy by amnioinfusion / 中国医师进修杂志

Objective To investigate the applied value of abnormalities of fetus with oligohydramnios in mid-pregnancy by anmioinfusion. Methods Fifty women with oligohydramnios diagnosed by ultrasonograph were analysed retrospectively. During the procedure 60-300 ml saline solution at 37 ℃ were infused into the amniotic cavity,made prenatal diagnosis at the same time necessarily. And examined the women to know whether the fetal anomaly existed or not after the amnioinfusion by the ultrasound. Results There were 15 cases with fetal anomaly, 8 cases with genitotirinary anomaly(2 cases associated with multiple organs anomaly), 1 case with single umbilical artery, 4 cases with chromosomal abnormality (2 cases associated with fetal growth restriction), 2 cases with pulmonary hypolasia. There was no significant difference in dilivery outcome between others and 35 cases with normal pregnant women (P >0.05). Conclusion Transabdominal amnioinfusion has double function on beth diagnosis and therapy for the oligohydramnios in the mid-pregnancy.

Clinical Effects of Continuous Transabdominal Amnioinfusion in Preterm Premature Rupture of Membranes : Retrospective Study / 대한주산의학회잡지

OBJECTIVE : To assess the clinical role of continuous transabdominal amnioinfusion in pregnancies with preterm premature rupture of membranes (PPROM) less than 34 weeks of gestation. METHODS : In this retrospective study between January 1999 and December 2003, 76 singleton pregnancies complicated with PPROM less than 34+0 weeks of gestation, were included. Thirty-eight patients consented to undergo the continuous transabdominal amnioinfusion. The control group, matched with the amnioinfusion group by parity and gestational age at rupture of membranes, was managed expectantly. RESULTS : The median intervals from PPROM and delivery (latency period) (8.0+/-7.3 days vs. 1.7+/-2.5 days, p<0.001), the gestational age at delivery (223+/-17.8 days vs. 211+/-18.0 days, p=0.003) and the birth weight (1,853+/-465 g vs. 1,556+/-459 g, p=0.006) were significantly increased in the amnioinfusion group compared to the control group, respectively. In maternal complications, the amnioinfusion group showed higher rate of placental abruption (5.2% vs. 2.6%, p=0.556) than the control group, but were comparable in the rates of cesarean section (44.7% vs. 42.1%, p=0.817) and clinical chorioamnionitis (18.4% vs. 18.4%). The rate of neonatal ventilator care of positive pressure ventilation was significantly decreased in the amnioinfusion group, compared to the control group (15.8% vs. 50.0%, p=0.002). In neonatal morbidity, respiratory distress syndrome was more frequent in the control group compared to the amnioinfusion group, although it did not show statistical significance (34.2% vs. 15.8%, p=0.06). There were no significant differences in rates of Intraventricular hemorrhage (IVH) grade III, IV, neonatal sepsis and neonatal mortality between two groups. CONCLUSION : Our results suggest that, in pregnancies complicated with preterm premature rupture of membranes less than 34 weeks of gestation, the continuous transabdominal amnioinfusion might have improved the neonatal outcome without increasing the perinatal infection rate.

A case of sirenomelia diagnosed after amnioinfusion / 대한산부인과학회지

Sirenomelia, also known as the mermaid syndrome, is a rare and usually lethal congenital malformation of uncertain etiology. It is characterized by fusion of the lower limbs and commonly associated with severe urogenital and gastrointestinal malformations. Early antenatal sonogram allows for earlier, and less traumatic termination of pregnancy, but usually it is impared by severe oligohydramnios related to bilateral renal agenesis. We diagnosed a sirenomelia with severe oligohydramnios at early second trimester after amnioinfusion and terminated. We report a case with a brief review of the literature.

A Case of Fetal Skin Bullae after Amnioinfusion / 대한산부인과학회잡지

Premature rupture of membrane generally leads to a poor perinatal outcome. For better perinatal survival, transabdominal prophylatic amnioinfusion and active expectant management was performed. We experienced a case of fetal right arm multiple skin bullae and stomach perforation after amnioinfusion. Underskin bullae was to disappear within a few days and stomach perforation site was treated by primary closure.

