Expert opinion: data back two indications for amnioinfusion.(Obstetrics)

NEW YORK -- Relief of repetitive variable decelerations and improvement of diagnosis of congenital anomalies in midterm fetuses with oligohydramnios are the two best-supported therapeutic indications for amnioinfusion, Dr. Catherine Y. Spong said at an obstetrics symposium sponsored by Columbia University and New York Presbyterian Hospital.

On the other hand, the data do not support two prophylactic indications for amniotic fluid replacement--prevention of variable decelerations in the setting of oligohydramnios and prevention of meconium aspiration syndrome, said Dr. Spong, chief of the Pregnancy and Perinatology Branch of the National Institute of Child Health and Human Development. National Institutes of Health, in Bethesda, Md.

Regardless of the indication, it's essential to monitor fluid levels when performing amnioinfusion (AI) and to stop immediately if fluid is not leaking back out. Careful monitoring can prevent a large proportion of the most common AI complications that have been reported, including uterine overdistension, dehiscence of a uterine scar, and amnionitis, said Dr. Spong, also of Georgetown University, Washington.

These are the two therapeutic indications for which data strongly support the use of AI:

* Relief of fetal decelerations. Existing clinical data suggest that intrauterine infusion corrects the oligohydramnios that makes the cord more vulnerable to compression during contractions.

A preliminary study of 42 patients showed that transvaginal intrauterine saline infusion was effective for relief of repetitive variable decelerations in 19 of 28 patients, and in 12 of 14 women with prolonged decelerations. None of the patients had initially responded to conventional therapy (Am. J. Obstet. Gynecol. 146[6]:670-78, 1983).

The same investigators later conducted a randomized, controlled trial in which half of 49 patients who received amnioinfusion during the first stage of labor experienced correction of variable decelerations, compared with just 2 of 47 women who did not receive AI (Am. J. Obstet. Gynecol. 153[3]:301-06, 1985).