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Bilateral renal agenesis (BRA) is a fetal anomaly which leads to anhydramnios and resultant pulmonary hypoplasia. Historically, this anomaly was universally fatal early in the neonatal period due to the severity of the associated lung disease. Over the last 30 years, innovations in fetal therapies—specifically, serial amnioinfusions—have led to instances of infant pulmonary survival and initiation of postnatal dialysis, raising the possibility that early neonatal death may not be inevitable. Amnioinfusions are not without risk, and maternal complications can include prelabor rupture of membranes, preterm labor, infection, and bleeding. The data detailing neonatal outcomes are still limited and actively being collected. Two case series and one non-randomized clinical trial have supplied most of the known outcome data for infants with BRA after prenatal amnioinfusion. Although there are survivors reported in the literature, mortality remains high, with many deaths in infancy due to dialysis-associated sepsis. In addition, previously unknown morbidities have been documented in these infants, including neurologic injury. These challenges, in addition to the mechanical difficulties of providing dialysis to extremely small infants, can result in significant burdens for patients and their caregivers and moral distress for the health care team. The present review aims to explain the pathophysiology of BRA, detail the historical context and rationale for serial amnioinfusions to treat the pulmonary insufficiency associated with BRA, describe the available data regarding outcomes of infants born following prenatal amnioinfusions, discuss ethical issues surrounding this fetal intervention, and describe critical aspects of prenatal counseling for patients considering the intervention. [ABSTRACT FROM AUTHOR]

Glomerulocystic kidney disease (GCKD) is a rare form of cystic renal disease. We report a four-week-old baby girl born to non-consanguineous parents; their antenatal third-trimester ultrasound showed severe oligohydramnios that required amnioinfusion. Post-natal ultrasound examination showed few tiny cysts (2-3mm) involving the cortices in bilateral kidneys. Kidney biopsy showed dilatation of Bowman's space and cystically dilated glomeruli, suggestive of GCKD. Whole exome sequencing revealed no pathogenic or likely pathogenic variant. [ABSTRACT FROM AUTHOR]

Objective: To determine intrapartum factors associated with perineal laceration at delivery. Methods: This was a planned secondary analysis of a multicenter randomized clinical trial of delayed versus immediate pushing among term nulliparous women in labor with neuraxial analgesia conducted in the United States. Intrapartum characteristics were extracted from the medical charts. The primary outcome was perineal laceration, defined as second degree or above, characterized at delivery in women participating in longer term pelvic floor assessments post-delivery. Multivariable logistic regression was used to refine risk estimates while adjusting for randomization group, birth weight, and maternal age. Results: Among the 941 women participating in the pelvic floor follow-up, 40.6% experienced a perineal laceration. No first stage labor characteristics were associated with perineal laceration, including type of labor or length of first stage. Receiving an amnioinfusion appeared protective of perineal laceration (adjusted odds ratio, 0.48; 95% confidence interval 0.26–0.91; P = 0.01). Second stage labor characteristics associated with injury were length of stage (2.01 h vs. 1.50 h; adjusted odds ratio, 1.36; 95% confidence interval 1.18–1.57; P < 0.01) and a prolonged second stage (adjusted odds ratio, 1.64; 95% confidence interval 1.06–2.56; P < 0.01). Operative vaginal delivery was strongly associated with perineal laceration (adjusted odds ratio, 3.57; 95% confidence interval 1.85–6.90; P < 0.01). Conclusion: Operative vaginal delivery is a modifiable risk factor associated with an increased risk of perineal laceration. Amnioinfusion appeared protective against injury, which could reflect a spurious finding, but may also represent true risk reduction similar to the mechanism of warm perineal compress. Significance: The objective of this study was to examine intrapartum factors associated with an increased risk of perineal laceration at delivery among nulliparous women. Operative vaginal delivery and the length of second stage, particularly prolonged second stage, are modifiable risk factors associated with an increased risk of perineal laceration. Receiving an amnioinfusion appeared to be protective against perineal laceration. There are few intrapartum modifiable risk factors other than operative delivery for perineal laceration in nulliparous women. Length of the second stage is an important risk factor for perineal lacerations that is modifiable through active management. [ABSTRACT FROM AUTHOR]

Introduction: The most common interventions in lower urinary tract obstruction are vesico-amniotic shunting (VAS) and serial amnioinfusions; however, their outcome remains uncertain. The aim of the study was to assess the kidney function as well as clinical complications in boys at the age of 6 months with posterior urethral valves (PUV), who underwent prenatal VAS and survived the neonatal period. Material and methods: The study group consisted of 14 boys and the mean time of the VAS procedure was 22 weeks of gestational age (GA). Children were born in 34 GA (29--39) with average birth weight of 2860 g. Four fetuses needed amnioinfusion. In the study we assessed physical development, prevalence and aetiology of urinary tract infections (UTIs), number of hospitalizations, estimated glomerular filtration rate, presence of hypertension, albuminuria, proteinuria and acidosis. Results: Average body weight at 6 months of life was 7.2 kg. 86% of children had at least one UTI; the same percentage were given antibacterial prophylaxis. 36% underwent urinary diversion. Median number of hospitalizations was 4. One patient required chronic renal replacement therapy, and one needed a short course of peritoneal dialysis. Median serum creatinine level was 0.65 mg/dl with estimated glomerular filtration rate (eGFR) 50.6 ml/min/1.73 m². Average serum cystatin C level was 1.50 mg/l with eGFR 48.5 ml/min/1.73 m². 43% developed acidosis. 71% had elevated albuminuria with a median urine albumin-to-creatinine ratio of 581.64 mg/g. 28.5% had overt proteinuria. Conclusions: Growth at the age of 6 month of infants with PUV after prenatal VAS was barely satisfactory. More than half had impaired kidney function, but the need for renal replacement therapy was uncommon. [ABSTRACT FROM AUTHOR]