The Effects of Diagnostic Amnioinfusion to Severe Oligohydramnios with Intact Membrane / 대한산부인과학회잡지

OBJECTIVE: To quantify the improvement in ultrasonographic fetal imaging following diagnostic amnioinfusion for the indication of unexplained midtrimester oligohydramnios. METHODS: Eight patients were referred for unexplained midtrimester oligohydramnios were retrospectively reviewed. Videotapes of those undergoing diagnostic antenatal amnioinfusion were analyzed for quality of visualiztion of routinely imaged structures before and after the infusion procedure. And genetic amniocentesis was performed in all patients. RESULTS: The overall rate of adequate visualization of fetal structures improved from 64.1% to 95.2% (P=0.008). In most cases we were able to achieve a definitive diagnosis. CONCLUSION: Diagnostic amnioinfusion can facilitate fetal imaging and increase diagnostic precision in the setting of unexplained severe oligohydramnios.

The Peripartum Prognosis of Amnioinfusion in Oligohydramnios without Preterm Premature Rupture of Membrane / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to evaluate the peripartum efficiency of amnioinfusion in oligohydramnios without preterm premature rupture of membrane. METHODS: 73 singleton pregnant women with oligohydramnios were enrolled in this study. Women with preterm premature rupture of membrane were excluded. 21 women were treated with transabdominal amnioinfusion 31 times and 52 women were closely observed without amnioinfusion. Mean amniotic fluid index, mean gestational age, mean maternal age and the parity at the time of diagnosis was not statistically different in both groups. RESULTS: Mean amounts of infused artificial amniotic fluid was 536ml (200-700), the mean time consumed was 61(+/-39.2)min. After infusion, mean amniotic fluid index was increased significantly from 4.2(+/-1.6) to 10.0(+/-2.9). But we found no statistically significant differences in pregnancy outcomes. The outcomes are as follows 1)Mean gestational age at birth was 36.3(+/-3.5) weeks in amnioinfusion group and 37.2(+/-2.9) weeks in control group. 2) Mean birth weight was 2.54(+/-0.9)kg versus 2.51(+/-0.8)kg. 3) The proportions of poor Apgar score at 1 minute and 5 minute were not significantly different. 4) Cesarean section rate was 0.79 versus 0.65. 5.There were two still births in both groups. CONCLUSION: Transabdominal amnioinfusion in oligohydramnios has little effects in improving longterm pregnancy outcomes.

The Clinical Utility of Amnioinfusion in Oligohydroamnios following PPROM / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate the clinical utility of transabdominal prophylactic amnioinfusion on oligohydroamnios caused by preterm premature rupture of membrane(PPROM). METHODS: There were 59 singleton pregnant women with oligohydroamnios caused by PPROM who were treated by transabdominal amnioinfusion at the department of from March 1997 to December 1998. Nineteen pregnant women who underwent prophylactic amnioinfusion were designated as study group and 40 pregnant women who did not undergo prophylactic amnioinfusion were designated as control group. Clinical data were drawn from medical records, such as time interval from amnioinfusion to deliver, birth weight, incidence of variable deceleration, Apgar score at 1 minute, Apgar score at 5 minutes, and so on. Statistical analyses were performed by means of Student t test, Mann Whitney U-test, Fisher's exact test where appropriate. P value below 0.05 was considered significant. RESULTS: The median interval from amnioinfusion to delivery w as longer in study group than in control group (13.0 29.3 days vs. 5.0 13.0 days, p<0.05). The incidence of variable deceleration during labor in study group was 16% and that in control group was 43%(p<0.05). The incidence of Apgar score at 5 minutes below 7 was lower in study group than that in control group(39% vs. 43%, p<0.05). The incidence of respiratory distress syndrome was lower in study group than that in control group(16% vs. 83%, p=0.05) However, there were no significant difference in the incidence of respiratory distress syndrome between them who did not undergo dexamethasone treatment, in mode of delivery, birth weight, and incidence of chorioamnionitis between two groups. CONCLUSION: Transabdominal prophylactic amnioinfusion may have a positive role in the management of PPROM.

