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Ono T, Tsumura K, Kawasaki I, Ikeda M, Hideshima M, Tsuda S, So K, Kawaguchi A, Nomiyama M, Yokoyama M. Continuous amnioinfusion for treatment of mid-trimester preterm premature rupture of membranes with oligoamnios. J Obstet Gynaecol Res 2019; 46:79-86. [PMID: 31650672 DOI: 10.1111/jog.14151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/07/2019] [Indexed: 01/15/2023]
Abstract
AIM Given the scarcity of relevant reports, this study aimed to elucidate whether pregnancy can be prolonged by maintaining the amniotic fluid volume with continuous transabdominal amnioinfusion (TA) for patients with mid-trimester preterm premature rupture of membranes (PPROM) and oligoamnios. METHODS We retrospectively examined patients who were managed during hospitalization at our department after developing PPROM between week 22 day 0 and week 25 day 6 of gestation and subsequent oligoamnios (amniotic fluid index [AFI] <5 cm) within 7 days after PPROM onset. Cases between 2006 and 2011 comprised the conventional management group (n = 14); cases administered continuous TA between 2012 and 2017 comprised the continuous TA group (n = 14). The primary outcome was the number of days between PPROM and delivery. The secondary outcomes were the proportion of normal amniotic fluid volume (AFI ≥ 5 cm) maintained between PPROM and delivery and the perinatal prognosis for the mother and infant. RESULTS The continuous TA group had significantly more days between PPROM and delivery and a significantly higher proportion of days that a normal amniotic fluid volume was maintained during that period, regardless of antimicrobial agents administered. Although no significant differences in the perinatal prognosis of disease were found between groups, there was a decreasing trend of composite perinatal mortality and morbidity, and the incidence rates were reduced by half. CONCLUSION Continuous TA for PPROM with oligoamnios may allow significant prolongation of the gestation period while maintaining the amniotic fluid volume and may lead to improved perinatal prognosis.
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Affiliation(s)
- Takeshi Ono
- Department of Obstetrics and Gynecology, National Hospital Organization, Saga National Hospital, Saga, Japan.,Department of Obstetrics and Gynecology, Karatsu Red Cross Hospital, Karatsu, Japan
| | - Keisuke Tsumura
- Department of Obstetrics and Gynecology, National Hospital Organization, Saga National Hospital, Saga, Japan
| | - Izumi Kawasaki
- Department of Obstetrics and Gynecology, National Hospital Organization, Saga National Hospital, Saga, Japan
| | - Masazumi Ikeda
- Department of Obstetrics and Gynecology, National Hospital Organization, Saga National Hospital, Saga, Japan.,Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Misako Hideshima
- Department of Obstetrics and Gynecology, National Hospital Organization, Saga National Hospital, Saga, Japan.,Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Satoko Tsuda
- Department of Obstetrics and Gynecology, National Hospital Organization, Saga National Hospital, Saga, Japan
| | - Kunio So
- Department of Obstetrics and Gynecology, National Hospital Organization, Saga National Hospital, Saga, Japan
| | - Atsushi Kawaguchi
- Center for Comprehensive Community Medicine Faculty of Medicine, Saga University, Saga, Japan
| | - Makoto Nomiyama
- Department of Obstetrics and Gynecology, National Hospital Organization, Saga National Hospital, Saga, Japan
| | - Masatoshi Yokoyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
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Sung JH, Kuk JY, Cha HH, Choi SJ, Oh SY, Roh CR, Kim JH. Amniopatch treatment for preterm premature rupture of membranes before 23 weeks' gestation and factors associated with its success. Taiwan J Obstet Gynecol 2017; 56:599-605. [DOI: 10.1016/j.tjog.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/26/2022] Open
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Dad N, Abushama M, Konje JC, Ahmed B. What is the role of amnioinfusion in modern day obstetrics? J Matern Fetal Neonatal Med 2015; 29:2823-7. [PMID: 26461043 DOI: 10.3109/14767058.2015.1105953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Amniotic fluid (AF) is a dynamic medium that plays a significant role in fetal well-being. It is production and amount varies with gestational age. It plays a vital role in fetal life as it contains antimicrobial factors, growth factors and it help the fetal lung to grow and expand. Amnioinfusion can be performed either transabdominally or transvaginal. Amnioinfuion can be done antenatally and during labor. Aminoinfusion can be used for diagnostic purposes to enable better visualization of the fetus as liquor is very important acoustic widow for better fetal examination. Amnioinfusion have some therapeutic benefits in conditions like early premature rupture of membrane and may help cases of external cephalic version for breech presentation at term. Amnioinfusion has been shown to reduce the incidence of variable deceleration due to cord compression, reduces the risk of meconium aspiration and it will help reduce cesarean delivery.
