Impact of antepartum diagnostic amnioinfusion on targeted ultrasound imaging of pregnancies presenting with severe oligo- and anhydramnios: An analysis of 61 cases

Intrapartum Trans-Cervical Amnioinfusion as Adjuvant to Conventional Management of Women Had Ruptured Membranes With Thick Meconium-Stained Amniotic Fluid.

“…Moreover, Vikraman et al (23) documented that antepartum AI is a valuable ancillary technique in prenatal diagnosis as it increases the diagnostic yield from pregnancies presenting with severe oligo-and 824 anhydramnios. Also, Haeri et al (24) used serial antepartum amnioinfusion for fetal pulmonary palliation to attenuate the risk of pulmonary hypoplasia in cases with abnormal fetal renal function who were not candidates for traditional intervention.…”

Etiology and management of early pregnancy renal anhydramnios: Is there a place for serial amnioinfusions?

“…For patients with anhydramnios prior to 22 weeks of gestation in the setting of LUTO, a vesicocentesis can sometimes be helpful to confirm lack of bladder filling, indicating likely renal dysplasia and poor candidacy for a vesicoamniotic shunt or ablation of posterior urethral valves (PUV). Once the sonographic diagnosis of EPRA is suspected, the RAFT protocol calls for the performance of a diagnostic amnioinfusion in order to (1) confirm intact membranes, (2) allow for a more detailed sonographic fetal evaluation to confirm the presence or absence of renal tissue and/or vasculature, and (3) more accurately assess for the presence of other anomalies. The presence of other significant fetal anomalies, aside from anomalies of the kidneys and urinary tract, may indicate a syndromic etiology.…”

Amnioinfusions to Treat Early Onset Anhydramnios Caused by Renal Anomalies: Background and Rationale for the Renal Anhydramnios Fetal Therapy Trial

“…It is characterized by the complete lack of renal tissue with ensuing anhydramnios and secondary pulmonary hypoplasia [7, 8]. Potter’s syndrome, a historical term used to describe the typical appearance of a neonate exposed to anhydramnios, is additionally characterized by flattened facial features and limb deformities, due to intrauterine compression and insufficient nutrients, along with pulmonary hypoplasia caused by anhydramnios.…”

“…Amnioinfusions are routinely used in ultrasound assessments and diagnoses for fetuses with low fluid volumes [12], but the risk of preterm premature rupture of membranes (PPROM) is still at least 1/300 per infusion. However, the safety of repeated amnioinfusions as a preventative method has been illustrated in multiple studies [2, 4, 8, 14], including a retrospective study of 61 patients presenting with severe oligo-anhydramnios from PPROM who received amnioinfusions with no fatalities recorded as a direct result of treatment. Mothers receiving amnioinfusions for pregnancies complicated by oligohydramnios resulting from early PPROM (16–26 weeks GA) had similar fetal survival as pregnancies complicated by PPROM without oligohydramnios [44].…”

“…If patients have adequate respiratory function after birth, the next step is neonatal dialysis (peritoneal dialysis or hemodialysis) and subsequent early childhood kidney transplant. Serial amnioinfusions involve the infusion of normal saline into the amniotic cavity to restore the aqueous environment of the fetus (normal volumes: 25 mL at 10 weeks, 400 mL at 20 weeks, 800 mL at 28 weeks GA) [8]. The timing and frequency of amnioinfusions, along with the optimal timing of delivery, remain uncertain [46].…”