- Henry Roque, MD, MS
Henry Roque, MD, MS
- Harvard School of Medicine
- Jonathan Gillen-Goldstein, MD
Jonathan Gillen-Goldstein, MD
- Director of Prenatal Diagnosis and Therapy
- for Madonna Perinatal Associates
- Mineola, NY
- Edmund F Funai, MD
Edmund F Funai, MD
- Professor and Chief Operating Officer
- USF Health
Amnioinfusion refers to the instillation of fluid into the amniotic cavity. This procedure is typically performed during labor through an intrauterine pressure catheter introduced transcervically after rupture of the fetal membranes. Alternatively, fluid can be infused through a needle transabdominally, the reverse process of amniocentesis.
The rationale for amnioinfusion is that augmenting amniotic fluid volume may decrease or eliminate problems associated with a severe reduction or absence of amniotic fluid, such as severe variable decelerations during labor.
In the absence of other indications for antibiotic use, we do not administer antibiotics during amnioinfusion. A randomized trial showed that prophylactic use of cefazolin in the infusate (1 g/1000 mL of normal saline) did not significantly reduce rates of maternal or neonatal infection .
The transcervical approach is preferred for women in labor because it does not require ultrasound guidance and the catheter can be used for repeated fluid instillation. After rupture of the fetal membranes, an intrauterine pressure catheter is inserted using standard technique and attached to intravenous extension tubing; a pediatric nasogastric feeding tube can be used if an intrauterine pressure catheter is not available . The catheter is used to infuse Lactated Ringers solution without dextrose into the amniotic cavity. We prefer Lactated Ringers to normal (0.9 percent) saline because the latter may cause small changes in the concentration of fetal electrolytes ; however, the electrolyte concentrations remain in the physiologic range so normal saline is an acceptable alternative [4,5].
Protocols vary across institutions and no one protocol has been proven to be superior. A survey of obstetrical units revealed that they used the following methods in decreasing order of frequency: (1) a fluid bolus (50 to 1000 mL) followed by a constant infusion, (2) serial boluses (200 to 1000 mL administered every 20 minutes to four hours), and (3) constant infusion (15 to 2250 mL/hour) . A randomized trial found that continuous and intermittent infusions were similarly effective .
- Edwards RK, Duff P. Prophylactic cefazolin in amnioinfusions administered for meconium-stained amniotic fluid. Infect Dis Obstet Gynecol 1999; 7:153.
- Abdel-Aleem H, Amin AF, Shokry M, Radwan RA. Therapeutic amnioinfusion for intrapartum fetal distress using a pediatric feeding tube. Int J Gynaecol Obstet 2005; 90:94.
- Shields LE, Moore TR, Brace RA. Fetal electrolyte and acid-base responses to amnioinfusion: lactated Ringer's versus normal saline in the ovine fetus. J Soc Gynecol Investig 1995; 2:602.
- Gonzalez JL, Mooney S, Gardner MO, et al. The effects of amnioinfused solutions for meconium-stained amniotic fluid on neonatal plasma electrolyte concentrations and pH. J Perinatol 2002; 22:279.
- Puder KS, Sorokin Y, Bottoms SF, et al. Amnioinfusion: does the choice of solution adversely affect neonatal electrolyte balance? Obstet Gynecol 1994; 84:956.
- Wenstrom K, Andrews WW, Maher JE. Amnioinfusion survey: prevalence, protocols, and complications. Obstet Gynecol 1995; 86:572.
- Rinehart BK, Terrone DA, Barrow JH, et al. Randomized trial of intermittent or continuous amnioinfusion for variable decelerations. Obstet Gynecol 2000; 96:571.
- Glantz JC, Letteney DL. Pumps and warmers during amnioinfusion: is either necessary? Obstet Gynecol 1996; 87:150.
- American Academy of Pediatrics and The American College of Obstetricians and Gynecologists. Intrapartum and postpartum care of the mother. In: Guidelines for Perinatal Care, 7th edition, 2012.
- Nageotte MP, Bertucci L, Towers CV, et al. Prophylactic amnioinfusion in pregnancies complicated by oligohydramnios: a prospective study. Obstet Gynecol 1991; 77:677.
- Burrows WR, Gervasi L, Kosty D, et al. Warming fluid for amnioinfusion during labor. J Reprod Med 1995; 40:123.
- Roberts WE, Martin RW, Roach HH, et al. Are obstetric interventions such as cervical ripening, induction of labor, amnioinfusion, or amniotomy associated with umbilical cord prolapse? Am J Obstet Gynecol 1997; 176:1181.
- Hicks P. Systematic review of the risk of uterine rupture with the use of amnioinfusion after previous cesarean delivery. South Med J 2005; 98:458.
- Tabor BL, Maier JA. Polyhydramnios and elevated intrauterine pressure during amnioinfusion. Am J Obstet Gynecol 1987; 156:130.
- Washburne JF, Chauhan SP, Magann EF, et al. Amnioinfusion-induced malpresentation. J Miss State Med Assoc 1998; 39:240.
- Novikova N, Hofmeyr GJ, Essilfie-Appiah G. Prophylactic versus therapeutic amnioinfusion for oligohydramnios in labour. Cochrane Database Syst Rev 2012; :CD000176.
- Ogita S, Imanaka M, Matsumoto M, et al. Transcervical amnioinfusion of antibiotics: a basic study for managing premature rupture of membranes. Am J Obstet Gynecol 1988; 158:23.
- Hofmeyr GJ. Amnioinfusion for umbilical cord compression in labour. Cochrane Database Syst Rev 2000; :CD000013.
- Shalev E, Battino S, Romano S, et al. Intraamniotic infection with Candida albicans successfully treated with transcervical amnioinfusion of amphotericin. Am J Obstet Gynecol 1994; 170:1271.
- Pierce J, Gaudier FL, Sanchez-Ramos L. Intrapartum amnioinfusion for meconium-stained fluid: meta-analysis of prospective clinical trials. Obstet Gynecol 2000; 95:1051.