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Affiliation(s)
- Nimra Dad
- a Weill Cornell Medical College Qatar , Ar-Rayyan , Qatar
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Abstract
PURPOSE OF REVIEW Nearly 1% of pregnancies are affected by some type of midtrimester oligohydramnios. Evidence is currently accumulating that suggests the better efficacy of the new therapeutic procedures relative to conventional management. This review summarizes the available evidence. RECENT FINDINGS The prolongation of the period between the diagnosis of oligohydramnios and delivery following amnioinfusion and amniopatch techniques appears to be strongly associated with the gestational age and whether the situation was based on rupture of the membranes or not. Case series reveal that amnioinfusion significantly improves the perinatal outcome and prolongs the pregnancy in severe second-trimester oligohydramnios in both idiopathic cases and those involving rupture of the amniotic membranes [preterm prelabor rupture of the membranes (PPROM)]. There is clear evidence of a lower frequency of perinatal complications and successfully prolonged gestation in iatrogenic PPROM after the amniopatch technique relative to population controls. SUMMARY Identification of potentially modifiable risk factors for the successful prolongation of pregnancy complicated with midtrimester oligohydramnios, and previable PPROM is needed for the improvement of treatment strategies and prognosis. Randomized trials are needed to determine whether amniotic fluid-replenishing strategies can improve pregnancy outcomes.
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Abstract
BACKGROUND Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration. OBJECTIVES To assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013). SELECTION CRITERIA Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium staining of the amniotic fluid. DATA COLLECTION AND ANALYSIS Three review authors independently assessed eligibility and trial quality, and extracted data. MAIN RESULTS Fourteen studies of variable quality (4435 women) are included.Subgroup analysis was performed for studies from settings with limited facilities to monitor the baby's condition during labour and intervene effectively, and settings with standard peripartum surveillance.Settings with standard peripartum surveillance: there was considerable heterogeneity for several outcomes. There was no significant reduction in the primary outcomes meconium aspiration syndrome, perinatal death or severe morbidity, and maternal death or severe morbidity. There was a reduction in caesarean sections (CSs) for fetal distress but not overall. Meconium below the vocal cords diagnosed by laryngoscopy was reduced, as was neonatal ventilation or neonatal intensive care unit admission, but there was no significant reduction in perinatal deaths or other morbidity. Planned sensitivity analysis excluding trials with greater risk of bias resulted in an absence of benefits for any of the outcomes studied.Settings with limited peripartum surveillance: three studies were included. In the amnioinfusion group there was a reduction in CS for fetal distress and overall; meconium aspiration syndrome (three studies, 1144 women; risk ratio (RR) 0.17, 95% confidence interval (CI) 0.05 to 0.52); perinatal mortality (three studies, 1151 women; RR 0.24, 95% CI 0.11 to 0.53) and neonatal ventilation or neonatal intensive care unit admission. In one of the studies, meconium below the vocal cords was reduced and, in the other, neonatal encephalopathy was reduced. AUTHORS' CONCLUSIONS Amnioinfusion is associated with substantive improvements in perinatal outcome only in settings where facilities for perinatal surveillance are limited. It is not clear whether the benefits are due to dilution of meconium or relief of oligohydramnios.In settings with standard peripartum surveillance, some non-substantive outcomes were improved in the initial analysis, but sensitivity analysis excluding trials with greater risk of bias eliminated these differences. Amnioinfusion is either ineffective in this setting, or its effects are masked by other strategies to optimise neonatal outcome.The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.
