Amnioinfusion

Aka: Amnioinfusion

1. Indications
   1. Oligohydramnios with or without Fetal Distress
      1. Preterm prolonged Rupture of Membranes
      2. Recurrent Variable Decelerations
   2. Cephalic presentation
   3. Thick particulate Meconium staining of amniotic fluid
2. Contraindication
   1. Amnioinfusion should not delay definitive management
   2. Chorioamnionitis
   3. Fetal Malpresentation (e.g. Breech, Transverse Lie)
   4. Scalp pH < 7.20
   5. Late Decelerations
   6. Multiple Gestation
   7. Uterine anomaly
   8. Undiagnosed Third Trimester Bleeding
   9. Placental Abruption
   10. Placenta Previa
3. Efficacy
   1. Heavy meconium stained fluid
      1. Improved perinatal outcome
      2. Reduced risk Meconium Aspiration Syndrome
      3. Decreased NICU admissions
      4. Decreased risk of Mechanical Ventilation
   2. Cord Compression suspected
      1. Reduces FHR Variable Decelerations
      2. Lowers rate of ceserean sections
4. Technique
   1. Cervical exam
      1. Evaluate dilation and presentation
      2. Evaluate for Umbilical Cord Prolapse
   2. Place fetal scalp electrode
   3. Place double lumen intrauterine pressure catheter
   4. Initial Bolus
      1. Warmed normal saline at 10-20 ml/minute
      2. Stop bolus at 250 to 500 cc
   5. Maintenance infusion of warmed normal saline
      1. Rate: 3 cc/min or 50 to 60 cc/hour
   6. Document intrauterine pressure continuously
   7. Goal: Maintain amniotic fluid index of 8-12 cm
5. Adverse Effects
   1. Umbilical Cord Prolapse
   2. Uterine scar rupture
   3. Amniotic Fluid Embolism
6. References
   1. Miyazaki (1985) J Obstet Gynecol 153(3):301-6