International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Akhter N et al. Int J Reprod Contracept Obstet Gynecol. 2015 Aug;4(4):1181-1184

www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20150451
Research Article

Antepartum transabdominal amnioinfusion in

oligohydramnios - a comparative study
Nihida Akhter1, Shahnaz Taing2, Irfan Nazir Mir3, Nadeem Ahmad4,
Tufail A. Sheikh5, Mir Mujtaba Ahmad6*

1
Registrar, 2Professor & Head, Department of OB&G, 3PG Scholar, 6Registrar, Department of Surgery, 4Registrar,
Department of Medicine, GMC, Srinagar, India
5
PG scholar, Department of Anaesthesiology, SKIMS, India

Received: 21 June 2015

Accepted: 10 July 2015

*Correspondence:
Dr. Mir Mujtaba Ahmad,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: The purpose of this study was to evaluate the role of antepartum transabdominal amnioinfusion in
oligohydramnios with the view to improving pregnancy outcome in oligohydramnios, a serious complication of
pregnancy that is associated with a poor perinatal outcome and complicates 1-5% of pregnancies.
Methods: The study comprised of a prospective analysis of 130 pregnant women with oligohydramnios, divided into
two groups, the study and control group of 65 patients each and were similar with regard to age, gravidity, parity,
gestational age. TAA was performed on all patients in the study group and the results were compared and analyzed.
Results: Mean gestational age at first treatment was 29.98 weeks in study group. Mean pre-procedure amniotic fluid
index was 4.01 and post-procedure was 12.49. A total of 106 infusions were done on 65 patients (mean1.63). Mean
latency period in study group was 49.53 and in controls 26.49. There was significant decrease in fetal distress in
patients in study group. 30 % of patients needed caesarean section in study group compared to 60% in controls.
Number of preterm deliveries was 18 and 45 respectively in study and control groups. 61% of newborns in the study
group weighed more than 2.5 kg compared to only 24% in control group. Neonatal ICU admissions and newborn
deaths were lesser in study group.
Conclusions: Transabdominal amnioinfusion is an extremely useful procedure to reduce complications arising from
oligohyramnios. It significantly increases the latency period, decreases the occurrence of fetal distress preterm
deliveries, need for caesarean or instrumental deliveries, improves birth weight of the newborns and significantly
reduces the neonatal morbidity and mortality.

Keywords: Transabdominal amnioinfusion, Amniotic fluid index, Oligohydramnios

INTRODUCTION that is associated with a poor perinatal outcome.

Oligohydramnios is an important problem due to its severe
Oligohydramnios is defined as a single reading of the complications which include antepartum and intrapartum
amniotic fluid index (AFI) below 5 cm or 3 readings below fetal death, cord prolapse or compression, compression
8 cm.1 Phelan first introduced AFI in 1987 which is an related limb deformities, and pulmonary hypoplasia.
objective and reproducible method of estimating amniotic Clinically the most serious consequence of
fluid. Although Oligohydramnios affects only 4–5.5% of oligohydramnios is pulmonary hypoplasia, which carries a
all pregnancies,2 it is a serious complication of pregnancy mortality rate of up to 80%3 Another serious consequence