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Affiliation(s)
- G Justus Hofmeyr
- University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of HealthDepartment of Obstetrics and Gynaecology, East London Hospital ComplexFrere and Cecilia Makiwane HospitalsPrivate Bag X 9047East LondonEastern CapeSouth Africa5200
| | - Hairong Xu
- Université de MontréalDépartement d'Obstétrique‐GynécologieHôpital Sainte‐Justine, Bureau 49743175 Chemin de la côte Sainte‐CatherineMontréalProvince of QuebecCanadaH3T 1C5
| | - Ahizechukwu C Eke
- Michigan State University School of Medicine/Sparrow HospitalDepartment of Obstetrics and Gynecology1322 East Michigan AvenueSuite 220LansingMichiganUSA48912
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Kozinszky Z, Pásztor N, Vanya M, Sikovanyecz J, Pál A. Management of severe idiopathic oligohydramnios: is antepartum transabdominal amnioinfusion really a treatment option? J Matern Fetal Neonatal Med 2012; 26:383-7. [DOI: 10.3109/14767058.2012.733753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Porat S, Amsalem H, Shah PS, Murphy KE. Transabdominal amnioinfusion for preterm premature rupture of membranes: a systematic review and metaanalysis of randomized and observational studies. Am J Obstet Gynecol 2012; 207:393.e1-11. [PMID: 22999157 DOI: 10.1016/j.ajog.2012.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/12/2012] [Accepted: 08/02/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to review systematically the efficacy of transabdominal amnioinfusion (TA) in early preterm premature rupture of membranes (PPROM). STUDY DESIGN We conducted a literature search of EMBASE, MEDLINE, and ClinicalTrials.gov databases and identified studies in which TA was used in cases of proven PPROM and oligohydramnios. Risk of bias was assessed for observational studies and randomized controlled trials. Primary outcomes were latency period and perinatal mortality rates. RESULTS Four observational studies (n = 147) and 3 randomized controlled trials (n = 165) were eligible. Pooled latency period was 14.4 (range, 8.2-20.6) and 11.41 (range -3.4 to 26.2) days longer in the TA group in the observational and the randomized controlled trials, respectively. Perinatal mortality rates were reduced among the treatment groups in both the observational studies (odds ratio, 0.12; 95% confidence interval, 0.02-0.61) and the randomized controlled trials (odds ratio, 0.33; 95% confidence interval, 0.10-1.12). CONCLUSION Serial TA for early PPROM may improve early PPROM-associated morbidity and mortality rates. Additional adequately powered randomized control trials are needed.
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Affiliation(s)
- Shay Porat
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mt Sinai Hospital, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Butt FT, Ahmed B. The role of antepartum transabdominal amnioinfusion in the management of oligohydramnios in pregnancy. J Matern Fetal Neonatal Med 2010; 24:453-7. [DOI: 10.3109/14767058.2010.497574] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Singla A, Yadav P, Vaid NB, Suneja A, Faridi MMA. Transabdominal amnioinfusion in preterm premature rupture of membranes. Int J Gynaecol Obstet 2010; 108:199-202. [PMID: 20015490 DOI: 10.1016/j.ijgo.2009.09.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 09/02/2009] [Accepted: 11/12/2009] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the effect of transabdominal amnioinfusion on prolongation of pregnancy, and maternal and neonatal outcomes in preterm premature rupture of membranes (pPROM). METHODS We conducted a prospective randomized controlled study of women with pPROM during singleton live pregnancy-between 26 and 33+6weeks-whose amniotic fluid index (AFI) was less than the 5th percentile. The study group underwent transabdominal amnioinfusion at admission and then weekly if their AFI fell below the 5th percentile again. The control group received expectant management. RESULTS The difference in the mean interval from pPROM to delivery between the groups was not statistically significant. Neonatal and maternal outcomes were significantly improved in the study group compared with the control group (fetal distress [10% vs 37%]; early neonatal sepsis [17% vs 63%]; neonatal mortality [17% vs 63%]; spontaneous delivery [83% vs 53%]; and postpartum sepsis [7% vs 33%]). CONCLUSION Transabdominal amnioinfusion reduced fetal distress, early neonatal sepsis, and neonatal mortality. In the study group, more participants delivered spontaneously and there were fewer cases of postpartum sepsis, although the pPROM-delivery interval was not increased.
