Amnioinfusion before 26 weeks' gestation for severe fetal growth restriction with oligohydramnios: preliminary pilot study.
OBJECTIVE
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.


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.


RESULTS
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.


CONCLUSIONS
In cases of extremely severe FGR before 26 WG with oligohydramnios and circulatory failure, amnioinfusion might be a promising, innovative tool.
Department of Fetal-Maternal Medicine, Nagara Medical Center, Gifu, Japan.
Yuichiro
Y
Takahashi
Shigenori
S
Iwagaki
Rika
R
Chiaki
Tomotake
T
Iwasa
Motoki
M
Takenaka
Ichiro
I
Kawabata
Mitsuaki
M
Itoh
D000653:Amniotic Fluid; D001724:Birth Weight; D003131:Combined Modality Therapy; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005440:Fluid Therapy / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007263:Infusions, Parenteral; D007564:Japan; D008297:Male; D016104:Oligohydramnios / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D010865:Pilot Projects; D011247:Pregnancy; D011255:Pregnancy Maintenance / Q000187:drug effects; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis; D035703:Therapies, Investigational / Q000009:adverse effects; D015145:Tocolysis / Q000009:adverse effects; D014463:Ultrasonography
amnioinfusion; cerebral palsy; fetal growth restriction; intrauterine growth restriction; oligohydramnios