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The article offers information on the ethical considerations of disclosing interim results to parents considering enrollment in a fetal intervention trial for renal anhydramnios. Topics include the implications of interim findings on informed consent; the need for transparency about potential outcomes and challenges; and the importance of including palliative care perspectives in discussions about the trial's risks and benefits.

Background: Mid-trimester preterm premature rupture of membranes (PPROM), defined as rupture of fetal membranes before 28 weeks of gestation, complicates approximately 10-12% of all pregnancies. it is associated with very high perinatal mortality and morbidity. The causes of the mid-trimester PPROM are multifactorial. The management of PPROM requires a balance between the benefits of prolongation of the pregnancy and the risk of intra-amniotic infection and its consequences for the mother and infant. Many optional treatments had been discussed in this issue to improve fetal outcome, these include, expectant management, repeated amnioinfusion, and amniopatch, etc. This study aimed to evaluate the effectiveness of amniopatch in the management of mid-trimester PROM. Methods: This study was being carried out in the obstetrics and gynecology department, Zagazig university hospitals from January 2016 to December 2018. The study included 36 pregnant women with PPROM from 20 -28 wk. All patients after informed written consent underwent a complete clinical examination and laboratory investigations, and amniopatch was done under complete aseptic conditions. Results: Out of 36 patients, only 13 cases showed partial success 36,1% (partial success was defined by sealing of membranes and temporary relieve of oligohydramnios). Of partial success cases there were 7 cases 53.8% re ROM again after sealing and 6 cases 46.2% enter in preterm labor despite sealing of membranes, and 23 cases failed 63.9% of which 18 cases missed abortion 78.2%, 3 cases inevitable abortion 13.1%, and 2 cases chorioamnionitis 8.7%. Conclusion: Amniopatch has only a partial success rate in the management of mid-trimester PPROM. [ABSTRACT FROM AUTHOR]

Aim: We compared the outcomes of serial transabdominal amnioinfusion and expectant management on the perinatal and neonatal outcomes of pregnancies complicated with very early preterm premature rupture of membranes (PPROM). Methods: We retrospectively reviewed the records of patients with very early PPROM admitted to the University of Inonu School of Medicine from 2014 to 2019. All such patients received comprehensive counseling on the possible prognoses; all were offered pregnancy termination, expectant management, and serial transabdominal infusion. Results: Sixty‐three women met the inclusion criteria; 36 were assigned to the expectant management group and 27 were assigned to the amnioinfusion group. The median delivery latency and the gestational age at delivery were significantly higher in the amnioinfusion than the expectant management group [35 (11–90), 14 (7–48), p < 0.001; 27.6 (22.1–34.0), 22.3 (19.0–26.5), p < 0.001, respectively]. Serial transabdominal amnioinfusion was associated with significantly less neonatal mortality than expectant management (29.6 vs 83.3%, p < 0.001). Multivariate binary logistic regression showed that the odds of neonatal mortality were 6.12 times higher among neonates in the expectant management group compared to that of the serial transabdominal amnioinfusion group after adjusting for potential confounders. Severe neonatal morbidities were significantly more common in the expectant management group than in the amnioinfusion group (p = 0.011). Conclusion: The present study has demonstrated a significant positive effect of serial transabdominal amnioinfusion procedure on latency period and neonatal morbidity and mortality in pregnant women complicated with very early PPROM. [ABSTRACT FROM AUTHOR]