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Affiliation(s)
- Anshuja Singla
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Abstract
BACKGROUND Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration. OBJECTIVES To assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009). SELECTION CRITERIA Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium-staining of the amniotic fluid. DATA COLLECTION AND ANALYSIS Two review authors assessed eligibility and trial quality, and extracted data, independently. MAIN RESULTS Thirteen studies of variable quality (4143 women) are included.Subgroup analysis was performed for studies from settings with limited facilities to monitor the baby's condition during labour and intervene effectively, and settings with standard peripartum surveillance.Settings with standard peripartum surveillance: there was considerable heterogeneity for several outcomes. There was no significant reduction in the primary outcomes meconium aspiration syndrome, perinatal death or severe morbidity, and maternal death or severe morbidity. There was a reduction in caesarean sections (CSs) for fetal distress but not overall. Meconium below the vocal cords diagnosed by laryngoscopy was reduced, as was neonatal ventilation or neonatal intensive care unit admission, but there was no significant reduction in perinatal deaths or other morbidity. Planned sensitivity analysis excluding trials with greater risk of bias resulted in an absence of benefits for any of the outcomes studied.Settings with limited peripartum surveillance: two studies (855 women) were included. In the amnioinfusion group there was a reduction in CS for fetal distress and overall; meconium aspiration syndrome (RR 0.25, 95% CI 0.13 to 0.47), and neonatal ventilation or neonatal intensive care unit admission; and a trend towards reduced perinatal mortality (RR 0.37, 95% CI 0.13 to 1.01). In one of the studies, meconium below the vocal cords was reduced and, in the other, neonatal encephalopathy was reduced. AUTHORS' CONCLUSIONS Amnioinfusion is associated with substantive improvements in perinatal outcome only in settings where facilities for perinatal surveillance are limited. It is not clear whether the benefits are due to dilution of meconium or relief of oligohydramnios.In settings with standard peripartum surveillance, some non-substantive outcomes were improved in the initial analysis, but sensitivity analysis excluding trials with greater risk of bias eliminated these differences. Amnioinfusion is either ineffective in this setting, or its effects are masked by other strategies to optimise neonatal outcome.The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.
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Affiliation(s)
- G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200
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The experience of amnioinfusion for oligohydramnios during the early second trimester. Taiwan J Obstet Gynecol 2008; 46:395-8. [PMID: 18182345 DOI: 10.1016/s1028-4559(08)60009-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In the past, oligohydramnios occurring early during the secondary trimester was the reason to terminate the pregnancy because of poor prognosis. Even though amnioinfusion has been reported for improving the prognosis of the infant, it is still not frequently used because of unfavorable results. We present our experience with amnioinfusion for oligohydramnios with or without preterm premature rupture of membranes. MATERIALS AND METHODS A retrospective study was performed from July 2005 to December 2006 in our hospital. Amnioinfusions were performed in pregnant women found with oligohydramnios during their second trimesters. Chromosomal studies were recommended and performed under informed consent. Level II sonography was performed after each amnioinfusion. Magnetic resonance imaging was arranged for those with suggested urinary tract malformations. RESULTS Seventeen cases were included in our study. No mother was exposed to drugs that have been associated with oligohydramnios. The women received one to six procedures of amnioinfusion separately with a total of 28 procedures. Only one procedure failed. No chromosomal anomalies were found. Fetal anomalies were found after amnioinfusion in five cases. One woman had preterm delivery within 1 week after amnioinfusion. In the four cases of oligohydramnios with rupture of membranes, one case had a healthy full-term baby delivered. In the 13 cases of oligohydramnios without rupture of membranes, there were two preterm infants delivered before 34 weeks of gestation, including pulmonary hypoplasia in one neonate, and three healthy babies delivered after 35 weeks of gestation. CONCLUSION Amnioinfusion performed the first time might provide some benefits for those with early-onset oligohydramnios, such as to provide confirmation of rupture of membranes, detailed sonography examination and further counseling. We would recommend that this procedure be considered once for these cases.
