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.

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.

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.