Transabdominal amnioinfusion to avoid petal demise and intestinal damage in fetuses with gastroschisis and severe oligohydramnios

Background/Purpose: Despite dramatic improvement in survival rate for neona tes with gastroschisis, significant postoperative morbidity and a low morta lity rate still occur. Furthermore, even in recent publications, some fetal death has been reported. Does this mean that antenatal diagnosis of gastro schisis is a missed opportunity? In fact, decreased amniotic fluid (AF) vol ume is observed in some fetuses with gastroschisis. However, oligohydramnio s is associated with an increased risk of fetal suffering. When severe olig ohydramnios is observed, intrapartum amnioinfusion, to restore AF volume, m ay help avoid fetal complications. Methods: Two fetuses with gastroschisis and severe oligohydramnios were tre ated antenatally with amnioinfusion of saline solution. In one case, fetal heart beat decelerations were observed at 27 weeks' gestation among with th e oligohydroamnios and serial transabdominal amnioinfusions were performed. In the second case, severe oligohydramnios was observed at 31, weeks and a n amnioinfusion was performed, The 2 babies were delivered at 31 and 34 wee ks, respectively. Results: In both cases, exteriorized bowel was nearly normal at birth, and primary closure could be performed. Outcome was favorable, and they were di scharged home on day 43 and day 54, respectively. Conclusions: Because fetuses with gastroschisis and oligohydramnios are par t of a particular high-risk group, serial ultrasound examination and comput erized fetal heart beat monitoring are necessary during the third trimester . In selected cases of gastroschisis associated with severe oligohydramnios , serial amnioinfusion may be required. Copyright (C) 2000 by W.B. Saunders Company.