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Amnioinfusion

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61. Postterm Pregnancy (Overview)

interventions designed to protect the lungs from the chemical pneumonitis caused by chronic meconium exposure, such as amnioinfusion [ , ] or routine nasopharyngeal suctioning of meconium-stained neonates. [ ] Postterm pregnancy is also an independent risk factor for neonatal encephalopathy [ ] and for death in the first year of life. [ , ] While much of the work above has been conducted in postterm pregnancies. Some of the fetal risks such as presence of meconium, increased risk of neonatal acidemia (...) in utero. Traditionally, saline amnioinfusion and aggressive nasopharyngeal and oropharyngeal suctioning at the perineum were used to decrease the risk of meconium aspiration syndrome. Recent studies contradict this standard practice. Fraser et al performed a prospective, randomized, multicenter study evaluating the risks and benefits of amnioinfusion for the prevention of meconium aspiration syndrome. [ ] They concluded that in clinical settings, which have peripartum surveillance, amnioinfusion

2014 eMedicine.com

62. Fetal Growth Restriction (Overview)

, continuous cardiotocography, steroids, maternal oxygen, and/or amnioinfusion and then repeat all testing up to 3 times a day depending on status. Situation 5 See the list below: Test results – IUGR with accelerating compromise, BPS less than or equal to 6, abnormal IVC and DV indices, pulsatile UV flow Interpretation – IUGR with decompensation, cardiovascular instability, hypoxemia certain, acidemia/asphyxia common, high perinatal mortality, death imminent Recommended management – If fetus is considered

2014 eMedicine.com

63. Breech Presentation (Overview)

or back down). [ ] Of those who received acoustic stimulation, 12 of 12 fetuses shifted to a spine-lateral position after acoustic stimulation, and 11 (91%) underwent successful ECV. In the control group, 0 of 11 shifts and 1 (9%) successful ECV ( P < .0001) occurred. Additional studies are needed. Amnioinfusion Although an earlier study reported on the utility of amnioinfusion to successfully turn 6 fetuses who initially failed ECV, [ ] a subsequent study was published of 7 women with failed ECV who (...) underwent amniocentesis and amnioinfusion of up to 1 liter of crystalloid. [ ] Repeat attempts of ECV were unsuccessful in all 7 cases. Amnioinfusion to facilitate ECV cannot be recommended at this time. Vaginal delivery rates after successful version The rate of cesarean delivery ranges from 0-31% after successful external cephalic version (ECV). Controversy has existed on whether there is a higher rate of cesarean delivery for labor dystocia following ECV. In 1994, a retrospective study by Egge et al

2014 eMedicine.com

64. Amniotic Fluid Embolism (Overview)

, of 182 patients with AFE, found a strong association between AFE and renal disease, placenta previa, polyhydramnios, placental abruption, and eclampsia and with procedures such as amnioinfusion, classical cesarean delivery, and dilation and curettage. The risk of AFE was also found to rise with maternal age, with the greatest increase occurring after age 39. [ ] Previous Next: Epidemiology United States and international statistics Incidence of amniotic fluid embolism (AFE) is estimated at 1 case per

2014 eMedicine.com

65. Polyhydramnios and Oligohydramnios (Follow-up)

an anomaly, delivery should be performed if the biophysical profile is nonreassuring. The instillation of isotonic sodium chloride solution in the second trimester may be of benefit in some patients. Use transabdominal amnioinfusion to instill 400-600 mL, which may improve visualization for ultrasonography and increase the amniotic fluid volume. In cases associated with postmaturity, review the pregnancy dating. If the gestation is truly longer than term, deliver the fetus by means of either induction (...) or cesarean delivery. If meconium is present during labor, administer amnioinfusion therapy to reduce the potential for fetal distress and prenatal aspiration. Transfer these pregnant women to a tertiary center when they have a high likelihood of maternal illness, preterm delivery, or infant problems that may require the resources of a tertiary care facility. Next: Medical Care The first step is identifying the etiology of the abnormal volume of amniotic fluid. Medical care includes the use of steroids

