1. Natalia Cruces, Marta Sobral, Amália Pacheco, Ivone Lobo Department of Obstetrics and Gynecology Hospital de Faro (Portugal) Amnioinfusion to Treat Severe Oligohydramnios in Early Premature Rupture of Membranes

2. AMNIOINFUSION  Amniotic fluid is required during certain periods of early and midgestation for fetal lung development  When the amniotic fluid is greatly decreased, especially in midpregnancy, the perinatal mortality rate approaches 100 percent

3. AMNIOINFUSION  First described by Carey in 1957  Recent survey of amnioinfusion in U.S: 96% Use amnioinfusion 72% Formal protocol Insertion of fluid into the amniotic cavity

4. AMNIOINFUSION  Transabdominal infusion: · Sterile needle inserted into the amniotic cavity · Instillation bolus 250-800ml  Technic: - Instillation of normal saline or lactated Ringer solution - Under ultrasonographic guidance - Control of the fluid volume instilled - Prevention of preterm delivery, uncertain  Transcervical infusion: In rupture of the membranes · Sterile catheter, singer or double lumen, placed transcervically · Infusion bolus of 250-500ml of fluid · Alternatively, constant infusion of 180ml/h can be started after bolus

5. AMNIOINFUSION  Therapeutic: 1.Relive of repetitive variable decelerations 2.Improvement of visualization of fetal anatomy in the setting of oligohydramnios 3.Improvement of the odds of success after a lailed version 4.Severe oligohydramnios 5.Treatment of chorioamnionitis STUDIED INDICATIONS

6. AMNIOINFUSION PROPOSED INDICATIONS  Prophylactic: Prevention of fetal heart rate decelerations in term or preterm patients in labor with oligohydramnios and/or meconium-stained amniotic fluid

7. AMNIOINFUSION INDICATIONS

8. AMNIOINFUSION 1. Uterine hypertonus, most frequent (14%) 2. Abnormal fetal heart tracing 3. Amnionitis 4. Premature roture of membranes 5. Umbilical cord prolapse 6. Dehiscence of uterine scar 7. Placental abruptio 8. Maternal pulmonary embolus COMPLICATIONS

9. AMNIOINFUSION 1. Placenta previa, transcervical amnioinfusion 2. Pregnant women during labor with prior cesarean section or major uterine surgery, were not initially considered to be candidates 3. Chorioamnionitis, relative CONTRAINDICATIONS

10. AMNIOINFUSION Locatelli A, Vergani P, Di Pirro G, et al. Role of amnioinfusion in the management of premature rupture of the membranas at < 26 weeks΄ gestation. Am J Obstet Gynecol 2000; 183:78-82. Nonrandomized, n= 49 PPRM Oligohydramnios >4 days after PPRM Persistent Oligohydramnios Vs Amnioinfusion not necessary or succesfull Worst neonatal outcome 20% neonatal survival → 62% Pulmonary Hypoplasia 60% Abnormal neurologic outcome Management of Oligohydramnios after Preterm Premature Rupture of Membranes (PPRM)

11. AMNIOINFUSION Traquilli AL, Giannubilo et al. Transabdominal amnioinfusion in preterm premature rupture of membranas: a randomised controlled trial. British Journal Obstet Gynecol 2005; 112:759-63. Management of Oligohydramnios after Preterm Premature Rupture of Membranes (PPRM) Oligohydramnios 24h PPRM, 24-32 weeks΄gestation Amnioinfusion Vs Expectant management Significant prolongation of pregnancy Better neonatal outcome; Higher neonatal survival Reduction in pulmonary hypoplasia

12. CONCLUSIONS Amnioinfusion can increase the amniotic fluid volume and relieve variable decelerations Amnioinfusion improvements visualization of fetal anatomy for prenatal diagnosis of congenital anomalies in the setting of oligohydramnios In early premature rupture of membranes, the Amnioinfusion could allow prolongation of pregnancy and better neonatal outcomes

13. AMNIOINFUSION Thank you!

14. Dra. Natalia Castro Cruces Department of Obstetrics and Gynecology, Hospital de Faro (Portugal) E-mail:jesus.cabal.cabal@hotmail.com AMNIOINFUSION