(1) Background: The morbidity of gastroschisis is defined by exposure of unprotected intestines to the amniotic fluid leading to inflammatory damage and consecutive intestinal dysmotility, the viscero-abdominal disproportion which results in an abdomen too small to incorporate the herniated and often swollen intestine, and by associated pathologies, such as in complex gastroschisis. To prevent intestinal damage and to provide for growth of the abdominal cavity, fetal interventions such as amnio exchange, gastroschisis repair or covering have been evaluated in several animal models and human trials. This review aims to evaluate the reported techniques for the fetal treatment of gastroschisis by focusing on minimally invasive procedures. (2) Methods: We conducted a systematic database search, quality assessment and analyzed relevant articles which evaluate or describe surgical techniques for the prenatal surgical management of gastroschisis in animal models or human application. (3) Results: Of 96 identified reports, 42 eligible studies were included. Fetal interventions for gastroschisis in humans are only reported for EXIT procedures and amnio exchange. In animal models, particularly in the fetal sheep model, several techniques of open or minimally invasive repair of gastroschisis or covering the intestine have been described, with fetoscopic covering being the most encouraging. (4) Discussion: Although some promising minimally invasive techniques have been demonstrated in human application and animal models, most of them are still associated with relevant fetal morbidity and mortality and barely appear to be currently applicable in humans. Further research on specific procedures, instruments and materials is needed before any human application. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to examine the rates of intraamniotic infection between intrauterine pressure catheter with amnioinfusion and intrauterine pressure catheter alone. Study Design  This was a retrospective cohort study of all women who had an intrauterine pressure catheter placement during labor at a tertiary referral hospital from January 2016 to June 2018. Outcomes were compared between women who had an intrauterine pressure catheter with amnioinfusion and intrauterine pressure catheter placement alone. The primary outcome was the rate of intraamniotic infection. Secondary outcomes included postpartum endometritis, postpartum hemorrhage (blood loss of ≥1,000 mL), quantitative blood loss (mL), and cesarean delivery. Multivariable logistic regression analysis was performed to calculate adjusted odds ratios (aOR) and 95% confidence interval (95% CI), controlling for age, race, body mass index, gestational age, and length of time of rupture of membranes. Results  Of 1,268 women with an intrauterine pressure catheter, 298 (23.5%) also had an amnioinfusion. Women who had amnioinfusion through an intrauterine pressure catheter compared with those who had intrauterine pressure catheter alone had similar rates of intraamniotic infection (5.4 vs. 8.0%, crude p  = 0.12, aOR 0.69; 95% CI 0.39–1.21), as well as secondary outcomes such as postpartum endometritis (3.0 vs. 2.5%, crude p  = 0.61, aOR 1.12; 95% CI 0.49–2.53), postpartum hemorrhage (16.1 vs. 15.8%, crude p  = 0.89, aOR 1.07; 95% CI 0.75–1.54), blood loss (479.5 vs. 500 mL, adjusted p  = 0.89), and cesarean delivery (40.6 vs. 43.1%, crude p  = 0.45, aOR 0.90; 95% CI 0.68–1.19). Conclusion  Amnioinfusion was not associated with increased odds of intraamniotic infection compared with intrauterine pressure catheter placement alone. Key Points Amnioinfusion involves instilling fluid into the amniotic cavity to relieve variable decelerations. Amnioinfusion is not associated with increased odds of chorioamnionitis compared to IUPC alone. Amnioinfusion is not associated with increased odds of PPH compared to IUPC placement alone. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of amniopatch in pregnancies associated with spontaneous preterm premature rupture of fetal membranes (PPROM).Methods: A randomized controlled trial that involved 100 women diagnosed with PPROM between 24 and 34 weeks of gestational age. Participants were randomized equally into two groups. Group I in which amniopatch was done in addition to the routine management. Group II was treated with routine management including antibiotics and corticosteroids.Results: Amniopatch was successful in complete sealing of the membrane defect in 6/50 (12%) of women while none the control group have undergone similar sealing (p = .0144, RR = 0.88). Women in the amniopatch group showed a significant increase of AFI compared to controls (12 versus 0, p = .0001, RR = 0.56).Conclusion: The amniopatch procedure is a successful technique that safely enhances sealing of fetal membranes and restore the AFI.Clinical trial registration: NCT03473210SynopsisThe amniopatch procedure is a successful technique that could be done safely to enhance sealing the fetal membranes and restoring the AFI after PPROM. [ABSTRACT FROM AUTHOR]

Severe intra‐amniotic inflammation, even with a negative bacterial culture, can lead to premature labor. We report a 43‐year‐old multiparous woman with severe intra‐amniotic inflammation and cervical insufficiency at 23 weeks and 5 days of gestation. Continuous transabdominal amnioinfusion was started 2 days after the diagnosis. The amniotic fluid interleukin‐6 level normalized after 2 days of treatment. She underwent Shirodkar cervical cerclage on day 7. Despite termination of amnioinfusion and catheter removal on day 16, the pregnancy was maintained without any subsequent treatment. At 33 weeks and 5 days of gestation, an intrauterine Ureaplasma parvum infection and the onset of contractions led to repeat cesarean delivery. The birth weight was 2292 g, and the Apgar scores were 8/8. Both mother and infant had good outcomes. Continuous transabdominal amnioinfusion may have eliminated factors causing intra‐amniotic inflammation, thereby prolonging the pregnancy and improving the infant's prognosis. [ABSTRACT FROM AUTHOR]

The article discusses the evolving management practices for meconium-staining of the amniotic fluid (MSAF) in newborns, highlighting shifts away from routine suctioning before shoulder delivery and intubation for tracheal suctioning. It mentions these changes reflect the impact of research, collaboration, and evolving guidelines in obstetrical and neonatal care.