Amnioinfusion in preterm premature rupture of membranes / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to determine the effectiveness of transabdominal amnioinfusion in the pregnant women with preterm premature rupture of the membranes (PPROM). METHODS: Between March 1997 and June 1999, 54 pregnancies of 26 weeks to 36 weeks of gestation complicated with preterm premature rupture of the membranes were admitted at our institution, 23 patients were excluded from study due to incomplete data, loss follow up or medical diseases was combined. Among included 31 cases were randomly selected either for amnioinfusion (n=16) or expectant management (n=15). After hospitalization, all patients were assessed for fetal heart rate abnormalities, fetal lung maturity and chorioamnionitis. Labor induction was not performed until progressive labor and chorioamnionitis occurred. Amnioinfusion was done through transabdominal catheter and infused group was managed with prophylactic antibiotics and conservative group were treated by hydration and antibiotics. RESULTS: The median interval from PPROM and delivery was significantly increased in amnioinfused group compared to expectant group (11.19+/-11.52 days vs 3.67+/-5.59 days, p=0.02). There were no differences in 1 minute and 5 minutes Apgar score. However, the duration of incubator treatment and oxygen supplementation were more necessary in expectant group compared to amnioinfused group (p=0.01, respectively). Respiratory distress syndrome was more frequent in expectant group although it did not show statistical significance (20% vs 6%, p<0.25). There was no differences in mode of delivery, birth weight and maternal clinical characteristics between two groups. CONCLUSION: Our results suggest that active management using transabdominal amnioinfusion in pregnancies complicated with PPROM may give a chance to gain minimal time to accelerate lung maturation and thus improve neonatal outcome without increasing complications.

Two Cases of Amnioinfusion for the Midtrimester Oligohydroamnios / 대한산부인과학회잡지

Reduced amniotic fluid volume generally leads to a poor perinatal outcome, especially when it is observed in the second trimester. The recent obstetric literatures have been reporting on various applications of amnioinfusion in the diagnostic, prophylactic and therapeutic management of oligohydroamnios. We experienced two cases of amnioinfusion, which were used to diagnose or to manage the midtrimester oligohydroamnios and we report them with a brief review.

Fetal outcome following transabdominal amnioinfusion in various causes of oligohydramnios / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficiency and fetal outcome following antepartum transabdominal amnioinfusion in various causes of oligohydramnios. MATERIALS AND METHODS: Forty four transabdominal amnioinfusion were performed in twenty seven cases of singleton pregnancy with severe oligohydramnios. Severe oligohyadrmnios defined as amnionic fliud index of 5cm or less than. In all cases, high resolution sonographies were done before and after amnioinfusion in order to detect fetal anomalies. Transabdominal amnioinfusion was performed through a closed system with warmed normal saline. RESULTS: Infusion (mean volume 435.9ml) of normal saline significantly increased the amniotic fluid index from 3.2cm to 7.5cm. The causes of oligohydramnios were as follows, premature rupture of membranes was 8 cases (29.6%), intrauterine growth restriction was 10 cases (37.0%), congenital anomaly was 4 cases (14.8%) and idiopathic was 5 cases (18.5%). The gestational weeks were prolonged significantly from 26.8 weeks to 29.5 weeks. The overall survival rate except congenital anomalies was 67%. Babies with idiopathic oligohydramnios were heavier and required less hospitalization dates than those of badies with oligohydramnios of other causes, but it was not statistically significant. There were several complications as follows, chorioamnionitis 2 cases, neonatal sepsis 2 cases, meconium aspiration syndrome 2 cases and fetal bradycardia 1 case. All of the babies discharged healthy without sequele. CONCLUSION: These results show that antepartum transabdominal amnioinfusion is a relatively safe procedure. And it can significantly increase the amnionic fluid index and prolong the gestational age which is optimal for neonatal survival in oligohydramnios of idiopathic cause or with intrauterine growth restriction.

A Case of Bilateral Renal Agenesis Diagnosed by Prenatal Ultrasonography / 대한산부인과학회잡지

Fetal bilateral renal agenesis is a lethal congenital anomaly. An early and reliable prenatal diagnosis is extremely important as it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, and the empty renal fossae. However, severe oligohydramnios makes it difficult to diagnose the disease because of poor sonographic resolution. We present a case of fetal bilateral renal agenesis diagnosed by ultrasonography after amnioinfusion at 19 weeks gestation.

Two Cases of Fetal Bilateral Renal Agenesis / 대한산부인과학회잡지

Fetal bilateral renal agenesis is a lethal congenital anomaly. An early and reliable prenatal diagnosis is extremely important as it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, and the empty renal fossa. However, severe oligohydramnios makes it difficult to diagnose the disease because of poor sonographic resolution. We present two cases of bilateral renal agenesis, one is diagnosed by ultrasonography after amnioinfusion at 24 weeks gestation, the other is diagnosed postnatally after term delivery.