AMNIOINFUSION

Dr Padmesh
• INTRODUCTION:
• DEFINITION:
• Amnioinfusion refers to the instillation of fluid into the
amniotic cavity through an intrauterine pressure catheter
introduced
– transcervically or
– through a needle transabdominally.
• PROCEDURE:
• Amnioinfuion can be done antenatally OR during labour.
• Transcervical/Transabdominal
• Lactated Ringers preferred over normal (0.9 percent) saline
because the latter may cause small changes in the
concentration of fetal electrolytes.
• Pre-warmed fluid used.
• Infusion may be given by gravity drainage or an infusion pump.
• No evidence for routine antibiotic prophylaxis in amniocentesis.
• Begin the infusion at 10 to 15 mL/minute  When
decelerations resolve or are no longer worrisome, reduce
infusion rate to 100 to 200 mL/hour and do not infuse more
than 1000 mL of fluid.
• Intrauterine pressure should not rise by more than 15 mm Hg
above baseline.
• Indications :
• I. DIAGNOSTIC INDICATIONS:

• 1. Enhance/facilitate prenatal diagnostic imaging:

A common indication for antepartum transabdominal
amnioinfusion is to enable a better visualization of fetal
anatomy in cases of severe oligohydramnios/anhydramnios.
• Indications :
• II. THERAPEUTIC INDICATIONS:

• (a) Idiopathic anhydramnios/oligohydramnios:

• Antepartum amnioinfusion is usually indicated for severe
olighydramnios that can lead to complications like:
– pulmonary hypoplasia,
– compression deformities,
– variable FHR decelerations and
– intraventricular haemorrhage
• Indications :
• II. THERAPEUTIC INDICATIONS:

• (b) Preterm premature rupture of membranes :

• A 2014 systematic review and meta-analysis compared
pregnancy outcome in patients who received antepartum
transabdominal amnioinfusion versus those who received usual
care for management of PPROM in the third trimester.
Transabdominal amnioinfusion resulted in statistically
significant reductions in neonatal death, sepsis/infection, and
pulmonary hypoplasia.

• (c) External Cephalic Version

• External cephalic version can be made easier after
amnioinfusion as it enables the fetus to move freely, unlike in
oligohydramnios.
• Indications :
• II. THERAPEUTIC INDICATIONS:

• (d) Variable decelerations:

• A systematic review of observational studies In women
with an unscarred uterus and variable decelerations during
labor, found that amnioinfusion was associated with a
reduction in cesarean delivery and improvement in some
neonatal outcomes
• Indications :
• II. THERAPEUTIC INDICATIONS:

• (e) Thick Meconium stained liquor:

• The proposed benefits of amnioinfusion include dilution of thick
clumps of meconium by the instilled fluid, and possible
prevention or relief of cord compression.
• Dilution of thick meconium with amnioinfusion has not been
shown to be effective in reducing the incidence of MAS.
Amnioinfusion is not beneficial in reducing meconium-related
neonatal morbidity, with the possible exception of settings with
limited facilities to monitor the fetus during labor.
• As a result, amnioinfusion is not recommended as a routine
approach for mothers with meconium-stained amniotic fluid
(MSAF).
• Indications :
• II. THERAPEUTIC INDICATIONS:
• (e) Thick Meconium stained liquor: COCHRANE:
• Units with standard peripartum surveillance
• The evidence reviewed does not support the use of
amnioinfusion for meconium-stained amniotic fluid (as opposed
to oligohydramnios-related fetal heart rate decelerations) in
clinical practice, given that it is an invasive procedure and has
not been shown to have clear benefits.
• Units with limited peripartum surveillance
• The three studies reviewed showed significant improvements in
perinatal outcome with a simplified technique of amnioinfusion.
The use of amnioinfusion should be considered for women with
meconium-stained liquor in units with limited facilities for
peripartum surveillance and high rates of meconium aspiration
syndrome. The reduction in the diagnosis of meconium
aspiration syndrome after amnioinfusion in these studies may
possibly be due to a reduction in fetal distress related to
oligohydramnios.
• Indications :
• II. THERAPEUTIC INDICATIONS:

• (f). Selective reduction in TTTS:

• If the donor twin is the primary target, amnioinfusion can
be performed to improve access for the bipolar forceps.

• (g) Cord compression:

• Amnioinfusion is a reasonable second-line option to
reduce cord compression. (1st option: change of maternal
position)
• Contraindications to amnioinfusion:
• Chorioamnionitis
• Placental abruption,
• Uterine contractions,
• Severe fetal heart rate abnormalities
• Maternal immunosuppression.
• COMPLICATIONS OF AMNIOINFUSION:
• PROM
• Chorioamnionitis
• Delivery within 24 hour of post infusion
• Haemorrhage from the cord
• Placental abruption
• Uterine hypertonicity
• Abnormal fetal heart rate
• Uterine rupture
THANK YOU