Aim: Given the scarcity of relevant reports, this study aimed to elucidate whether pregnancy can be prolonged by maintaining the amniotic fluid volume with continuous transabdominal amnioinfusion (TA) for patients with mid‐trimester preterm premature rupture of membranes (PPROM) and oligoamnios. Methods: We retrospectively examined patients who were managed during hospitalization at our department after developing PPROM between week 22 day 0 and week 25 day 6 of gestation and subsequent oligoamnios (amniotic fluid index [AFI] <5 cm) within 7 days after PPROM onset. Cases between 2006 and 2011 comprised the conventional management group (n = 14); cases administered continuous TA between 2012 and 2017 comprised the continuous TA group (n = 14). The primary outcome was the number of days between PPROM and delivery. The secondary outcomes were the proportion of normal amniotic fluid volume (AFI ≥ 5 cm) maintained between PPROM and delivery and the perinatal prognosis for the mother and infant. Results: The continuous TA group had significantly more days between PPROM and delivery and a significantly higher proportion of days that a normal amniotic fluid volume was maintained during that period, regardless of antimicrobial agents administered. Although no significant differences in the perinatal prognosis of disease were found between groups, there was a decreasing trend of composite perinatal mortality and morbidity, and the incidence rates were reduced by half. Conclusion: Continuous TA for PPROM with oligoamnios may allow significant prolongation of the gestation period while maintaining the amniotic fluid volume and may lead to improved perinatal prognosis. [ABSTRACT FROM AUTHOR]

Anhydramnios caused by early anuria is thought to be universally fatal due to pulmonary hypoplasia. Bilateral renal agenesis and early fetal renal failure leading to anhydramnios constitute early pregnancy renal anhydramnios (EPRA). There have been successful reports of amnioinfusions to promote lung growth in the setting of EPRA. Some of these successfully treated EPRA fetuses have survived the neonatal period, undergone successful dialysis, and subsequently received a kidney transplant. Conversely, there are no reports of untreated EPRA survivors. This early success of amnioinfusions to treat EPRA justifies a rigorous prospective trial. The objective of this study is to provide a review of what is known about fetal therapy for EPRA and describe the Renal Anhydramnios Fetal Therapy trial. We review the epidemiology, pathophysiology, and genetics of EPRA. Furthermore, we have performed systematic review of case reports of treated EPRA. We describe the ethical framework, logistical challenges, and rationale for the current single center (NCT03101891) and planned multicenter trial. [ABSTRACT FROM AUTHOR]

Background: Bilateral renal agenesis has uniformly been a lethal diagnosis in the perinatal or neonatal period. With the advent of more advanced renal replacement therapy as a bridge to renal transplantation, amnioinfusion has been explored at our center as a way to prevent lethal pulmonary hypoplasia secondary to oligohydramnios. Case presentation: We describe two cases of bilateral renal agenesis with serial amnioinfusion during pregnancy. The families opted for full neonatal intervention and post-natal renal support. While lethal pulmonary hypoplasia was avoided, early and refractory hypotension limited the ability to perform dialysis in these neonates. Conclusions: Our limited experience shows that barriers to care such as lethal respiratory failure and technical limitations of early dialysis are not the only barriers prohibiting care for this population. [ABSTRACT FROM AUTHOR]

Introduction: Oligohydramnios is an extremely rare condition where there is a deficiency of liquor amnii in the amount of less than 200Ml at the time of delivery. Sonographically, it is amaximum vertical pocket of liquor is < 2 cm or the amniotic fluid index is < 5 cm (less than 5 percentiles) is specified. Patient History: A 23 years old ANC & 8 months mother was admitted on 11.9.2019 with the complaints of reduced fetal movements and abdominal discomfort. Past History: Patient has history of blood transfusion 3months back and has history of cervical cerclage at 7months of pregnancy. Clinical Findings: Reduced fetal movements, abdominal discomfort, leaking of the amniotic fluid, low amniotic fluid on ultrasound, low maternal weight gain, pre labor rupture of membranes. Investigations: Ultrasonography (AFI=5cm), Hb%-9.1gm%, MCV-74, MCH-23.5pico/gm, HCT-28.5%, Total WBC Count--8000/cu.mm, Lymphocytes-20%. Surgical Management: Patient does not have any past surgical history. Medical Management: Tab. AFI plus BD, L- Arginitrate sachet 5gm/BD/orally, Tab. iron OD, Tab. Calcium OD. Nursing Management: Assess both maternal and fetal conditions carefully, fetal heart rate and vital signs should be assessed properly. During labor, an amnio-infusion should be given via intrauterine catheter. Fluid should be administered via amniocentesis before giving birth. The level of amniotic fluid may help by increasing the amount of oral fluid intake. Conclusion: Patient was admitted to AVBRH and was diagnosed as oligohydramnios and got appropriate treatment and her condition has improved. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Although an absent or reversed a‐wave in ductus venosus (DV‐RAV) is reported to be the terminal finding of fetal growth restriction (FGR), we have seen DV‐RAV that disappears within a short span of time in some FGR cases with a hypercoiled cord. The purpose of this study was to investigate the relationship between hypercoiled cord and reversible DV‐RAV in FGR. Methods: This was a retrospective study of 499 FGR cases, including 14 with DV‐RAV. Transabdominal amnioinfusion (AI) was performed when oligohydramnios was severe (maximum vertical pocket <2 cm) and/or variable deceleration was detected. DV‐RAV that disappeared quickly was defined as ‘temporary DV‐RAV’. DV‐RAV that continued until delivery or fetal death (FD) was defined as ‘persistent DV‐RAV’. A hypercoiled cord was defined as one with an umbilical coiling index >0.6 antenatally or >0.3 postnatally. Clinical characteristics and clinical courses of the two types of DV‐RAV were compared. Results: DV‐RAV disappeared after AI in all five cases in which temporary DV‐RAV was identified. The incidence of a hypercoiled cord was significantly higher among temporary DV‐RAV cases (100%) than among persistent DV‐RAV cases (14.3%; P = 0.015). The time from detection of DV‐RAV to delivery or FD was significantly longer among temporary DV‐RAV cases (4.5 weeks) than among persistent DV‐RAV cases (0.7 weeks; P = 0.027). Conclusion: Temporary DV‐RAV is suspected to be related to the combination of a hypercoiled cord and oligohydramnios. DV‐RAV may not be always be a terminal finding in FGR with a hypercoiled cord. [ABSTRACT FROM AUTHOR]

