Transabdominal amnioinfusion in oligohydramnios at term before induction of labor with intact membranes: A randomized clinical trial

• Published in: American journal of obstetrics and gynecology Vol. 175; no. 2; pp. 465 - 470
• Main Authors: Vergani, Patrizia, Ceruti, Patrizia, Strobelt, Nicola, Locatelli, Anna, D'Oria, Patrizia, Mariani, Silvana
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-08-1996; Elsevier
• Subjects: Abdomen; Adult; Amnion; Biological and medical sciences; Delivery, Obstetric; Dinoprostone - administration & dosage; Diseases of mother, fetus and pregnancy; Female; fetal distress; Fetal Distress - prevention & control; Gynecology. Andrology. Obstetrics; Humans; Injections; Labor, Induced; Medical sciences; oligohydramnios; Oligohydramnios - drug therapy; Pregnancy; Pregnancy Outcome; Pregnancy. Fetus. Placenta; Sodium Chloride - administration & dosage; Sodium Chloride - therapeutic use; Transabdominal amnioinfusion; fetal distress; oligohydramnios; Transabdominal amnioinfusion; Human; Infusion; Randomization; Treatment; Pregnancy disorders; Term pregnancy; Amniotic fluid; Abdominal route; Oligoamnios; Delivery
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(96)70163-1

OBJECTIVE: Our purpose was to determine the effectiveness of transabdominal amnioinfusion before induction of labor in reducing the incidence of fetal distress in pregnancies with oligohydramnios at term.
STUDY DESIGN: Between June 1991 and September 1994 primiparous women with ultrasonographic evidence of oligohydramnios at term, intact membranes, and unripe cervix (Bishop score ≤6), candidates for induction of labor with cervical or vaginal prostaglandin E
2
gel, were randomly selected to receive transabdominal amnioinfusion (amnioinfused group,
n = 39) or to proceed with direct labor induction (control group,
n = 40). Inclusion criteria were (1) singleton gestation, (2) vertex presentation, (3) ultrasonographic estimation of fetal weight
≥2500 gm, and (4) reactive nonstress test. Fetoneonatal outcome variables were compared between the two groups. Statistical analysis used contingency tables, Student
t
test, or Wilcoxon rank-sum tests, where applicable.
RESULTS: Amnioinfusion was successfully performed in 100% of the patients randomized for the procedure. The incidence of severely abnormal fetal heart rate tracings was significantly higher in the control than in the amnioinfused group (42% [17/33] vs 5% [2/37], relative risk 12.9, 95% confidence interval 2.4 to 56.4). The rate of cesarean sections performed for fetal distress was fivefold higher in the control group (25% [10/40] vs 5% [2/39], relative risk 4.9, 95% confidence interval 1.1 to 32.4). No bleeding complications or fetomaternal infectious morbidity were noticed.
CONCLUSION: Transabdominal amnioinfusion is a safe, effective option for the prevention of fetal distress in pregnancies with oligohydramnios at term with intact membranes and unripe cervix. (Am J Obstet Gynecol 1996;175:465-70.)