Amnioinfusion: antibiotics & type of solution influence complication rates

OBJECTIVE: Amnioinfusion (AI) plays an important role in the evaluation and treatment of fetal obstructive uropathy (FOU) and oligo/ anhydramnios. However, it may alter the intrauterine environment increasing the risks for PTD, PPROM, and chorioamnionitis. We evaluated the impact of different infusion solutions and use of prophylactic antibiotics on post-infusion complications. STUDY DESIGN: 22 pregnancies with documentation of AI and pregnancy outcome were identified from a database of fetuses with oligo/ anhydramnios and FOU. Diagnostic AI was done for visualization; subsequent infusions were done at time of shunt placement or to maintain AFV in unshunted cases. Infusion solutions included normal saline (NS), 5% dextrose in lactated ringers (D5LR), and lactated ringers (LR). Infusion volumes were GA-dependent, ranged from 150-400 cc, and returned AFV to low normal. All solutions were warmed to 35-37° C and instilled through a sterile closed system. Oral prophylactic antibiotics were given in the last 7 I.R infusion patients. RESULTS: 21/22 underwent diagnostic cystoscopy and/or vesicoanmiotic shunting. Mean GA at first infusion (21 6/7 wks) was similar for all groups. Patients receiving antibiotics had a mean GA at delivery of 36.5 wks as compared to only 31.3 wks in those who did not (p -0.012, Wilcoxon rank-sum test). # infusions PTD/PPROM compl. Soin. ,V (mean) chorio (mean) raie. NS 3 3 (1.0) 1 2 (30 wk) 100% D5I.R 11 26 (2.4) 2 6 (29 wk) 73% LR 8 9 (1.1) Ü3 (33 wk) 38% CONCLUSIONS: A decrease in the complication rate was observed in the patients who received LR as compared to D5LR or NS. The use of prophylactic antibiotic therapy in conjunction with the use of LR as an infusion solution may reduce the rate of complications.