Mid-trimester preterm premature rupture of membranes (PPROM), defined as rupture of fetal membranes prior to 28 weeks of gestation, complicates approximately 0.4%–0.7% of all pregnancies. This condition is associated with a very high neonatal mortality rate as well as an increased risk of long- and short-term severe neonatal morbidity. The causes of the mid-trimester PPROM are multifactorial. Altered membrane morphology including marked swelling and disruption of the collagen network which is seen with PPROM can be triggered by bacterial products or/and pro-inflammatory cytokines. Activation of matrix metalloproteinases (MMP) have been implicated in the mechanism of PPROM. The propagation of bacteria is an important contributing factor not only in PPROM, but also in adverse neonatal and maternal outcomes after PPROM. Inflammatory mediators likely play a causative role in both disruption of fetal membrane integrity and activation of uterine contraction. The “classic PPROM” with oligo/an-hydramnion is associated with a short latency period and worse neonatal outcome compared to similar gestational aged neonates delivered without antecedent PPROM. The “high PPROM” syndrome is defined as a defect of the chorio-amniotic membranes, which is not located over the internal cervical os. It may be associated with either a normal or reduced amount of amniotic fluid. It may explain why sensitive biochemical tests such as the Amniosure (PAMG-1) or IGFBP-1/alpha fetoprotein test can have a positive result without other signs of overt ROM such as fluid leakage with Valsalva. The membrane defect following fetoscopy also fulfils the criteria for “high PPROM” syndrome. In some cases, the rupture of only one membrane – either the chorionic or amniotic membrane, resulting in “pre-PPROM” could precede “classic PPROM” or “high PPROM”. The diagnosis of PPROM is classically established by identification of nitrazine positive, fern positive watery leakage from the cervical canal observed during in specula investigation. Other more recent diagnostic tests include the vaginal swab assay for placental alpha macroglobulin-1 test or AFP and IGFBP1. In some rare cases amniocentesis and infusion of indigo carmine has been used to confirm the diagnosis of PPROM. The management of the PPROM requires balancing the potential neonatal benefits from prolongation of the pregnancy with the risk of intra-amniotic infection and its consequences for the mother and infant. Close monitoring for signs of chorioamnionitis (e.g. body temperature, CTG, CRP, leucocytes, IL-6, procalcitonine, amniotic fluid examinations) is necessary to minimize the risk of neonatal and maternal complications. In addition to delayed delivery, broad spectrum antibiotics of penicillin or cephalosporin group and/or macrolide and corticosteroids have been show to improve neonatal outcome [reducing risk of chorioamnionitis (average risk ratio (RR)=0.66), neonatal infections (RR=0.67) and abnormal ultrasound scan of neonatal brain (RR=0.67)]. The positive effect of continuous amnioinfusion through the subcutaneously implanted perinatal port system with amniotic fluid like hypo-osmotic solution in “classic PPROM” less than 28/0 weeks’ gestation shows promise but must be proved in future prospective randomized studies. Systemic antibiotics administration in “pre-PPROM” without infection and hospitalization are also of questionable benefit and needs to be further evaluated in well-designed randomized prospective studies to evaluate if it is associated with any neonatal benefit as well as the relationship to possible adverse effect of antibiotics on to fetal development and neurological outcome. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the circulatory levels of endothelin 1 (ET-1) and the placental alkaline phosphatase (ALP) in pregnant women with placenta percreta (PP) and a control group.Methods: This study was carried out in the Obstetrics and Gynecology and in the Biochemistry Departments of Harran University Medical School. Forty-four women who underwent cesarean section (CS) due to PP and 44 women who underwent CS for other obstetric reasons were included in this study. The PP diagnosis was made by a pathologic examination that showed an extreme trophoblastic invasion involving the uterine serosa.The levels of circulating ET-1 and placental ALP were measured by an enzyme-linked immunosorbent assay (ELISA).Results: Women with PP more frequently received antenatal steroids and blood transfusions and they delivered at an earlier gestational age compared to controls. In women with PP, preoperative circulating ET-1 and placental ALP levels were lower than in the controls (p < .05 for both).Conclusions: The findings suggest that a decrease in ET-1 and placental ALP levels might play a role in the pathogenesis of PP. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of disrespect and abuse during childbirth and its associated factors in Peru.Methods: In an observational cross-sectional study, women were surveyed within 48 hours of live delivery at 14 hospitals located in nine Peruvian cities between April and July 2016. The survey was based on seven categories of disrespect and abuse proposed by Bowser and Hill. To evaluate factors associated with each category, prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using adjusted Poisson models with robust variances.Results: Among 1528 participants, 1488 (97.4%) had experienced at least one category of disrespect and abuse. Frequency of abandonment of care was increased with cesarean delivery (PR 1.27, 95% CI 1.03-1.57) but decreased in the jungle region (PR 0.27, 0.14-0.53). Discrimination was associated with the jungle region (PR 5.67, 2.32-13.88). Physical abuse was less frequent with cesarean than vaginal delivery (PR 0.23, 0.11-0.49). The prevalences of abandonment of care (PR 0.42, 0.29-0.60), non-consented care (PR 0.70, 0.57-0.85), discrimination (PR 0.40, 0.19-0.85), and non-confidential care (PR 0.71, 0.55-0.93) were decreased among women who had been referred.Conclusion: Nearly all participants reported having experienced at least one category of disrespect and abuse during childbirth care, which was associated with type of delivery, being referred, and geographic region. [ABSTRACT FROM AUTHOR]

