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Table of Contents
Vol. 18, No. 3, 2003
Issue release date: May – June
Section title: Paper
Fetal Diagn Ther 2003;18:183–189
(DOI:10.1159/000069375)

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. · Fisk N.M.
Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, and Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College, Hammersmith Campus, London, UK

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Article / Publication Details

First-Page Preview
Abstract of Paper

Received: October 03, 2001
Accepted: June 24, 2002
Published online: May 02, 2003
Issue release date: May – June

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 3

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT

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.

© 2003 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Paper

Received: October 03, 2001
Accepted: June 24, 2002
Published online: May 02, 2003
Issue release date: May – June

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 3

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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