Does amnioinfusion reduce fetal heart rate variability?
Human and animal studies have demonstrated an association between decreased amniotic fluid and the occurrence of variable decelerations in the fetal heart rate. Amnioinfusion is a new investigational technique directed at decreasing the number and severity of variable decelerations by infusion of a normal saline solution into the uterine cavity.
What is amnioinfusion and how does it work?
Amnioinfusion is a procedure that adds amniotic fluid to your uterus during labor. Not having enough amniotic fluid can cause pregnancy and delivery complications. It’s only performed in a certain circumstances. What is amnioinfusion? Amnioinfusion is a technique healthcare providers use to add amniotic fluid to your uterus.
What are the risks of amnioinfusion?
Like all procedures, there are some risks involved. Complications of amnioinfusion could include: Chorioamnionitis (infection of your placenta and amniotic fluid). Umbilical cord prolapse. Polyhydramnios (too much amniotic fluid).
Is amnioinfusion safe and effective in the treatment of deceleration?
In conclusion, amnioinfusion was found to be a safe and effective intervention for the relief of repetitive variable decelerations. Further, amnioinfusion lowered the incidence of cesarean section for fetal distress in one study of nulliparous patients.
What percentage does amnioinfusion decrease variables?
The amnioinfusion was considered successful if it resulted in a decrease of >50% in total number of variable decelerations or a decrease of >50% in the rate of atypical or severe variable decelerations after administration of the bolus.
How effective is amnioinfusion?
Amnioinfusion was effective in preventing or relieving fetal heart rate decelerations. The main clinical benefit was a large reduction in the number of cesarean sections performed for the indication of non-reassuring fetal heart rate tracing.
Can oligohydramnios cause variable decelerations?
During labor, the baby of a patient suffering from oligohydramnios may have what are known as “variable decelerations” of the heart rate. It is generally felt that such variable decelerations of the baby's heart rate occur as a result of the compression of the umbilical cord during the process of labor and delivery.
What is variable deceleration?
Variable deceleration. An abrupt* decrease in FHR below the baseline. The decrease is ≥15 bpm, lasting ≥15 secs and <2 minutes from onset to return to baseline. The onset, depth, and duration of variable decelerations commonly vary with successive uterine contractions.
Does IV fluids increase amniotic fluid?
The results of the current study showed that IV hydration caused a significant increase in the amniotic fluid index in the hydration group. This increase might have been due to acute changes in amniotic volume or the maternal plasma osmolality.
What does an amnioinfusion do?
Amnioinfusion refers to the instillation of fluid into the amniotic cavity. The rationale 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.
What should I expect after an amnioinfusion?
The exact recommendations may vary depending on your condition, but you can expect to receive fluids for 10 to 30 minutes. Your healthcare provider will continue to measure your amniotic fluid levels to ensure the fluid is being retained. After amnioinfusion, you may have mild discomfort or pain.
Can a baby survive without amniotic fluid at 30 weeks?
Without sufficient amniotic fluid, a baby is at risk of suffering serious health complications from: Intrauterine Growth Restriction (IUGR). This is also known as fetal growth restriction. It is diagnosed when a fetus's estimated weight is too low for its gestational age.
Is normal delivery possible with low amniotic fluid at 37 weeks?
If you have low amniotic fluid and you're 36 to 37 weeks pregnant, the safest option might be delivering the baby.
Are variable decelerations common?
[1] Intermittent, variable decelerations, defined as decelerations occurring with less than half of contractions, are the most common fetal heart rate abnormality that takes place in labor.
Are late or variable decelerations worse?
Late decelerations are the worst classification of fetal heart rate because as previously mentioned, after contraction, the baby's heart rate should immediately return to its baseline. Late decelerations occur when the baby's heart rate does not return to normal.
What is minimal variability in fetal heart rate?
Variability is minimal below 6 bpm and absent when non visible. Decelerations are classified as early, variable, late, and prolonged. Early and late decelerations have an onset gradual decrease of FHR, in contrast variable decelerations have an abrupt onset.
How long does an amnioinfusion take?
Generated sound waves will be bounced back by tissue and amniotic fluid to form images that will appear on a monitor. Ultrasound usually takes about 20 to 30 minutes. An amnioinfusion takes approximately one to two hours.
Can they replace amniotic fluid?
It is not possible to replace the fluid or repair the hole in the membranes around your baby. You may carry on leaking fluid for the rest of your pregnancy as amniotic fluid continues to be made. However, treatment may be offered to reduce the risk to your baby.
When is amnioinfusion done?
Aetna considers amnioinfusion medically necessary for any of the following indications: Prophylactic treatment of oligohydramnios, or. Reduction of variable decelerations of the fetal heart rate because of cord compression during labor, or.
Can drinking water increase amniotic fluid?
Some studies show that drinking water can help increase amniotic fluid levels in people who are pregnant. Talk to your healthcare provider about increasing your water intake as a treatment for oligohydramnios.
What is amnioinfusion in nursing?
