Prenatal amnioinfusion as diagnostic and therapeutic intervention in cases with severe second trimester oligo- and anhydramnios – a retrospective analysis

Introduction:

The severe oligo- or anhydramnios in the second trimester is mostly caused by premature rupture of the bladder (PPROM), congenital malformations of the urogenital tract or placental dysfunction. Amnioinfusion is in unclear terms a method to improve the diagnosis of the underlying cause by improving ultrasound conditions and simultaneous genetic analysis. In rare cases, it could also be a way of preventing postpartum complications.

Material and methods:

A retrospective, monocentric analysis of amnioinfusion was performed in our prenatal diagnostics department from 2009 to 2018. Inclusion criteria were a severe oligo- or anhydramnios (determined by the deepest pocket method) between 17 to 29 weeks of gestational age. Detailed data analysis was performed on the basis of pre-, peri- and postnatal clinical data. The primary endpoint was the question of improving ultrasound diagnostics. Secondary endpoint was the analysis of the perinatal outcome.

Results:

A total of 25 amnioinfusions were performed on 22 identified patients. On the mean, amnioinfusion was performed in 23 ± 4.3 weeks of gestation and 273 ± 88.7 ml of fluid was infused. In 6 cases (27.2%) urogenital malformations, in 5 cases (22.7%) a PPROM, in 5 cases (22.7%) a severe superior syndrome, in 4 cases (18.1%) a fetal growth restriction and in 2 cases (9.1%) no cause for the oligo- or anhydramnios could be identified. In all cases with fetal growth restriction, despite pronounced premature birth and growth restriction, a positive postpartum course was observed without serious complications or residual damage.

Discussion:

Amnioinfusion is a helpful method for improving prenatal diagnostics in cases of severe oligo- or anhydramnios. In cases of severe fetal growth restriction, it could be a possible therapeutic option to reduce postpartum complications.