Amniocentesis and amnioinfusion during pregnancy. Report of four complicated cases.
We report two foetal complications after amnioinfusion with dye injection for evaluation of severe oligohydramnios in pregnancy. In the first case, an underskin colouring was to disappear within a few days. In the second case, an irreversible skin after-effect with muscular atrophy and lesion of the underskin tissues developed progressively, although the trained practitioner did not notice any particular resistance during the injection of the dye and the ultrasonographer did not point out that the foetus had been stuck by the needle. Both later reported cases concern two life threatening maternal complications due to amniocentesis for foetal karyotyping indicated by maternal age, a septic shock occurred 24h after entering the amniotic cavity, leading to a long stay in intensive care units. In one of those cases, the patient recovered from a cardiac arrest. We come to the conclusion that the essential continuous ultrasonographic monitoring cannot avoid all complications, some of which may lead to severe adverse foetal effects and others may need an intensive medical care for the mother, mainly after iatrogenic chorioamnionitis. Experience of the perinatologist remains an important factor to limit the complications without avoiding them completely. The indications must be carefully evaluated, the information given to the patients must be clear and in the future, intraamniotic injections of dyes will have to be avoided and replaced by non-invasive tests for diagnosis of preterm premature rupture of membranes, such as diamine-oxidase, foetal fibronectin or PROM-tests. The rules of a good practice will have to be defined and widely spread.
Winer
N
N
Departement de Gynécologie, Obstétrique et Néonatalogie, Centre Hospitalier Universitaire de Nantes, 44093 Nantes Cedex 1, France.
David
A
A
Leconte
P
P
Aubron
F
F
Rogez
J M
JM
Rival
J M
JM
Pinaud
M
M
Roze
J C
JC
Boog
G
G
D000328:Adult; D000649:Amniocentesis / Q000009:adverse effects*; D000653:Amniotic Fluid; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002821:Chorioamnionitis / Q000209:etiology; D004396:Coloring Agents / Q000008:administration & dosage; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000209:etiology; D005070:Evans Blue / Q000008:administration & dosage; D005260:Female; D005315:Fetal Diseases / Q000209:etiology; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis; D006801:Humans; D007621:Karyotyping; D008423:Maternal Age; D009133:Muscular Atrophy / Q000209:etiology; D016104:Oligohydramnios / Q000175:diagnosis; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012772:Shock, Septic / Q000209:etiology; D014463:Ultrasonography
D000900:Anti-Bacterial Agents; D004396:Coloring Agents; D005070:Evans Blue