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Definition
Khatun, T., Ansari, A.A., Hamid, I., Gupta, R.S. and Ahmad, M.P., 2017. oligohydramnios and
fetal outcome: A Review. Med Phoenix, 1(1), pp.23-30.
Amniotic Fluid Function
■ helps to protect the fetus from trauma to the maternal
abdomen
■ cushions the umbilical cord from compression between
the fetus and uterus
■ has antibacterial properties that provide some
protection from infection
■ serves as a reservoir of fluid and nutrients for the fetus
■ provides the necessary fluid, space, and growth factors
to permit normal development of the fetal lungs and
musculoskeletal and gastrointestinal systems.
Khatun, T., Ansari, A.A., Hamid, I., Gupta, R.S. and Ahmad, M.P., 2017.
oligohydramnios and fetal outcome: A Review. Med Phoenix, 1(1), pp.23-30.
Potential Indications
Improved Treatment or
visualization during prevention of As an aid to external
sonographic or chorioamnionitis in cephalic version
fetoscopic PROM
Eliminate repetitive variable
decelerations
■ The most effective use of amnioinfusion is to
prevent or relieve umbilical cord compression
during labor.
■ is benefit was confined to women receiving a
therapeutic procedure after the occurrence of FHR
abnormalities
■ There was NO advantage to routine prophylactic
amnioinfusion because of oligohydramnios when
the tracing was normal
Miyazaki FS, Taylor NA. Saline amnioinfusion for relief of variable or prolonged
decelerations. A preliminary report. Am J Obstet Gynecol 1983; 146:670.
■ Prevention and treatment of repetitive variable decelerations
[1]
■ Prevention of meconium aspiration [2,3]
■ Reduction in cesarean deliveries performed for repetitive
FHR decelerations [4]
■ Improved visualization during sonographic or fetoscopic
assessment of fetal anomalies [5-7]
■ Treatment or prevention of chorioamnionitis in premature
rupture of membranes [8]
■ As an aid to external cephalic version [9].
Prevent meconium aspiration
Wenstrom KD, Parsons MT. The prevention of meconium aspiration in labor using
amnioinfusion. Obstet Gynecol 1989; 73:647.
To reduce need for cesarean
delivery
■ Amnioinfusion reduce the rate of cesarean delivery
for persistent FHR abnormalities if the procedure
lowers the frequency of cord compression leading
to these abnormalities.
■ there was NO advantage to routine amnioinfusion
among women with oligohydramnios or meconium
stained amniotic fluid in the absence of FHR
decelerations
Pryde PG, Hallak M, Lauria MR, et al. Severe oligohydramnios with intact membranes: an
indication for diagnostic amnioinfusion. Fetal Diagn Ther 2000; 15:46.
To facilitate external cephalic
version
■ Transabdominal amnioinfusion has been used to
facilitate external cephalic version
■ In one study, version after amnioinfusion was
successful in a series of six patients who had
previously failed the procedure
■ In another similar series, version after
amnioinfusion was unsuccessful in all seven
patients
Benifla JL, Goffinet F, Darai E, Madelenat P. Antepartum transabdominal amnioinfusion to facilitate
external cephalic version after initial failure. Obstet Gynecol 1994; 84:1041.
Adama van Scheltema PN, Feitsma AH, Middeldorp JM, et al. Amnioinfusion to facilitate external
cephalic version after initial failure. Obstet Gynecol 2006; 108:591.
For management of PPROM
Chorioamnionitis
relative
Complications
Centers Reporting
Complication No. (%)
Uterine hypertonus 27 (14)
Abnormal fetal heart rate tracing 17 (9)
Amnionitis 7 (4)
Cord prolapse 5 (2)
Uterine rupture 4 (2)
Maternal cardiac or respiratory compromise 3 (2)
Placental abruption 2 (1)
Maternal death 2 (1)
Wenstrom, K., Andrews, W.W. and Maher, J.E., 1995. Amnioinfusion survey:
prevalence, protocols, and complications. Obstetrics & Gynecology, 86(4),
pp.572-576.
Technique
“Protocols for amnioinfusion vary across
institutions. There is no evidence that any
one method is superior in terms of safety,
efficacy, or complications rates”
Prophylactic Antibiotics
Gonzalez JL, Mooney S, Gardner MO, et al. The effects of amnioinfused solutions for
meconium-stained amniotic fluid on neonatal plasma electrolyte concentrations and
pH. J Perinatol 2002; 22:279.
Transcervical Approach
Method Used:
■ a fluid bolus (50 to 1000 mL) followed by a
constant infusion,
■ serial boluses (200 to 1000 mL administered every
20 minutes to four hours), and
■ constant infusion (15 to 2250 mL/hour).
■ A randomized trial found that continuous and
intermittent infusions were similarly effective.
Glantz JC, Letteney DL. Pumps and warmers during amnioinfusion: is either necessary? Obstet
Gynecol 1996; 87:150.
Nageotte MP, Bertucci L, Towers CV, et al. Prophylactic amnioinfusion in pregnancies complicated
by oligohydramnios: a prospective study. Obstet Gynecol 1991; 77:677.
Monitoring
Nageotte MP, Bertucci L, Towers CV, et al. Prophylactic amnioinfusion in pregnancies complicated
by oligohydramnios: a prospective study. Obstet Gynecol 1991; 77:677.
Transabdominal
Amnioinfusion
Transabdominal Approach
Porat, S., Amsalem, H., Shah, P.S. and Murphy, K.E., 2014. Transabdominal
Amnioinfusion for Preterm Premature Rupture of Membranes: A Systematic Review
and Meta-analysis of Randomized and Observational Studies. Obstetric Anesthesia
Digest, 34(1), p.18.
Transabdominal Approach
Porat, S., Amsalem, H., Shah, P.S. and Murphy, K.E., 2014. Transabdominal
Amnioinfusion for Preterm Premature Rupture of Membranes: A Systematic Review
and Meta-analysis of Randomized and Observational Studies. Obstetric Anesthesia
Digest, 34(1), p.18.
Transabdominal Approach