2014 eMedicine Pediatrics

66. Potter Syndrome (Follow-up)

Gynecol . 1999 Feb. 180(2 Pt 1):441-6. . Hawkins JS, Dashe JS, Twickler DM. Magnetic resonance imaging diagnosis of severe fetal renal anomalies. Am J Obstet Gynecol . 2008 Mar. 198(3):328.e1-5. . Fisk NM, Ronderos-Dumit D, Soliani A, Nicolini U, Vaughan J, Rodeck CH. Diagnostic and therapeutic transabdominal amnioinfusion in oligohydramnios. Obstet Gynecol . Aug/1991. 78(2):270-8. . . Raboei EH. The role of the pediatric surgeon in the perinatal multidisciplinary team. Eur J Pediatr Surg . 2008 Oct (...) Genet . Mar/1999. 83(1):23-7. . . Hahn H, Park SY, Eom JH, Park SW. Quiz page. Congenital intrathoracic kidney after regression of an adrenal mass. Am J Kidney Dis . 2009 Jan. 53(1):A27-8. . Palmer RE, Kotsianti A, Cadman B, Boyd T, Gerald W, Haber DA. WT1 regulates the expression of the major glomerular podocyte membrane protein Podocalyxin. Curr Biol . Nov/2001. 11(22):1805-9. . . Media Gallery Sonogram obtained before second-trimester amnioinfusion. This fetus has bilaterally absent kidneys

2014 eMedicine Pediatrics

67. Pulmonary Hypoplasia (Follow-up)

of death was 20 hours (range, 12-48 h), mostly commonly from respiratory failure. While antepartum amnioinfusions for treatment of oligohydramnios have significantly reduced the risk of pulmonary hypoplasia, longitudinal follow-up studies are lacking on the long-term outcomes of these children. Of children with pulmonary hypoplasia secondary to congenital diaphragmatic hernia (CDH), the postnatal survival rate of CDH at tertiary centers has improved, with reported rates of 70-92%. [ ] However

2014 eMedicine Pediatrics

68. Breech Presentation (Diagnosis)

or back down). [ ] Of those who received acoustic stimulation, 12 of 12 fetuses shifted to a spine-lateral position after acoustic stimulation, and 11 (91%) underwent successful ECV. In the control group, 0 of 11 shifts and 1 (9%) successful ECV ( P < .0001) occurred. Additional studies are needed. Amnioinfusion Although an earlier study reported on the utility of amnioinfusion to successfully turn 6 fetuses who initially failed ECV, [ ] a subsequent study was published of 7 women with failed ECV who (...) underwent amniocentesis and amnioinfusion of up to 1 liter of crystalloid. [ ] Repeat attempts of ECV were unsuccessful in all 7 cases. Amnioinfusion to facilitate ECV cannot be recommended at this time. Vaginal delivery rates after successful version The rate of cesarean delivery ranges from 0-31% after successful external cephalic version (ECV). Controversy has existed on whether there is a higher rate of cesarean delivery for labor dystocia following ECV. In 1994, a retrospective study by Egge et al

2014 eMedicine.com

69. Breech Presentation (Follow-up)

or back down). [ ] Of those who received acoustic stimulation, 12 of 12 fetuses shifted to a spine-lateral position after acoustic stimulation, and 11 (91%) underwent successful ECV. In the control group, 0 of 11 shifts and 1 (9%) successful ECV ( P < .0001) occurred. Additional studies are needed. Amnioinfusion Although an earlier study reported on the utility of amnioinfusion to successfully turn 6 fetuses who initially failed ECV, [ ] a subsequent study was published of 7 women with failed ECV who (...) underwent amniocentesis and amnioinfusion of up to 1 liter of crystalloid. [ ] Repeat attempts of ECV were unsuccessful in all 7 cases. Amnioinfusion to facilitate ECV cannot be recommended at this time. Vaginal delivery rates after successful version The rate of cesarean delivery ranges from 0-31% after successful external cephalic version (ECV). Controversy has existed on whether there is a higher rate of cesarean delivery for labor dystocia following ECV. In 1994, a retrospective study by Egge et al