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Midrio P, Stefanutti G, Mussap M, D'Antona D, Zolpi E, Gamba P. Amnioexchange for fetuses with gastroschisis: is it effective? J Pediatr Surg 2007; 42:777-82. [PMID: 17502182 DOI: 10.1016/j.jpedsurg.2006.12.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND/PURPOSE Amniotic fluid of fetuses with gastroschisis (GS) contains inflammatory mediators, gastrointestinal, and urinary waste products. Dilution and removal of such harmful substances have been advocated to prevent damage to the herniated intestine. We evaluated the effectiveness of serial amnioexchange procedures in 8 consecutive fetuses with GS. METHODS Amnioexchange was performed bimonthly during the third trimester. Amniotic fluid collected before each procedure was tested for pH, osmolarity, urea, creatinine, cystatin-C, proteins, albumin, bilirubin, biliary salts, pancreatic amylase, serum amyloid A, C-reactive protein, alanine transaminase (ALT), alcaline phosphatase (ALP), gamma-glutamyl transpetidase (gammaGT), tumor necrosis factor alpha, interleukin 2, interleukin 6, epidermal growth factor, transforming growth factor beta, and myeloperoxidase. RESULTS A total of 25 samples (median, 3 per fetus) were examined. Biochemical or inflammatory markers did not correlate with gestational age, nor was any trend observed in values from individual patients during the course of amnioexchange treatment. There was no correlation between biochemical or inflammatory markers and clinical outcome, including time to full enteral feeding. CONCLUSIONS Serial amnioexchanges did not modify the biochemical or inflammatory status of amniotic fluid nor appeared to prevent injury to the herniated gut. Because repeated amnioexchanges may carry some risks, their use in fetuses with GS is not recommended outside the setting of a prospective randomized trial.
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Affiliation(s)
- Paola Midrio
- Paediatric Surgery Unit, University of Padova, 35121 Padova, Italy.
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Chhabra S, Dargan R, Nasare M. Antepartum transabdominal amnioinfusion. Int J Gynaecol Obstet 2007; 97:95-9. [PMID: 17379222 DOI: 10.1016/j.ijgo.2006.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 05/19/2006] [Accepted: 06/14/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the usefulness of antepartum transabdominal amnioinfusion (APTA) in reducing perinatal morbidity and mortality due to oligohydramnios. METHODS In this case-control study of 100 pregnant women with oligohydramnios, 50 received APTA and 50 were treated conservatively. These controls were matched for age, parity, and pregnancy duration with the case patients. RESULTS There was a mean 4.02-cm increase in amniotic fluid index (AFI) after amnioinfusion. Only 18% of case patients required cesarean sections vs. 46% of controls. The perinatal mortality rate was 18% among controls and 4% among case patients, and the difference was significant. CONCLUSION Antepartum amnioinfusion is a useful procedure to reduce complications resulting from decreased intra-amniotic volume. It is especially useful in preterm pregnancies, where the procedure allows for a better perinatal outcome by prolonging the duration of pregnancy.
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Affiliation(s)
- S Chhabra
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Institute of Medical Sciences, 442 102, Wardha Sewagram, Maharashtra, India.
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Management of Oligohydramnios with Antepartum Amnioinfusion, Amniopatch and Cerclage. Taiwan J Obstet Gynecol 2005. [DOI: 10.1016/s1028-4559(09)60169-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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