Congenital bilateral renal agenesis has been considered a uniformly fatal condition. However, the report of using serial amnioinfusions followed by the live birth in 2012 and ongoing survival of a child with bilateral renal agenesis has generated hope, but also considerable controversy over an array of complex clinical and ethical concerns. To assess the ethical concerns associated with using serial amnioinfusions for bilateral renal agenesis, we assembled a multidisciplinary group to map the ethical issues relevant to this novel intervention. The key ethical issues identified were related to 1) potential risks and benefits, 2) clinical care compared with innovation compared with research, 3) counseling of expectant parents, 4) consent, 5) outcome measures, 6) access and justice, 7) conflicts of interest, 8) effects on clinicians, 9) effects on institutions, and 10) long-term societal implications. These ethical issues should be addressed in conjunction with systematic efforts to examine whether this intervention is safe and effective. Future work should capture the experiences of expectant parents, women who undergo serial amnioinfusions, those born with bilateral renal agenesis and their families as well as clinicians confronted with making difficult choices related to it. [ABSTRACT FROM AUTHOR]

Objective: We studied the association between sperm DNA fragmentation (SDF) and several clinical in vitro fertilization outcomes. Methods: We retrospectively analyzed 169 consecutive fresh IVF cycles. Semen was collected on the day of oocyte retrieval, and we assessed standard semen parameters and the SDF level (by terminal deoxynucleotidyl transferase dUTP nick-end labeling). Poor ovarian response (POR) was defined as the collection of three or fewer mature oocytes. Oocytes were inseminated by the conventional method or intracytoplasmic sperm injection. Results: SDF did not affect the fertilization or pregnancy rate, but did have a significant effect on the miscarriage rate. In the miscarriage group (n=10), the SDF level was significantly higher (23.9% vs. 14.1%) and number of mature oocytes was significantly lower (4.3 vs. 7.6) than in the live birth group (n=45). Multiple regression analysis showed that SDF was an independent predictor of miscarriage (odds ratio, 1.051; 95% confidence interval, 1.001–1.104). The cutoffs for the SDF level and number of mature oocytes that could predict miscarriage were >13% and ≤3, respectively. In the low-SDF group (≤13%), the miscarriage rate was similar in POR patients and those with a normal ovarian response (NOR; 14.2% vs. 4.3%). In the high-SDF group (>13%), the miscarriage rate was significantly higher in the POR group than in the NOR group (60.0% vs. 13.3%, p=0.045). Conclusion: Our study demonstrated that a high SDF level (>13%) was associated with a high miscarriage rate, and that it mainly contributed to miscarriage in the POR group. The results suggest that SDF measurements should be considered in couples with POR in order to predict the prognosis of the pregnancy. [ABSTRACT FROM AUTHOR]

The article focuses on innovations in fetal therapy and bilateral renal agenesis. It talks about twin-twin transfusion syndrome and treatments for fetal urinary tract obstruction and congenital diaphragmatic hernia. It mentions multiple etiologies of oligohydramnios which can be split into Primary Fetal causes and Secondary obstructive causes and on the most common cause of oligohydramnios, premature rupture of membranes (PROM). It examines the us of serial amnioinfusion in treating PROM.

Background: The passage meconium in utero has been noted in 7-22 % of live births. It puts the neonate at risk of for meconium aspiration syndrome (MAS). The risk of meconium aspiration is high with thick meconium, therefore any mechanism by which thick meconium can be converted into thin meconium is postulated to have positive effect on neonatal outcome. Amnioinfusion theoretically restores amniotic fluid volume, dilutes thick meconium & cushions the umbilical cord which reduces cord compression. This study is an effort to evaluate whether amnioinfusion helps in reducing neonatal morbidity & mortality in patients with meconium stained amniotic fluid (MASF); also to see whether it decreases operative intervention in mother. Methods: In prospective randomised study, 160 pregnant women with meconium stained liquor were categorised into amnioinfusion group and control group with 80 patients in each. Amnioinfusion group received transcervical amnioinfusion in addition to routine care. Maternal complications and neonatal outcome in both groups were compared. Results: Amnioinfusion group had higher incidence of vaginal delivery especially in multipara and maternal complications and neonatal outcome was comparable in both the groups. Meconium aspiration syndrome was significantly less in case group neonates. Conclusion: AI significantly reduces the incidence of MAS, meconium below vocal cords and therefore reduces requirement for mechanical ventilation and NICU admission. Amnioinfusion is relatively easy to perform, inexpensive and safe technique that reduces operative intervention (caesarean section) and can play a major role in management of patients with meconium stained liquor especially in developing countries with limited resources. [ABSTRACT FROM AUTHOR]