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is abnormal neurological outcome. A normal amniotic period and on operative interference in pregnancies
fluid volume is critical for normal fetal growth and with oligohydramnios.
development. Oligohydramnios is associated with  To evaluate the role of transabdominal
increased perinatal morbidity and mortality at any amnioinfusion in reducing complications resulting
gestational age, but the risks are relatively high when from oligohydramnios.
it is detected during second trimester. Prolonged
oligohydramnios in the 2nd and 3rd trimester leads to METHODS
deformation sequence in 10-15% of cases, characterised
by cranial, facial and skeletal abnormalities. An AFI of A randomized controlled study was conducted in the
<5cm requires prompt additional antenatal testing rather department of obstetrics and gynaecology at Govt. Lalla
than immediate induction in low risk term pregnancies. Ded Hospital Srinagar from March 2012 – September
Severe oligohydramnios identified in second trimester 2013. The study comprised of a prospective analysis of
is an indication that perinatal outcome will be poor. 130 pregnant patients with oligohydramnios. All pregnant
Oligohydramnios poses not only a diagnostic challenge but females with oligohydramnios (AFI < 5cms) with maternal
also a dilemma of management for the obstetricians. The age between 20-34 years, gestational age of 28-34 weeks,
general outcome is usually poor. Near term, it has been parity from 1-4, singleton pregnancy, cephalic
associated with complications of labour and delivery. presentation, with intact membranes, and a reactive CTG at
There is increased incidence of meconium stained liquor, admission were matched for age, parity and pregnancy
abnormal FHR tracing, prolonged labour, increased rate of duration and divided into two groups, the study and the
induction, increased incidence of operative intervention control group respectively of 65 patients each. A written
due to malpresentations, fetal distress and its associated informed consent was taken. Twenty-four hours after
morbidity and mortality, low Apgar score, low birth admission pregnant women were randomly assigned to
weight, admission to NICU, birth asphyxia. study and control groups respectively. Transabdominal
amnioinfusion was performed on all patients in the study
Antepartum amnioinfusion involves artificially increasing group and the control group was managed expectantly.The
the amniotic fluid volume by injecting normal saline or results were compared and analyzed.
Ringer lactate solutions into the amniotic cavity
transabdominally. The objective is to prolong the RESULTS
gestational period by augmenting the amniotic fluid
volume,4 which may also decrease the associated risks of In this study of 130 pregnant women both groups were
oligohydramnios and increase perinatal survival. The comparable with regard to antepartum variables i.e.
2006 National Institute of Clinical Excellence (NICE) maternal age, gravidity, parity, gestational age and AFI at
guidelines currently state that oligohydramnios is not presentation.
routinely treated in pregnancy.5 Conservative expectant
management for the prolongation of gestation4 is Mean AFI pre and post amnioinfusion in study group was
therefore the commonly practiced approach. 4.10cm and 12.48cm, and that in control group was
4.11cm. Fetal distress as reflected from non-reactive stress
Because of the high morbidity and mortality of second test, fetal heart deceleration, thick meconium, was
trimester oligohydramnios, termination of pregnancy is significantly reduced in the study group. The mean latency
usually offered.6 The aim of this study is to assess the in the study and control was 49.5 days and 26.4 days
outcome in pregnancies complicated by oligohydramnios respectively, which was significant. Spontaneous deliveries
that were managed by amnioinfusion, and to evaluate the (36.92%) were significantly higher in the study group
effect of amnioinfusion on the latency period, which compared to controls (16%). In the study group lesser
refers to the time from treatment to delivery. It has been number of patients required operative intervention (30%)
proven to be safe and effective. It can be prophylactic, compared to 60% using LSCS in control group.The mean
diagnostic, or therapeutic. Apgar score in the study group at 1 and 5 min. was 6.61
and 8.92 and that in controls 5.80 and 6.66 respectively.In
Two techniques are used for amnioinfusion: our study 61% of newborns weighted >2.5kg in the study
group compared to only 24% newborns weighing >2.5kg
 Transabdominal in control group. There was significant reduction of
 Transvaginal neonatal admission to NICU and neonatal deaths in the
study group compared to the controls.
Aims & objective
Table 1: Characteristics of study and control group at
 Purpose of this study was to assess the role of admission.
antepartum transabdominal amnioinfusion in preterm
pregnancies with oligohydramnios. Study group Controls
 To evaluate the effect of antepartum transabdominal Number of
amnioinfusion on amniotic fluid volume, latency 1. 65 65
Patients
2. Maternal Age 26.3 26.5

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 Akhter N et al. Int J Reprod Contracept Obstet Gynecol. 2015 Aug;4(4):1181-1184

