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Amnioinfusion

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81. Polyhydramnios and Oligohydramnios (Diagnosis)

. [ ] 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

82. Potter Syndrome (Diagnosis)

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

83. Antenatal Hydronephrosis (Follow-up)

in initial attempts (eg, use of amnioinfusion to enhance fetal visualization, use of fetal paralysis, routine use of antibiotics, and increased focus on proper catheter placement), as well as specific outcome measures needed for appropriate evaluation of the effects of fetal intervention (eg, gross survival, postnatal survival, shunted survival, and nadir creatinine at 1 year). [ ] Laparoscopy has also been described but has been associated with high rates of complications. [ ] Fetal cystoscopic ablation (...) of posterior urethral valves has been described; success rates have varied. [ ] The fetoscope is passed percutaneously through a cannula into the fetal bladder, and ablation of the valves is achieved with laser coagulation. Other less invasive techniques have been developed to help prevent oligohydramnios-induced pulmonary hypoplasia. As previously mentioned, serial transabdominal amnioinfusion is helpful in placement of percutaneous shunts. It may also have a therapeutic role in the reduction of pulmonary

2014 eMedicine Pediatrics

84. Meconium Aspiration Syndrome (Diagnosis)

Mar. 33 (1):29-42, v-vi. . Hofmeyr GJ, Xu H. Amnioinfusion for meconium-stained liquor in labour. Cochrane Database Syst Rev . 2010 Jan 20. CD000014. . Fraser WD, Hofmeyr J, Lede R, et al, for the Amnioinfusion Trial Group. Amnioinfusion for the prevention of the meconium aspiration syndrome. N Engl J Med . 2005 Sep 1. 353 (9):909-17. . Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 379: management of delivery of a newborn (...) , American Academy of Pediatrics. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: neonatal resuscitation guidelines. Pediatrics . 2006 May. 117 (5):e1029-38. . Cialone PR, Sherer DM, Ryan RM, Sinkin RA, Abramowicz JS. Amnioinfusion during labor complicated by particulate meconium-stained amniotic fluid decreases neonatal morbidity. Am J Obstet Gynecol . 1994 Mar. 170 (3):842-9

2014 eMedicine Pediatrics

85. Congenital Lung Malformations (Follow-up)

and expect some lung growth and development. Serial amnioinfusions have been helpful in certain cases of oligohydramnios. In the extrauterine intrapartum (EXIT) procedure, the fetal head, neck, and shoulders are delivered through a uterine opening to allow for an assessment of the airway while the fetus is still attached to placental circulation. This technique has been used as a primary procedure to treat tracheal occlusion, to manage neck masses, and to facilitate the safe delivery of conjoined twins

2014 eMedicine Pediatrics

86. Congenital Lung Malformations (Treatment)

and expect some lung growth and development. Serial amnioinfusions have been helpful in certain cases of oligohydramnios. In the extrauterine intrapartum (EXIT) procedure, the fetal head, neck, and shoulders are delivered through a uterine opening to allow for an assessment of the airway while the fetus is still attached to placental circulation. This technique has been used as a primary procedure to treat tracheal occlusion, to manage neck masses, and to facilitate the safe delivery of conjoined twins

2014 eMedicine Pediatrics

87. Antenatal Hydronephrosis (Overview)

. 1982 Mar 11. 306(10):591-3. . McKenna PH, Ferrer FA. Prenatal and postnatal urologic emergencies. Belman B, King L, Kramer S, eds. Clinical Pediatric Urology . 4th ed. London: Martin Dunitz; 2002. 169-172. Quintero RA, Hume R, Smith C, et al. Percutaneous fetal cystoscopy and endoscopic fulguration of posterior urethral valves. Am J Obstet Gynecol . 1995 Jan. 172(1 Pt 1):206-9. . Vergani P, Locatelli A, Strobelt N, et al. Amnioinfusion for prevention of pulmonary hypoplasia in second-trimester

2014 eMedicine Pediatrics

88. Meconium Aspiration Syndrome (Treatment)

. [ , ] In patients with meconium aspiration syndrome (MAS), a thorough cardiac examination and echocardiography are necessary to evaluate for congenital heart disease and persistent pulmonary hypertension of the newborn (PPHN). Quantifying the degree of pulmonary hypertension, prior to instituting therapy, is essential. Prevention of MAS Prevention of MAS is paramount. Obstetricians should closely monitor fetal status in an attempt to identify fetal distress. When meconium is detected, amnioinfusion with warm (...) , sterile saline is theoretically beneficial to dilute the meconium in the amniotic fluid, thereby minimizing the severity of the aspiration. However, current evidence does not support routine amnioinfusion to prevent MAS. [ , , ] One large, multicenter study determined that amnioinfusion did not reduce the risk of moderate or severe MAS or MAS-related death. [ ] As noted earlier under , current recommendations no longer advise routine intrapartum suctioning for infants born to mothers with meconium

2014 eMedicine Pediatrics

89. Meconium Aspiration Syndrome (Overview)

Mar. 33 (1):29-42, v-vi. . Hofmeyr GJ, Xu H. Amnioinfusion for meconium-stained liquor in labour. Cochrane Database Syst Rev . 2010 Jan 20. CD000014. . Fraser WD, Hofmeyr J, Lede R, et al, for the Amnioinfusion Trial Group. Amnioinfusion for the prevention of the meconium aspiration syndrome. N Engl J Med . 2005 Sep 1. 353 (9):909-17. . Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 379: management of delivery of a newborn (...) , American Academy of Pediatrics. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: neonatal resuscitation guidelines. Pediatrics . 2006 May. 117 (5):e1029-38. . Cialone PR, Sherer DM, Ryan RM, Sinkin RA, Abramowicz JS. Amnioinfusion during labor complicated by particulate meconium-stained amniotic fluid decreases neonatal morbidity. Am J Obstet Gynecol . 1994 Mar. 170 (3):842-9