Aim This study investigated the feasibility and safety of fetoscopic laser photocoagulation (FLP) for amniotic fluid discordance (AFD) bordering on twin-twin transfusion syndrome (TTTS) with an absent or reverse end-diastolic velocity (AREDV) in the umbilical artery (UA), and evaluated the perinatal and long-term outcomes. Methods A prospective intervention study was performed between 20 + 0 and 25 + 6 weeks of gestation (UMIN000004165). AFD bordering on TTTS was defined as maximum vertical pocket (MVP) of amniotic fluid in one twin's sac ≤3 cm and amniotic fluid MVP in the other twin's sac ≥7 cm excluding TTTS. Neurodevelopmental outcome was evaluated at 6 months and at 3 years of age. Results Eleven women were treated without complications between September 2010 and July 2011. In all cases amnioinfusion was required, with a median surgical time of 70 min. There were nine cases of selective intrauterine growth restriction in which the growth discordant rate was >25%. The survival rates of the donor and recipient twins were 27.3% (3/11) and 100% (11/11), respectively. None of the surviving donor twins and two of the 11 recipient twins had hemiplegia at 6 months of age. One additional recipient twin had developmental delay at 3 years of age. Conclusions Fetoscopic laser photocoagulation for AFD bordering on TTTS with AREDV in the UA was feasible without complications but frequently resulted in donor twin death and a high survival rate of the recipient twin, albeit with neurodevelopmental abnormalities in some cases. FLP does not seem to be a promising treatment option for AFD bordering on TTTS. [ABSTRACT FROM AUTHOR]

Bacterial infection is one of the main causes of preterm premature rupture of membranes (PPROM) leading to preterm delivery, pulmonary hypoplasia, sepsis and joint deformities. Expectant management, broad-spectrum antibiotics and antenatal corticosteroids are routinely used in this condition with very limited success to prevent bacteremia, chorioamnionitis, funisitis and intra-amniotic infection syndrome. Here, we report a case in which we attempted to treat PPROM at 26+3 weeks of gestation with anhydramnion colonized by multiresistant Klebsiella. A perinatal port system was implanted subcutaneously at 28+0 weeks of gestation, enabling long-term continuous lavage of the amniotic cavity with a hypotonic aqueous composition similar to human amniotic fluid combined with intra-amniotic antibiotic application. The patient gave birth to a preterm female infant at 31+1 weeks without any signs of infection. The girl was discharged with a weight of 2,730 g in very good condition. In the follow-up examinations at 5 months and 1 year of age, there was no apparent neurological disturbance, developmental delay or Klebsiella colonization. [ABSTRACT FROM AUTHOR]

Background: Not much data are available on the natural history of bilateral renal agenesis, as the medical community does not typically offer aggressive obstetric or neonatal care asbilateral renal agenesis has been accepted as a lethal condition. Aim: To provide an evidence-based, ethically justified approach to counseling pregnant women about the obstetric management of bilateral renal agenesis. Study design: A systematic literature search was performed using multiple databases. We deploy an ethical analysis of the results of the literature search on the basis of the professional responsibility model of obstetric ethics. Results: Eighteen articles met the inclusion criteria for review. With the exception of a single case study using serial amnioinfusion, there has been no other case of survival following dialysis and transplantation documented. Liveborn babies die during the neonatal period. Counseling pregnant women about management of pregnancies complicated by bilateral renal agenesis should be guided by beneficence-based judgment informed by evidence about outcomes. Conclusions: Based on the ethical analysis of the results from this review, without experimental obstetric intervention, neonatal mortality rates will continue to be 100%. Serial amnioinfusion therefore should not be offered as treatment, but only as approved innovation or research. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective our study was to assess the role of diagnostic antepartum amnioinfusion on the yield from targeted ultrasounds performed in pregnancies with severe oligo- and anhydramnios.Study Design: This was a retrospective and descriptive study, conducted in the fetal medicine units of two private tertiary care referral centers in south India. The details of all the cases of diagnostic amnioinfusion performed at these two centers from January 2009 to June 2016 were collected and analyzed. Inclusion criteria were pregnancies between 17 and 26 weeks of gestational age with severe oligo- or anhydramnios. Pregnancies with obvious preterm premature rupture of membranes (PPROM) were excluded. The primary outcome measure was the improvement in diagnostic information pertaining to cause of severe oligo- and anhydramnios, and the nature of such anomalies.Results: A total of 61 cases of were identified. The median gestational age at performance of the procedure was 22 weeks [IQR, 19.5-23]. The mean volume of normal saline infused was 314±54ml. A significant increase in the single vertical pocket (SVP) was observed following the procedure (pre-procedure SVP=0.6±0.9cm, post procedure SVP=3.4±1.7; paired t test, p<0.001). In 37 cases (37/61, 60.7%), there were no pre-procedure ultrasound findings. There was significant overall detection of abnormalities post procedure (mean pre-procedure findings=0.39±0.49, mean post procedure findings=1.59±1.24; paired t test, p<0.001). The most frequent group of anomalies/abnormalities were renal (36/61, 59%), followed by PPROM (13/61, 21.3%) and finally fetal growth restriction (11/61, 18%).Conclusion(s): Antepartum amnioinfusion is a valuable ancillary technique in prenatal diagnosis as it increases the diagnostic yield from pregnancies presenting with severe oligo- and anhydramnios. [ABSTRACT FROM AUTHOR]