Amnioinfusion is a method of replacing intrauterine amniotic fluid volume through intrauterine infusion of a saline solution using a pressure catheter. This method simply and effectively relieves variable decelerations not alleviated by the conventional measures of maternal position change and oxygen administration. The mechanisms underlying variable decelerations, the technique for amnioinfusion administration, and two case studies are reported. Nursing responsibilities regarding amnioinfusion include pattern recognition, assisting with or initiation of amnioinfusion, and maintenance and evaluation of this intervention.
Who reported amnioinfusion in humans?
Amnioinfusion in humans has been reported by Nageotte et al. and Miyazaki and colleagues.
What is the most common type of abnormal fetal heart rate pattern encountered in the intrapartum period?
Variable decelerations are the most common type of abnormal fetal heart rate pattern encountered in the intrapartum period.
What is the equipment used for amnioinfusion?
Equipment for the amnioinfusion single catheter method ( Figure 2) includes 1,000 ml of warm ed normal saline, macrodrip intravenous fluid, extension tubing, and an 18-gauge needle. The extension tubing is placed between the intrauterine catheter and the transducer to prevent possible corrosion of the transducer by the saline solution. The 18-gauge needle is attached to the intravenous tubing and inserted into the side port of the extension tubing. An infusion of 500 ml of fluid during the first 20 minutes, then a rate adjustment according to the occurrence and severity of the variable decelerations completes fusion preparation.
How long after membrane rupture did the patient have regular uterine activity?
Approximately 48 hours after the time of membrane rupture, the patient began having regular uterine activity. Severe and persistent variable decelerations were noted ( Figure 4 ). A two-catheter amnioinfusion method was initiated per protocol with a cervical dilation of 3 cm. The severity of variables declined significantly ( Figure 5, Figure 6, Figure 7 ). The amnioinfusion was maintained throughout the remainder of the labor. A spontaneous vaginal delivery of a female infant weighing 1,760 g occurred after about three hours. Apgar scores were 6 at one minute and 7 at five minutes; arterial cord blood pH was 7.31. The infant was attended by neonatal staff at delivery, admitted to the neonatal intensive care unit, and discharged after 14 days with an uncomplicated neonatal stay.
How much saline is in amnioinfusion?
The total amount of saline infused via amnioinfusion was approximately 5,500 ml over a three- hour course. No postpartum maternal complications occurred.
What causes variable deceleration?
Variable decelerations are caused by intermittent compression of the umbilical cord during contractions.
What are the common anomalies after amnioinfusion?
US shows that after amnioinfusion, other fetal anomalies are more readily assessed. Clubfeet and other joint contractures are commonly present (tibia and fibula ).
What is an amnioinfusion?
Amnioinfusion is a technique of replacing amniotic fluid during labor via a transcervical intrauterine catheter (see Chapter 18, Section C ). Infusion of fluid expands the amniotic cavity space and relieves cord compression.
How much fluid should I infuse after a bolus?
After the initial bolus, a maintenance infusion of 1 to 3 ml/min is used. If intrapartum ultrasound is used, the amnioinfusion can be adjusted to keep the AFI between 8 and 12 cm. An infusion of 250 ml fluid results in an average increase of the AFI of 4 cm and often results in a small increase in the basal uterine tone. 12 Clinicians who can obtain an AFI during labor can easily determine when an adequate fluid cushion has been achieved (an AFI between 8 and 12 cm). When an AFI is not available, it is recommended that the total quantity infused not exceed 800 ml.
How is a vesicoamniotic shunt placed?
A vesicoamniotic shunt is placed under US guidance using a double-pigtail catheter inserted through a narrow trocar. Amnioinfusion of warmed lactated Ringer solution is often performed before the procedure to allow placement of the distal end of the catheter within the amniotic cavity. It may be prudent to repeat the anatomic survey after amnioinfusion because lack of fluid can significantly limit visualization of fetal abnormalities. Placement of the catheter is as low as possible in the fetal bladder, to avoid displacement after decompression, and color Doppler may be used to outline the umbilical arteries to avoid vascular trauma during catheter placement.17
Why is amnioinfusion performed in the setting of oligohydramnios?
Amnioinfusion is performed in the setting of oligohydramnios to allow for a potential space into which the intra-amniotic end of the catheter may be placed.
How to reverse pulmonary hypoplasia in utero?
Based on this same logic, there have been efforts to reverse pulmonary hypoplasia in utero by fetal tracheal occlusion. In a case report of PPROM at 16 weeks’ gestation, fetoscopic tracheal balloon occlusion was performed at 27 6 7 weeks (Kohl et al, 2009). Within 6 days, the fetal lung volume as measured by MRI increased from 13 to 70 mL ( Figure 46-12, C) and the lung blood flow normalized. The fetus was delivered at 28 6 7 weeks using the EXIT procedure (ex utero–intrapartum treatment), had no signs of pulmonary hypertension, and was discharged home at 8 weeks of age. This approach has been used for fetuses with congenital diaphragmatic hernia (Done et al, 2008), but with mixed results. Whether this technique proves to be valuable for PPROM is uncertain, but the restoration of lung size in only 6 days suggests that pulmonary hypoplasia may be more reversible than previously assumed.
