Amnioinfusion before 26 weeks' gestation for severe fetal growth restriction with oligohydramnios: Preliminary pilot study
Article first published online: 18 NOV 2013
© 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology
Journal of Obstetrics and Gynaecology Research
Volume 40, Issue 3, pages 677–685, March 2014
How to Cite
Takahashi, Y., Iwagaki, S., Chiaki, R., Iwasa, T., Takenaka, M., Kawabata, I. and Itoh, M. (2014), Amnioinfusion before 26 weeks' gestation for severe fetal growth restriction with oligohydramnios: Preliminary pilot study. Journal of Obstetrics and Gynaecology Research, 40: 677–685. doi: 10.1111/jog.12224
- Issue published online: 3 MAR 2014
- Article first published online: 18 NOV 2013
- Manuscript Accepted: 26 JUN 2013
- Manuscript Received: 20 FEB 2013
- cerebral palsy;
- fetal growth restriction;
- intrauterine growth restriction;
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.
Material and Methods
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.
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.
In cases of extremely severe FGR before 26 WG with oligohydramnios and circulatory failure, amnioinfusion might be a promising, innovative tool.