2014 eMedicine.com

70. Fetal Growth Restriction (Diagnosis)

, continuous cardiotocography, steroids, maternal oxygen, and/or amnioinfusion and then repeat all testing up to 3 times a day depending on status. Situation 5 See the list below: Test results – IUGR with accelerating compromise, BPS less than or equal to 6, abnormal IVC and DV indices, pulsatile UV flow Interpretation – IUGR with decompensation, cardiovascular instability, hypoxemia certain, acidemia/asphyxia common, high perinatal mortality, death imminent Recommended management – If fetus is considered

2014 eMedicine.com

71. Amniotic Fluid Embolism (Diagnosis)

, of 182 patients with AFE, found a strong association between AFE and renal disease, placenta previa, polyhydramnios, placental abruption, and eclampsia and with procedures such as amnioinfusion, classical cesarean delivery, and dilation and curettage. The risk of AFE was also found to rise with maternal age, with the greatest increase occurring after age 39. [ ] Previous Next: Epidemiology United States and international statistics Incidence of amniotic fluid embolism (AFE) is estimated at 1 case per

2014 eMedicine.com

72. Breech Presentation (Treatment)

or back down). [ ] Of those who received acoustic stimulation, 12 of 12 fetuses shifted to a spine-lateral position after acoustic stimulation, and 11 (91%) underwent successful ECV. In the control group, 0 of 11 shifts and 1 (9%) successful ECV ( P < .0001) occurred. Additional studies are needed. Amnioinfusion Although an earlier study reported on the utility of amnioinfusion to successfully turn 6 fetuses who initially failed ECV, [ ] a subsequent study was published of 7 women with failed ECV who (...) underwent amniocentesis and amnioinfusion of up to 1 liter of crystalloid. [ ] Repeat attempts of ECV were unsuccessful in all 7 cases. Amnioinfusion to facilitate ECV cannot be recommended at this time. Vaginal delivery rates after successful version The rate of cesarean delivery ranges from 0-31% after successful external cephalic version (ECV). Controversy has existed on whether there is a higher rate of cesarean delivery for labor dystocia following ECV. In 1994, a retrospective study by Egge et al

2014 eMedicine.com

73. Postterm Pregnancy (Treatment)

interventions designed to protect the lungs from the chemical pneumonitis caused by chronic meconium exposure, such as amnioinfusion [ , ] or routine nasopharyngeal suctioning of meconium-stained neonates. [ ] Postterm pregnancy is also an independent risk factor for neonatal encephalopathy [ ] and for death in the first year of life. [ , ] While much of the work above has been conducted in postterm pregnancies. Some of the fetal risks such as presence of meconium, increased risk of neonatal acidemia (...) in utero. Traditionally, saline amnioinfusion and aggressive nasopharyngeal and oropharyngeal suctioning at the perineum were used to decrease the risk of meconium aspiration syndrome. Recent studies contradict this standard practice. Fraser et al performed a prospective, randomized, multicenter study evaluating the risks and benefits of amnioinfusion for the prevention of meconium aspiration syndrome. [ ] They concluded that in clinical settings, which have peripartum surveillance, amnioinfusion

2014 eMedicine.com

74. Premature Rupture of Membranes (Overview)

informed and educated about the risks and the dismal prognosis for the neonate. Delivery is also appropriate when the mother is concerned about her own risks, especially when PPROM has occurred prior to 20 weeks' gestation. Incomplete abortion may be the appropriate term for the condition, as products of conception (the amniotic fluid) have passed the cervical opening and into the vagina in these cases. Other heroic measures such as amnioinfusion, tocolysis, and cervical plug to seal the membranes

2014 eMedicine.com

75. Fetal Growth Restriction (Treatment)

, continuous cardiotocography, steroids, maternal oxygen, and/or amnioinfusion and then repeat all testing up to 3 times a day depending on status. Situation 5 See the list below: Test results – IUGR with accelerating compromise, BPS less than or equal to 6, abnormal IVC and DV indices, pulsatile UV flow Interpretation – IUGR with decompensation, cardiovascular instability, hypoxemia certain, acidemia/asphyxia common, high perinatal mortality, death imminent Recommended management – If fetus is considered

2014 eMedicine.com

76. Premature Rupture of Membranes (Follow-up)

informed and educated about the risks and the dismal prognosis for the neonate. Delivery is also appropriate when the mother is concerned about her own risks, especially when PPROM has occurred prior to 20 weeks' gestation. Incomplete abortion may be the appropriate term for the condition, as products of conception (the amniotic fluid) have passed the cervical opening and into the vagina in these cases. Other heroic measures such as amnioinfusion, tocolysis, and cervical plug to seal the membranes

