Result:
All the 80 cases received amnioinfusion under direct ultrasound guidance
by the same operator. During amnioinfusion, no local anesthesia or
tocolytics were administered. All cases included in the study had severe
oligohydramnios with the average deepest pool being 1.8 cm. The
incidence of overweight and obese patients in this study group was high,
compromising almost 25% of the group (Table 1). All the cases in this
cohort presented in the second and third trimesters (Table 2). The mean
gestational age at the time of the procedure was 25.5 weeks (range 18 –
33). However, the gestational age at delivery was 28.5 weeks (range 20
– 39). No adverse events were encountered at the time of the procedure
such as hemorrhage, uterine irritability, fetal organ trauma, and
abruption (Table 2). Five cases developed chorioamnionitis at a later
stage. Amniocentesis was performed only when there was no apparent fetal
structural anomaly. We found 3 cases of trisomy 21 and one case of
abnormal chromosome 4. The incidence of gestational diabetes mellitus in
this group was about 22.5% (18 cases). There were four cases of high
blood pressure during pregnancy all on medication in form of methyldopa.
Hypertension was properly controlled in the patients and none developed
preeclampsia. The procedure was uncomplicated and no case needed a
second needle insertion. There were 5 cases which developed signs of
chorioamnionitis within two weeks of the procedure, two of these five
cases developed spontaneous rupture of membrane. In the study group,
there were 52 cases of fetal structural malformation (Table 1). There
were 25 cases diagnosed with bilateral renal agenesis and infantile
polycystic kidney disease. The diagnosis was confirmed only after
amnioinfusion in 18 cases. The diagnosis was impossible before
amnioinfusion because the patients had high BMI and surgical scarring
mainly from previous caesarean delivery and liposuction (Figure 1).
There were 26 cases of intrauterine fetal death mostly fetuses with
fetal structural malformation. Majority of patients in this group
delivered vaginally (68 cases). Three cases delivered by forceps
delivery. Elective Caesarean delivery for obstetrics indication was done
in 12 cases. Two patients in the vaginal delivery group needed manual
removal of placenta under general anesthesia because of retained
placenta and mild postpartum hemorrhage (Table 3). All cases delivered
prematurely, 22 cases delivered before 28 weeks of gestation, 14 cases
delivered between 28 - 30 weeks of gestation and only 4 cases delivered
after 31 weeks of gestation (Table 2). Due to prematurity, a low mean
birth weight of 1.4 kg was recorded. The average number of days in the
NICU was 4.3 days (Table 3). The prenatal and neonatal mortalities in
this group were very high at 45% and 35%, respectively.