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Transabdominal Amnioinfusion

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Transabdominal amnioinfusion in a procedure in which normal saline or lactated Ringer’s solution is infused into the uterus during pregnancy to replace the amniotic fluid in the case of premature rupture of membranes (PROM), usually at 24 to 34 weeks of gestation. Generally about 30 to 40 milliliters of fluid will be introduced each day to reach a total of 1,000 milliliters when pregnancy is term. Amniotic fluid will be highest at 36 weeks and then will reduce after that. The amniotic fluid is very likely to get too low after 40 weeks of pregnancy.

Benefits
  1. Amnioinfusion can manage the loss of amniotic fluid through a leak or rupture of the amniotic sac, treat oligohydraminos (deficiency of amniotic fluid), and alleviate cord compression that causes abnormal fetal heart rate and that can lead to birth asphyxia.
  2. Amnioinfusion can dilute meconium in the waters, reducing the risk of aspiration.
  3. Amnioinfusion can reduce the risk of Cesarean section for fetal distress and reduce the costs associated with a longer hospital stay.
  1. Chorioamnionitis.
  2. Fetal anomalies incompatible with life.
  3. Impending delivery.
  4. Pregnancy with multiples.
  5. Persistent nonreactive fetal heart rate pattern.
  6. Undiagnosed third trimester bleeding.
  7. Uterine anomalies.
  1. Please do not take any aspirin or medication containing aspirin for at least five days before the procedure, and please do not take Heparin or Lovenox for at least 24 hours before the procedure.
  2. Ultrasound will be used before, during and after the procedure.
  3. Once the doctor has located the safest spot for the procedure, the area will be cleaned with Betadine, which is a brownish color. It can stain your skin or clothes so after the procedure wipe off as much of it as you can.
  4. The doctor will then insert a small needle through your skin and into the uterus and amniotic sac where your baby is. Some women feel a contraction when the needle touches the uterus. While it can be stressful and frightening to undergo this procedure, most women find that it is more comfortable and less painful that they imagined.
  5. Ultrasound is used to:
  6. Confirm that you are pregnant with just one baby.
  7. Assess gestational age by measuring the baby’s head circumference, which is a fairly accurate method for calculating gestational age when compared with last menstrual period (LMP).
  8. Select the safest area for introducing the needle for amnioinfusion into the uterus, avoiding the baby and umbilical cord.
  9. You will have to lie on your back on an examination table, with your stomach exposed. Please wear loose, comfortable clothing that allows easy access to your abdomen.
  10. The doctor will apply a gel to your abdomen and place a transducer on your abdomen and move it around. Generated sound waves will be bounced back by tissue and amniotic fluid to form images that will appear on a monitor.
  11. Ultrasound usually takes about 20 to 30 minutes.
  12. An amnioinfusion takes approximately one to two hours.
  1. Most pregnant women experience minor discomfort during a transabdominal amnioinfusion. Some may experience contractions during the procedure, which usually disappear after a short time.
  2. Some women experience pain at the insertion site for a few hours after the procedure, but this can last up to two to three days. It will disappear on its own.
  1. Rest for about 30 minutes after the procedure. The doctor may prescribe medication to relax the uterine muscles, depending on their specific treatment plan.
  2. After the amnioinfusion you should return home or stay in the hospital to rest in bed for one night or as recommended by the doctor.
  3. You may take pain medication if you are very uncomfortable.
  4. The insertion site does not need to be dressed. You can bathe normally.
  5. For one week after the procedure, avoid lifting heavy objects, going up and down the stairs too frequently, exercising and other strenuous activities, and sexual intercourse.
Please avoid traveling in the first week after the procedure.
  1. Hydramnios—having too much amniotic fluid.
  2. Prolapsed cord.
  3. Abnormally high intrauterine pressure.
  4. Placental abruption—the placenta comes off the wall of the uterus prematurely.
  5. Uterine infection.
  6. Chills caused by cold liquid being infused.
  7. Fetal bradycardia.
  8. Fetal tachycardia.
  1. Slight vaginal bleeding or leaking of amniotic fluid; uterine contractions.
  2. Even a normal pregnancy holds some risk of miscarriage. Amnioinfusion increases this risk slightly.
Please come back to the hospital if you experience severe abdominal pain or contractions (mild contractions that last two to three hours are normal), you notice clear liquid or blood coming out of your vagina, and/or if you have a fever higher than 38 degrees Celsius.
May lead to oligohydramnios or low amniotic fluid volume, affecting the development of the fetus. If fluid is too low, it can lead to life-threatening complications.
None.
 
A transabdominal amnioinfusion is a personal decision and you should speak with your doctor about all your options as well as the risks association with the procedure.

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