2014 eMedicine.com

77. Postterm Pregnancy (Follow-up)

interventions designed to protect the lungs from the chemical pneumonitis caused by chronic meconium exposure, such as amnioinfusion [ , ] or routine nasopharyngeal suctioning of meconium-stained neonates. [ ] Postterm pregnancy is also an independent risk factor for neonatal encephalopathy [ ] and for death in the first year of life. [ , ] While much of the work above has been conducted in postterm pregnancies. Some of the fetal risks such as presence of meconium, increased risk of neonatal acidemia (...) in utero. Traditionally, saline amnioinfusion and aggressive nasopharyngeal and oropharyngeal suctioning at the perineum were used to decrease the risk of meconium aspiration syndrome. Recent studies contradict this standard practice. Fraser et al performed a prospective, randomized, multicenter study evaluating the risks and benefits of amnioinfusion for the prevention of meconium aspiration syndrome. [ ] They concluded that in clinical settings, which have peripartum surveillance, amnioinfusion

2014 eMedicine.com

78. Fetal Growth Restriction (Follow-up)

, continuous cardiotocography, steroids, maternal oxygen, and/or amnioinfusion and then repeat all testing up to 3 times a day depending on status. Situation 5 See the list below: Test results – IUGR with accelerating compromise, BPS less than or equal to 6, abnormal IVC and DV indices, pulsatile UV flow Interpretation – IUGR with decompensation, cardiovascular instability, hypoxemia certain, acidemia/asphyxia common, high perinatal mortality, death imminent Recommended management – If fetus is considered

2014 eMedicine.com

79. Polyhydramnios and Oligohydramnios (Overview)

. [ ] However, there is an increased risk of primary cesarean delivery with increasing maternal BMI. Complications Polyhydramnios Risks and complications of amnioinfusion include amniotic fluid embolism, maternal respiratory distress, increased maternal uterine tone, and transient fetal respiratory distress. An increase in the risk of maternal or fetal infection is not substantiated. Risks of amniocentesis include fetal loss (1-2%). Other complications are placental abruption, preterm labor, fetal-maternal (...) A, Greenspoon JS, Paul RH. Prophylactic amnioinfusion improves outcome of pregnancy complicated by thick meconium and oligohydramnios. Am J Obstet Gynecol . 1992 Jul. 167 (1):117-21. . Morales WJ, Talley T. Premature rupture of membranes at Am J Obstet Gynecol. 1993 Feb. 168 (2):503-7. . Phelan JP, Ahn MO, Smith CV, Rutherford SE, Anderson E. Amniotic fluid index measurements during pregnancy. J Reprod Med . 1987 Aug. 32 (8):601-4. . Pitt C, Sanchez-Ramos L, Kaunitz AM, Gaudier F. Prophylactic

2014 eMedicine Pediatrics

80. Potter Syndrome (Overview)

obtained before second-trimester amnioinfusion. This fetus has bilaterally absent kidneys consistent with a diagnosis of Potter syndrome. The cystic structures in the renal fossae are most likely the adrenal glands. Next: Pathophysiology Prior to 16 weeks' gestations, the amount of amniotic fluid is dependent on the transmembrane flow. After that, fetal urine production is the predominant mechanism that determines the amniotic fluid volume. The fetus continuously swallows amniotic fluid, which (...) and therapeutic transabdominal amnioinfusion in oligohydramnios. Obstet Gynecol . Aug/1991. 78(2):270-8. . . Raboei EH. The role of the pediatric surgeon in the perinatal multidisciplinary team. Eur J Pediatr Surg . 2008 Oct. 18(5):313-7. . Rani R, Cameron A, Munro F. Prenatal diagnosis and management of urethral obstruction. J Obstet Gynaecol Res . 1997 Feb. 23(1):59-62. . Chow JS, Benson CB, Lebowitz RL. The clinical significance of an empty renal fossa on prenatal sonography. J Ultrasound Med . 2005 Aug

2014 eMedicine Pediatrics

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