What are the complications of a shunt?
Complications include displacement of the shunt out of the bladder in about 40% of cases; urinary ascites in 20%; and incidental gastroschisis after shunt displacement, in which bowel herniates through the shunt site, in 10%. 6,10 In addition, 70% of pregnancies have delivered preterm, with preterm rupture of membranes in more than 30%. 6 Long-term complications include end-stage renal disease in approximately one-third, milder renal impairment in another 20%, and respiratory problems in almost half of surviving children. 2
How many ml of amnioinfusion?
The amnioinfusion setup consists of a 1,000-ml bottle of normal saline solution and intravenous tubing that is connected directly to the intrauterine catheter ( Figure 1 ).
What is the goal of amnioinfusion?
When planning amnioinfusion, the central goals are (1) relief of cord compression and fetal adjustment to intrauterine life, (2) avoidance of complications in the patient that are associated with the amnioinfusion procedure, and (3) alleviation of concerns on the part of the patient and her partner regarding the condition of the fetus and the amnioinfusion procedure.
What are the nursing actions during amnioinfusion?
Nursing actions during amnioinfusion include providing a clear description of the equipment and procedure based on the level of sophistication of the patient. Included in the teaching plans ( Table 1) should be a plan for discussions of the role of amniotic fluid, the function of the umbilical cord, and methods of assessing the condition of the fetus during labor. Illustrations or models may be helpful in explaining the procedure to the patient and support person. Careful assessment and documentation of fetal heart-rate patterns and uterine activity are of paramount importance during and after the procedure. Since patients usually are aware that the fetus is experiencing stress in utero, the nurse should interpret the ongoing monitoring at all times to the patient. The patient needs to be encouraged to remain in the left lateral recumbent position to prevent supine hypotensive syndrome.
What is the assessment phase of a nursing procedure?
Nursing actions during the assessment phase focus on gathering data from the patient and her partner concerning their level of understanding of both the condition of the fetus and the amnioinfusion technique. Other assessment parameters include data on the development of the patient, the patient’s social supports, and the degree of fatigue due to labor. Assessment of the physical condition of the mother and fetus should include base-line information on vital signs, generation of fetal heart-rate patterns, and observation of the amount and character of the amniotic fluid. Before implementing the procedure, the physician must obtain informed consent from the patient. Informed consent consists of three things: disclosure of information concerning the procedure; a discussion of the risks, benefits, and alternatives; and the consent itself.
What is amnioinfusion used for?
Amnioinfusion is used to reestablish the protective qualities of amniotic fluid by infusing normal saline into the uterine cavity. Before initiating the procedure, the health-care provider must obtain informed consent from the patient. A vaginal exam is performed to rule out prolapse of the umbilical cord and establish fetal presentation and cervical dilation. Continuous direct fetal monitoring by a scalp electrode and an intrauterine pressure catheter is established. The patient is maintained in the left lateral recumbent position to avoid supine hypotensive syndrome.
What is amnioinfusion in fetal heart rate?
Amnioinfusion is a new investigational technique directed at decreasing the number and severity of variable decelerations by infusion of a normal saline solution into the uterine cavity. The technique may provide a mechanism for protecting the umbilical cord from compression and, thereby, ameliorating fetal distress. This article describes amnioinfusion and discusses related nursing implications for patients undergoing the procedure.
Why is amniotic fluid important?
The situation suggests that the volume of amniotic fluid may be critical for the protection of the umbilical cord and umbilical blood flow. Amnioinfusion is a new investigational technique that allows for the replacement of amniotic fluid with normal saline in the uterine cavity of laboring patients.
What is amnioinfusion in labor?
Amnioinfusion refers to the instillation of fluid into the amniotic cavity. The rationale 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. The procedure can be performed by transcervical or transabdominal routes. Transcervical amnioinfusion for the treatment of recurrent variable decelerations is the most common indication. Other possible uses include transabdominal amnioinfusion to aid in ultrasound diagnosis or to aid external cephalic version, although supporting data are lacking.
What is the most common indication for transcervical amnioinfusion?
Transcervical amnioinfusion for the treatment of recurrent variable decelerations is the most common indication. Other possible uses include transabdominal amnioinfusion to aid in ultrasound diagnosis or to aid external cephalic version, although supporting data are lacking.
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The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of UpToDate content is governed by the UpToDate Terms of Use. ©2021 UpToDate, Inc. All rights reserved.
What is amnioinfusion in labor?
Amnioinfusion refers to the instillation of fluid into the amniotic cavity. The rationale 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. The procedure can be performed by transcervical or transabdominal ...
What is the most common indication for transcervical amnioinfusion?
Transcervical amnioinfusion for the treatment of recurrent variable decelerations is the most common indication. Other possible uses include transabdominal amnioinfusion to aid in ultrasound diagnosis or to aid external cephalic version, although supporting data are lacking.
Is UpToDate a substitute for medical advice?
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of UpToDate content is governed by the UpToDate Terms of Use. ©2021 UpToDate, Inc. All rights reserved.