Intraamniotic Pressures Following Vaginal Gemeprost Prior to 1st and 2nd Trimester Termination of Pregnancy

Intra-amniotic pressures were measured following 1 mg gemeprost for cervical preparation before first trimester vacuum aspiration (n = 10) and following 2 mg gemeprost before second trimester dilatation and evacuation (n = 15). Twenty-five women, matched for gestational age and parity, who did not receive gemeprost served as controls. Compared to control values (2-8 mmHg), basal intra-amniotic pressure (IAP) was significantly increased after 1 mg and 2 mg of gemeprost (median 20.0, range 4-45 mmHg, median 20.0, range 8-60 mmHg, respectively). Uterine contractions were recorded in 8 of 10 subjects after 1 mg (median DELTAIAP 28.0,95% CI 10.0-42.6 mmHg) and 14 of 15 subjects after 2 mg (median DELTAIAP 52.5, 95% CI 26.7-60.3 mmHg). Gemeprost produces an increase in uterine contractility which may be additional to cervical softening properties and which may be responsible for the adverse effects of pain and bleeding experienced by some women prior to termination

Normal Amniotic Pressure Throughout Gestation

Objective To characterize amniotic pressure (AP) in pregnancies with normal amniotic fluid volume

Diagnostic and therapeutic transabdominal amnioinfusion in oligohydramnios

We report our experience with 92 antenatal amnioinfusion procedures. In order to facilitate ultrasound visualization, a diagnostic infusion was attempted at a median of 22 weeks (range 16-36) in 61 pregnancies with oligohydramnios in the absence of ruptured membranes on clinical examination. The procedure was successful in 58 (95%). Infusion (mean volume 181 mL, range 40-64) significantly increased (P < .001) the deepest pool of amniotic fluid to a mean of 3.2 cm. Suspected fetal anomalies were then confirmed in 27 of 30 cases, whereas kidneys were clearly demonstrated in three fetuses suspected of renal agenesis. In addition, previously unsuspected anomalies were identified in five. Vaginal leakage indicating ruptured membranes occurred in 16 women. Leakage occurred in zero of 24 patients with, compared to 16 of 35 without, fetal urinary disorders (chi-2 = 15.1, P < .001), which does not support the recent suggestion that amnioinfusion causes rather than unmasks rupture of the membranes. Membranous detachment was observed by ultrasound in 13 patients, 11 of whom leaked vaginally. Information obtained at amnioinfusion led to a change of etiologic diagnosis in eight (13% of subjects). Forty serial infusions were performed in nine women as a pilot study to prevent oligohydramnios sequelae. There were no skeletal deformities; three neonates survived, and five of the six perinatal deaths had normal lung-body weight ratios. Overall, only two of 89 infusions (2.2%) were complicated by clinical amnionitis. Our findings support a role for amnioinfusion in oligohydramnios

Relief of Presumed Compression in Oligohydramnios - Amnioinfusion Does Not Affect Umbilical Artery Doppler Wave-Forms

The suggestion that amnioinfusion improves umbilical artery Doppler indices of downstream resistance in oligohydramnios by relieving cord compression was investigated by obtaining waveforms before and immediately after amnioinfusion in 16 pregnancies with severe oligohydramnios. There was no significant difference in the change in umbilical artery pulsatility index (PI) between 11 pregnancies in which amniotic fluid volume was restored (mean DELTAPI = -0.07, 95% confidence interval -0.17 to +0.07), and 5 pregnancies in which immediate vaginal leakage of infused fluid prevented restitution of amniotic fluid volume. Fetal heart rate did not change significantly in either group. End-diastolic frequencies did not return with restitution of amniotic fluid volume in the 2 pregnancies in which they were absent before infusion (absent in 1, reverse in 1). This study suggests that restitution of amniotic fluid volume in human pregnancies complicated by severe oligohydramnios does not acutely alter the umbilical artery PI

Uterine peritoneal amniotic fluid leakage: an unusual complication of intrauterine shunting

Bilateral pleuroamniotic shunting was performed at 33 weeks' gestation in a fetus with bilateral hydrothorax, hydrops, and gross polyhydramnios. The procedure was successful, but acute amniotic fluid leakage into the maternal peritoneal cavity occurred soon after. This produced marked maternal discomfort and transient oligohydramnios, with consequent fetal distress. Expectant management was adopted in view of fetal lung immaturity. Resolution of maternal ascites occurred within 24 hours and the fetal heart rate normalized as amniotic fluid reaccumulated. The pregnancy progressed uneventfully thereafter