Name of the Procedure:

Transabdominal amnioinfusion (Amniotic Fluid Infusion)

Summary

Transabdominal amnioinfusion is a procedure in which a sterile fluid is infused into the amniotic sac using a needle that passes through the abdomen. Ultrasound guidance is used to ensure accurate placement of the needle and to monitor the process.

Purpose

Transabdominal amnioinfusion is primarily used to treat or manage conditions related to low amniotic fluid (oligohydramnios) during pregnancy. The goals include improving fetal health by increasing the volume of amniotic fluid, which can help reduce the risk of umbilical cord compression and improve outcomes related to fetal development and movement.

Indications

• Oligohydramnios (low amniotic fluid)
• Severe variable decelerations in fetal heart rate during labor
• Meconium-stained amniotic fluid
• To assist in certain diagnostic procedures, such as amniocentesis, when amniotic fluid levels are critically low

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• Blood tests and ultrasound assessments will be conducted to evaluate overall health and amniotic fluid levels.
• Detailed instructions about medication adjustments will be provided, especially concerning anticoagulants or other drugs that may affect the procedure.

Procedure Description

1. The patient is positioned comfortably, usually lying down.
2. An ultrasound is performed to locate the optimal insertion site and to monitor the fetus.
3. The skin on the abdomen is cleaned and sterilized to prevent infection.
4. Local anesthesia is administered to numb the insertion area.
5. A fine needle is inserted through the abdominal wall into the amniotic sac, guided by continuous ultrasound imaging.
6. Sterile fluid is slowly infused into the amniotic sac through the needle.
7. The needle is then carefully removed, and the insertion site is bandaged.

Duration

The procedure typically takes between 30 and 60 minutes, including preparation and post-procedure monitoring.

Setting

The procedure is usually performed in a hospital or specialized outpatient clinic with the necessary facilities for continuous ultrasound monitoring.

Personnel

• Obstetrician or maternal-fetal medicine specialist
• Ultrasound technician
• Registered nurse
• Occasionally, an anesthesiologist may be involved if more extensive anesthesia is required.

Risks and Complications

• Infection at the insertion site
• Premature rupture of membranes
• Preterm labor
• Fetal injury (extremely rare due to ultrasound guidance)
• Bleeding or spotting
• Maternal discomfort or pain during the procedure

Benefits

• Increase in amniotic fluid volume
• Potential reduction in the risk of umbilical cord compression
• Improved fetal outcomes and reduced risk of complications related to low amniotic fluid levels
• Usually, the benefits are realized within hours to days post-procedure.

Recovery

• Patients may be monitored for a few hours for any immediate complications.
• Follow-up ultrasound may be scheduled to assess amniotic fluid levels and fetal health.
• Normal activities can often be resumed within 24 hours, although heavy lifting and strenuous exercise should be avoided for a few days.
• Patients will need to attend regular prenatal appointments to monitor ongoing fetal well-being.

Alternatives

• Increased maternal hydration (oral or intravenous)
• Amnioreduction (in the case of polyhydramnios)
• Monitoring and managing underlying conditions leading to oligohydramnios
• Each alternative has its pros and cons, such as variable efficacy (e.g., maternal hydration) or suitability based on the specific clinical context.

Patient Experience

• The patient might feel pressure or mild discomfort during needle insertion.
• Post-procedure, some abdominal cramping or slight pain at the insertion site is possible.
• Pain management typically includes over-the-counter pain relievers and rest.
• Emotional support and clear communication from healthcare providers help enhance comfort and reduce anxiety throughout the process.