AMNIOINFUSION IN THE MANAGEMENT OF OLIGOHYDRAMNIOS

Oligohydramnios, with its extremely varied aetiology, is associated wi th unfavourable perinatal outcome, especially if detected during the s econd trimester. Amnioinfusion has recently become widely used for the diagnostic, prophylactic and therapeutic management of oligohydramnio s, although as yet no incontrovertible proof exists of its advantages over conservative treatments. This study analyses our preliminary expe rience regarding antepartum amnioinfusion, aimed at clarifying its dia gnostic and therapeutic role and its relative harmlessness. The outcom es of 80 pregnancies with oligohydramnios were analysed, comparing the 35 amnioinfused cases with the 45 conservatively treated ones; the ca ses were classed as second or third trimester, according to when a red uction in amniotic fluid was diagnosed. In the amnioinfused group, lat ency was longer; this was only significant in the third trimester (a m edian 14 days vs. 5 days; p < 0.05), no difference occurring in the in cidence of spontaneous abortion, intrauterine death or preterm deliver y. Analysis of neonatal outcomes at the second trimester shows a lesse r incidence of neonatal deaths (5% vs. 33%; p < 0.05). The number of n eonates discharged after amnioinfusion at the II trimester (3 out of 4 ) constitutes 75% of live births, compared with only 25% (2 out of 8) among those not undergoing amnioinfusion in the same period. Cumulativ e analysis of neonatal complications in the two treatment groups revea led no significant differences; cases of serious neurological damage a t the third trimester were more frequent in the non-amnioinfused group (7 out of 27 vs. 0 out of 15; p < 0.05). There were no differences be tween the two groups (amnioinfused and not) with regard to maternal pa rameters of phlogosis analysed (leukocytosis, hyperpyrexia, CRP C-reac ting Protein). In conclusion, our experience shows that within the lim its of the small number of samples here used, amnioinfusion, involving few maternal or fetal risks, is advantageous as to perinatal mortalit y and morbidity. We thus confirm it as one of the few available method s in the active management of pregnancies affected by second-term and incipient third-term oligohydramnios.