Test amnioinfusion to determine suitability for serial therapeutic amnioinfusion in midtrimester premature rupture of membranes

Tan, L-K., Kumar S, Jolly, M., Gleeson, C., Johnson P and Fisk, N. M. (2003) Test amnioinfusion to determine suitability for serial therapeutic amnioinfusion in midtrimester premature rupture of membranes. Fetal Diagnosis And Therapy, 18 3: 183-189. doi:10.1159/000069375


Author Tan, L-K.
Kumar S
Jolly, M.
Gleeson, C.
Johnson P
Fisk, N. M.
Title Test amnioinfusion to determine suitability for serial therapeutic amnioinfusion in midtrimester premature rupture of membranes
Journal name Fetal Diagnosis And Therapy   Check publisher's open access policy
ISSN 1015-3837
1421-9964
Publication date 2003-05-01
Year available 2003
Sub-type Article (original research)
DOI 10.1159/000069375
Open Access Status
Volume 18
Issue 3
Start page 183
End page 189
Total pages 7
Place of publication Basel, Switzerland; Sydney, Australia
Publisher Karger
Language eng
Subject 111401 Foetal Development and Medicine
1114 Paediatrics and Reproductive Medicine
Abstract Objective:To evaluate whether a test amnioinfusion procedure is useful in selecting cases of midtrimester preterm premature rupture of membranes (PPROM) which may benefit from serial amnioinfusions if the initial fluid is retained. Study Design:The Centre for Fetal Care database between 1992 and 2000 was reviewed for women with PPROM <26 weeks who had undergone amnioinfusion. Amniotic fluid index (AFI) was assessed before and after a test amnioinfusion procedure. Those who retained fluid ! 48 h underwent serial AFI assessment with a view to serial amnioinfusion when oligohydramnios recurred. Results: Eighty-five amnioinfusion procedures were performed in 60 women with oligohydramnios. Nineteen of these women presented with confirmed PPROM at a median gestation of 19 (range 15-22) weeks and severe olighohydramnios (median AFI 1, range 0-3 cm), in whom 20 test amnioinfusions were carried out. Two amnioinfusions were abandoned during the procedure because of fetal bradycardia and both mothers opted for termination of pregnancy. Only 4 women retained fluid during the test amnioinfusion, 1 of whom miscarried at 19 weeks before serial amnioinfusion could be started. The remaining 3 underwent a median of 4 (range 1-6) serial amnioinfusion procedures; none had evidence of pulmonary hypoplasia. Thirteen (68%) leaked fluid within 48 h; within this group there was 1 subsequent miscarriage and 9 pregnancy terminations. The remaining 3 pregnancies resulted in livebirths 2 of which had pulmonary hypoplasia with 1 early neonatal death. Overall survival was poor (4/19), largely attributed to the high incidence of terminations in the presence of persistent severe oligohydramnios. In continuing pregnancies reaching viability survival was 67% (4 of 6). Conclusion: Three quarters of women with mid-trimester PPROM lose fluid at test amnioinfusion and therefore would not be suitable candidates for serial amnioinfusion. However, if infused fluid is retained, this allows subsequent serial amnioinfusion and prolongation of pregnancy in about 75%, with an attendant decrease in the risk of pulmonary hypoplasia. However, even successful serial amnioinfusion remains associated with procedure-related complications (i.e. chorioamnionitis, placental abruption) which themselves may predispose to preterm delivery. Copyright (C) 2003 S. Karger AG, Basel.
Formatted abstract
Objective: To evaluate whether a test amnioinfusion procedure is useful in selecting cases of midtrimester preterm premature rupture of membranes (PPROM) which may benefit from serial amnioinfusions if the initial fluid is retained.
Study Design: The Centre for Fetal Care database between 1992 and 2000 was reviewed for women with PPROM <26 weeks who had undergone amnioinfusion. Amniotic fluid index (AFI) was assessed before and after a test amnioinfusion procedure. Those who retained fluid ge48 h underwent serial AFI assessment with a view to serial amnioinfusion when oligohydramnios recurred.
Results: Eighty-five amnioinfusion procedures were performed in 60 women with oligohydramnios. Nineteen of these women presented with confirmed PPROM at a median gestation of 19 (range 15-22) weeks and severe olighohydramnios (median AFI 1, range 0-3 cm), in whom 20 test amnioinfusions were carried out. Two amnioinfusions were abandoned during the procedure because of fetal bradycardia and both mothers opted for termination of pregnancy. Only 4 women retained fluid during the test amnioinfusion, 1 of whom miscarried at 19 weeks before serial amnioinfusion could be started. The remaining 3 underwent a median of 4 (range 1-6) serial amnioinfusion procedures; none had evidence of pulmonary hypoplasia. Thirteen (68%) leaked fluid within 48 h; within this group there was 1 subsequent miscarriage and 9 pregnancy terminations. The remaining 3 pregnancies resulted in livebirths 2 of which had pulmonary hypoplasia with 1 early neonatal death. Overall survival was poor (4/19), largely attributed to the high incidence of terminations in the presence of persistent severe oligohydramnios. In continuing pregnancies reaching viability survival was 67% (4 of 6).
Conclusion: Three quarters of women with mid-trimester PPROM lose fluid at test amnioinfusion and therefore would not be suitable candidates for serial amnioinfusion. However, if infused fluid is retained, this allows subsequent serial amnioinfusion and prolongation of pregnancy in about 75%, with an attendant decrease in the risk of pulmonary hypoplasia. However, even successful serial amnioinfusion remains associated with procedure-related complications (i.e. chorioamnionitis, placental abruption) which themselves may predispose to preterm delivery.

Keyword Test amnioinfusion
Premature rupture of membranes
Oligohydramnios
Pulmonary hypoplasia
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown
Additional Notes Issue date: May/June 2003

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Mon, 23 Mar 2009, 21:26:32 EST by Thelma Whitbourne on behalf of Faculty Of Health Sciences