(Mean) in gestation
years age (at
3. Gravidity delivery)
G1 31(47.6%) 30(46.1%) Latency
G2 17(26.15) 16(24.6%) 11. (Mean)(In 49.5 26.4
G3 13(20%) 15(23%) Days)
G3 4(6.15%) 4(6.15%) No. of
4. Parity 12. Preterm 18 (27.69%) 45 (69.23%)
P0 48(73%) 44(67.69%) Deliveries
P1 13(20%) 16(24.61%) Mean
13. APGAR
p2 4(6.15) 3(4.61%)
Score
P3 0 2(3.01)
At 1 min 6.61 5.8
Number of
At 5 Min 8.92 6.66
5. previous
Birth
abortions
14. Weight >2.5 61% 24%
0 42(64.6%) 40(61.54%)
kg
1 19(29.2%) 22(33.8%)
Admission
2 4(6.15%) 3(4.62%) 15. of newborn 14(21.5%) 32(49.2%)
Mean AFI to NICU
6. 4.01 4.11
(in cms) No. of
16. neonatal 293.07%) 12(18.46%)
Table 2: Various studied parameters following TAA deaths
in study group.

Studygroup Controls
Mean No. of
1. 1.63 -
TAA
Mean
2. AFI(in cms) 4.01 4.11
at admission
Mean
3. AFI(in cms) 12.49
after TAA
Non-Stress
4.
Test
Reactive 60% 30.70%
Non-
40% 69.30%
Reactive
Late
5. 9/65 (13.8%) 15/65 (2.3%)
decelration
Variable 30/65
6. 5/65 (7.69)
Decelration (46.1%)
Meconium
7. Figure 1: Before second trimester amnioinfusion.
type
Clear 40 (61.5%) 20 (30.76%) DISCUSSION
Thick 12 (18.4%) 10 (15.3%)
Thin 13 (20%0 35 (53.84%) Oligohydramnios complicates 1-5% of pregnancies. It
Types of leads to various fetal and maternal complications.
8.
Labour
Induced 41 (63%) 54 (83%) Fetal complications
Spontaneous 24 (36.9%) 11 (16.92)
Mode of Cord compression and fetal distress, fetal pulmonary
9.
Delivery hypoplasia and stillbirth, fetal growth restriction, low
Vaginal 40 (61.53%) 16(24.61) Apgar score, NICU admission and fetal mortality.
LSCS 20 (30.76%) 39(60%)
Instrumental 5 (7.69%) 10 (15.38%)
10. Mean

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 Akhter N et al. Int J Reprod Contracept Obstet Gynecol. 2015 Aug;4(4):1181-1184

Maternal complications amnioinfusion. The procedure of antepartum

transabdominal amnioinfusion is a promising therapeutic
Prolonged labour due to inertia, Induction of labour, modality for the reduction of fetal morbidity and
increased incidence of operative intervention due to mortality. The procedure is effective and easy to perform
malpresentations and its associated morbidity and with benefits clearly outweighing the risks. Optimizing
mortality. the selection of patients who are good candidates for the
procedure is a prerequisite.

CONCLUSION

Antepartum transabdominal amnioinfusion is an

extremely useful, safe and effective procedure to reduce
complications arising from oligohydramnios. It
significantly increases the latency period, decreases the
occurrence of fetal distress, preterm deliveries, need for
caesarean or instrumental deliveries, improves birth
weight of the newborns and significantly reduces the
neonatal morbidity and mortality.

Funding: No funding sources

Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee

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Figure 2: After second trimester amnioinfusion.
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had a favourable outcome after transabdominal Cite this article as: Akhter N, Taing S, Mir IN,
Ahmad N, Sheikh TA, Ahmad MM. Antepartum
transabdominal amnioinfusion in oligohydramnios -
a comparative study. Int J Reprod Contracept Obstet
Gynecol 2015;4:1181-4.

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