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.