Discussion
This study showed that amnioinfusion is a safe procedure and can be performed at the outpatient setting. The procedure is inexpensive with minimal equipment needed and can be performed by all obstetricians trained in intrauterine invasive procedures. This will make it easily accessible to all patients.
In this study, the main fetal structural anomaly observed was renal. There were 10 cases of bilateral renal agenesis and 15 cases of infantile polycystic kidney disease. The diagnosis of renal anomaly was difficult because of high BMI, lack of fluid as acoustic window and the presence of scar tissue due to previous surgery, mainly repeat Cesarean delivery and liposuction which are performed extensively in this part of the world. The diagnosis was confirmed only after amnioinfusion. Counseling of parents improved dramatically after confirming the diagnosis of this serious fetal anomaly which is incompatible with life. We advise obstetricians to avoid intrapartum monitoring and avoid intervention except for maternal indication, so as to avoid unnecessary operative delivery. In this part of the world, patients tend to have a large family and another caesarean delivery may increase the chance of contracting a more serious complication such as morbidity adherent placenta, as a result of multiple repeat cesarean deliveries. Our study showed that even in the absence of fetal malformation, the presence of oligohydramnios is associated with many complications such as, higher chance of early preterm labour, severe intrauterine growth restriction, high operative delivery rate, low Apgar score and NICU admission. These findings have been debated by many other investigators13,14,15. In the absence of major fetal malformation and a border line oligohydramnios, there could be a group of patients who may benefit from amnioinfusion mainly to improve lung maturity if it was done at the right gestational age16.