2014 eMedicine Pediatrics

90. Premature Rupture of Membranes (Diagnosis)

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

91. Postterm Pregnancy (Diagnosis)

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

92. Oligohydramnios

may be AFI less than the fifth percentile. Single deepest pocket (SDP) of less than 2 cm Amniotic fluid index (AFI) of less than 5 cm or less than the fifth percentile See the images below. Sonogram 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. Sonogram obtained after second-trimester amnioinfusion. This fetus has bilaterally (...) fetal kidneys and fluid-filled bladder may be observed to rule out renal agenesis (see the following 2 images), cystic dysplasia, and ureteral obstruction. Check fetal growth to rule out intrauterine growth restriction (IUGR) leading to oliguria. Sonogram 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. Sonogram obtained after second

2014 eMedicine Radiology

93. Antenatal Hydronephrosis (Diagnosis)

. 1982 Mar 11. 306(10):591-3. . McKenna PH, Ferrer FA. Prenatal and postnatal urologic emergencies. Belman B, King L, Kramer S, eds. Clinical Pediatric Urology . 4th ed. London: Martin Dunitz; 2002. 169-172. Quintero RA, Hume R, Smith C, et al. Percutaneous fetal cystoscopy and endoscopic fulguration of posterior urethral valves. Am J Obstet Gynecol . 1995 Jan. 172(1 Pt 1):206-9. . Vergani P, Locatelli A, Strobelt N, et al. Amnioinfusion for prevention of pulmonary hypoplasia in second-trimester

2014 eMedicine Pediatrics

94. Antenatal Hydronephrosis (Treatment)

in initial attempts (eg, use of amnioinfusion to enhance fetal visualization, use of fetal paralysis, routine use of antibiotics, and increased focus on proper catheter placement), as well as specific outcome measures needed for appropriate evaluation of the effects of fetal intervention (eg, gross survival, postnatal survival, shunted survival, and nadir creatinine at 1 year). [ ] Laparoscopy has also been described but has been associated with high rates of complications. [ ] Fetal cystoscopic ablation (...) of posterior urethral valves has been described; success rates have varied. [ ] The fetoscope is passed percutaneously through a cannula into the fetal bladder, and ablation of the valves is achieved with laser coagulation. Other less invasive techniques have been developed to help prevent oligohydramnios-induced pulmonary hypoplasia. As previously mentioned, serial transabdominal amnioinfusion is helpful in placement of percutaneous shunts. It may also have a therapeutic role in the reduction of pulmonary

2014 eMedicine Pediatrics

95. Meconium Aspiration Syndrome (Follow-up)

. [ , ] In patients with meconium aspiration syndrome (MAS), a thorough cardiac examination and echocardiography are necessary to evaluate for congenital heart disease and persistent pulmonary hypertension of the newborn (PPHN). Quantifying the degree of pulmonary hypertension, prior to instituting therapy, is essential. Prevention of MAS Prevention of MAS is paramount. Obstetricians should closely monitor fetal status in an attempt to identify fetal distress. When meconium is detected, amnioinfusion with warm (...) , sterile saline is theoretically beneficial to dilute the meconium in the amniotic fluid, thereby minimizing the severity of the aspiration. However, current evidence does not support routine amnioinfusion to prevent MAS. [ , , ] One large, multicenter study determined that amnioinfusion did not reduce the risk of moderate or severe MAS or MAS-related death. [ ] As noted earlier under , current recommendations no longer advise routine intrapartum suctioning for infants born to mothers with meconium

2014 eMedicine Pediatrics

96. Premature Rupture of Membranes (Treatment)

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

98. Risk Factors Associated with Preterm Delivery after Fetoscopic Laser Ablation for Twin Twin Transfusion Syndrome. (PubMed)

in case selection and outcomes between the centers. After controlling for the center of surgery, multivariate analysis indicated that a lower maternal age at procedure, a history of previous prematurity, shortened cervical length, use of amnioinfusion, a cannula diameter of 12 French (Fr), lack of a collagen plug placement and iatrogenic preterm premature rupture of membranes (iPPROM) were significantly associated with a lower gestational age at delivery.Specific fetal/maternal and operative variables

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2013 Ultrasound in Obstetrics and Gynecology

99. RCT of Postoperative Infections Following Caesarean Section Infections Following Caesarean Section

, Length of rupture of membranes, Number of vaginal examinations, Use of internal monitoring, Meconium, Use of antenatal steroids, cervical dilators, vacuum, amnioinfusion, extraamniotic saline infusion. Type of section, Anaesthesia type, Uterine incision type, Uterine closure layers, Uterine incision extensions, Need for transfusion, Intraoperative blood loss, Time of day, Operative time, Deviation from the standard surgical procedure. Birth weight (gram), Gestational age (week Eligibility Criteria Go

2013 Clinical Trials

100. Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery. (PubMed)

selection strategies were obesity, induction/augmentation of labor, twins, hydramnios, anemia, and arrest of descent. Amnioinfusion appeared to be protective against uterine atony (OR, 0.53; 95% CI, 0.29-0.98).Independent risk factors for uterine atony requiring treatment include Hispanic and non-Hispanic white ethnicity, preeclampsia, and chorioamnionitis.Copyright © 2013 Mosby, Inc. All rights reserved.

2013 American Journal of Obstetrics and Gynecology Controlled trial quality: predicted high

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