Discussion
This study showed that amnioinfusion is a safe procedure and can be
performed at the outpatient setting. The procedure is inexpensive with
minimal equipment needed and can be performed by all obstetricians
trained in intrauterine invasive procedures. This will make it easily
accessible to all patients.
In this study, the main fetal structural anomaly observed was renal.
There were 10 cases of bilateral renal agenesis and 15 cases of
infantile polycystic kidney disease. The diagnosis of renal anomaly was
difficult because of high BMI, lack of fluid as acoustic window and the
presence of scar tissue due to previous surgery, mainly repeat Cesarean
delivery and liposuction which are performed extensively in this part of
the world. The diagnosis was confirmed only after amnioinfusion.
Counseling of parents improved dramatically after confirming the
diagnosis of this serious fetal anomaly which is incompatible with life.
We advise obstetricians to avoid intrapartum monitoring and avoid
intervention except for maternal indication, so as to avoid unnecessary
operative delivery. In this part of the world, patients tend to have a
large family and another caesarean delivery may increase the chance of
contracting a more serious complication such as morbidity adherent
placenta, as a result of multiple repeat cesarean deliveries. Our study
showed that even in the absence of fetal malformation, the presence of
oligohydramnios is associated with many complications such as, higher
chance of early preterm labour, severe intrauterine growth restriction,
high operative delivery rate, low Apgar score and NICU admission. These
findings have been debated by many other
investigators13,14,15. In the absence of major fetal
malformation and a border line oligohydramnios, there could be a group
of patients who may benefit from amnioinfusion mainly to improve lung
maturity if it was done at the right gestational
age16.