A case controlled study of serial transabdominal amnioinfusions in the management of second trimester oligohydramnios due to premature rupture of membranes

Abstract

Objective: The aim of this study was to evaluate the role of transabdominal amnioinfusion in relieving oligohydramnios and improving pregnancy outcome.

Study design: Pregnant women with oligohydramnios amniotic fluid index (AFI<5) and premature rupture of membranes (PROM) from <27 weeks gestation were managed with serial transabdominal amnioinfusions. Under ultrasonic guidance, a 20-gauge needle was instilled in the uterine cavity and normal saline was infused until the AFI was normal. Repeat amnioinfusion was done weekly if oligohydramnios recurred. Amnioinfused cases were compared to cases with pPROM and oligohydramnios who had standard management.

Results: The mean gestational age at first procedure was 22 weeks. The mean pre-procedure AFI was 1.1cm and post-procedure was 12 cm. The mean number of infusions was 2.4. The mean first infusion to delivery interval was 33 days. The amnioinfused group when compared to the control group had decreased perinatal mortality of 33% versus 83% (P=0.036, OR=0.4, 95% CI=0.17-0.93), neonatal mortality of 17% versus 71% (P=0.049, OR=0.26, 95% CI=0.07-0.97) and neonatal sepsis 86% versus 27%(P=0.049, OR=0.32, 95% CI=0.12-0.87) with no statistical difference in gestational age at rupture and delivery nor birthweight. Babies discharged home compared to non-survivors had a significant increase in gestational age at delivery, birthweight, NICU days and transabdominal amnioinfusions. Logistic regression showed that only transabdominal amnioinfusion and gestational age correlated with survival.

Conclusion: In selected cases of oligohydramnios with pPROM, transabdominal amnioinfusions may be associated with fluid retention and improved neonatal survival.