Amnioinfusion before 26 weeks' gestation for severe fetal growth restriction with oligohydramnios: Preliminary pilot study. Issue 3 (18th November 2013)

• Record Type: Journal Article
• Authors: Takahashi, Yuichiro; Iwagaki, Shigenori; Chiaki, Rika; Iwasa, Tomotake; Takenaka, Motoki; Kawabata, Ichiro; Itoh, Mitsuaki
• Is Part Of: Journal of obstetrics and gynaecology research. Volume 40:Issue 3(2014:Mar.)
• Page Start: 677
• Page End: 685
• Publication Date: 2013-11-18
• Subjects: Gynecology -- Periodicals; Obstetrics -- Periodicals; 618.1005
• DOI: 10.1111/jog.12224
• Languages: English
• ISSNs: 1341-8076

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="jog12224-sec-0001" sec-type="section"> <title>Aim</title> <p>The prognosis for severe fetal growth restriction (FGR) with severe oligohydramnios before 26 weeks' gestation (WG) is currently poor; furthermore, its management is controversial. We report the innovative new management of FGR, such as therapeutic amnioinfusion and tocolysis.</p> </sec> <sec id="jog12224-sec-0002" sec-type="section"> <title>Material and Methods</title> <p>For FGR and severe oligohydramnios before 26 WG complicated with absent or reversed umbilical artery end‐diastolic flow velocity and/or deceleration by ultrasonography, we performed transabdominal amnioinfusion with tocolysis. Cases with multiple anomalies were excluded. Survival rate and long‐term prognosis were analyzed.</p> </sec> <sec id="jog12224-sec-0003" sec-type="section"> <title>Results</title> <p>Among 570 FGR cases, 18 were included in the study. Mean diagnosis and delivery were at 22.6 ± 2.0 and 28.7 ± 3.3 WG. Median birthweight was 625 g (−4.2 standard deviation). Final survival rate was 11/13 (85%). There were five fetal deaths. In seven cases, oligohydramnios improved. Growth was detected in 10/18 fetuses. Furthermore, 8/8 decelerations, 4/12 cases of reversed umbilical artery end‐diastolic flow velocity, 7/14 cases of brain‐sparing effect, and 6/13 venous Doppler abnormalities were improved. When we detected umbilical cord compression, 8/10 cases were rescued. Eleven infants were followed up for an average of 5 years; one case of cerebral palsy with normal development and 10 cases with intact motor functions without major neurological handicap were confirmed.</p> </sec> <sec id="jog12224-sec-0004" sec-type="section"> <title>Conclusions</title> <p>In cases of extremely severe FGR before 26 WG with oligohydramnios and circulatory failure, amnioinfusion might be a promising, innovative tool.</p> </sec> </abstract>