Background: On rare occasions, elective iatrogenic reduction of a dichorionic twin is performed due to maternal request and in order to improve the perinatal outcome. Materials and methods: Nine twin-to-singleton reductions were identified retrospectively at the Feto-maternal Unit, University of Szeged, Hungary, between December 1997 and June 2015. A post-procedure, routine weekly sonographic scan revealed severe oligohydramnios in two out of the nine cases (22.2%) and amnioinfusion was performed in the mid-trimester to prolong gestation. The fetus survived in one case (11.1%) and the pregnancy continued until preterm birth. Conclusion: A repeated sonographic follow-up for an early diagnosis of oligohydramnios is feasible to avoid miscarriage after artificial embryo reduction. [ABSTRACT FROM AUTHOR]

The article offers a response from the American Heart Association (AHA) Neonatal Resuscitation Program (NRP) Steering Committee to the article "Delivery Room Management of Meconium-Stained Newborns and Respiratory Support" by A. Chiruvolu et al. Topics include statement included in the 7th edition of the NRP in 2016 and evidence that led to a change in NRP recommendations against routine tracheal suctioning for infants born through meconium-stained amniotic fluid (MSAP) who were vigorous.

Objective: Insufficient amount of amniotic fluid may cause various complications from intrauterine asphyxia to fetal death associated with fetal movement, fetal growth, lung development and cord compression. There are some studies showing that amniotic fluid restoration by amnioinfusion is helpful for the extension of gestation and survival in such patients. In this study, we aimed to present amnioinfusion results in second trimester oligohydramnios cases. Methods: In this retrospective study, the medical records of the patients who had amnioinfusion in the Perinatology Department of Mustafa Kemal University between January 2013 and March 2015 were analyzed. All patients had detailed sonographic analysis results before and after the procedures. Ages, gravida values, parities, and weeks of gestation during amnioinfusion and after delivery of the patients were recorded. The patients were called by phone and information was obtained about the perinatal survival of the babies. Results: Twenty-six of 34 patients who had amnioinfusion were included in the study. In these patients, the mean age was 29.2, gravida was 2.9, parity was 1.1 and the number of abortion was 0.7. It was found that the mean week of gestation for the procedure was 21.5 (range: 15.3 to 27.2) weeks, amniotic fluid index was 2.1 (range: 0.5 to 4) cm, the number of procedure was 1.6 (range: 1 to 5) and mean week of delivery was 26.4 (range: 18 to 35.4) weeks. Ten (45%) fetuses were born alive. It was reported that 6 of them died during perinatal period. Only 4 (18%) babies were alive. The mean period between the procedure and the delivery was 5.1 (range: 0 to16.7) weeks. Conclusion: In cases without ruptures of membrane at second trimester, it seems that amnioinfusion is associated with perinatal survival at a rate of 18%. It is seen in these patients that amnioinfusion did not provide a certain improvement in poor prognosis. [ABSTRACT FROM AUTHOR]

Objective To assess short- and long-term outcomes of pregnant women with very early rupture of membranes randomized to serial amnioinfusion or expectant management, and to collect data to inform a larger, more definitive clinical trial. Methods This was a prospective non-blinded randomized controlled trial with randomization stratified for pregnancies in which the membranes ruptured between 16 + 0 and 19 + 6 weeks' gestation and 20 + 0 and 23 + 6 weeks' gestation to minimize the risk of random imbalance in gestational age distribution between randomized groups. Intention-to-treat analysis was used. The study was conducted in four UK hospital-based fetal medicine units (Liverpool Women's NHS Trust, St Mary's Hospital Manchester, Birmingham Women's NHS Foundation Trust and Wirral University Hospitals Trust). The participants were women with confirmed preterm prelabor rupture of membranes at 16 + 0 to 24 + 0 weeks' gestation. Women with multiple pregnancy, fetal abnormality or obstetric indication for immediate delivery were excluded. Participants were randomly allocated to either serial weekly transabdominal amnioinfusions if the deepest pool of amniotic fluid was < 2 cm or expectant management until 37 weeks' gestation. Short-term maternal, pregnancy and neonatal and long-term outcomes for the child were studied. Long-term respiratory morbidity was assessed using validated respiratory questionnaires at 6, 12 and 18 months of age and infant lung function test at around 12 months of age. Neurodevelopment was assessed using the Bayley Scales of Infant Development, second edition (BSID-II) at corrected age of 2 years. Results Fifty-eight women were randomized to the study. Two babies were excluded from the analysis because of termination of pregnancy for lethal anomaly, leaving 56 participants (28 assigned to serial amnioinfusion and 28 to expectant management) recruited between 2002 and 2009. There was no significant difference in perinatal mortality (19/28 vs 19/28; relative risk ( RR) 1.0 (95% CI, 0.70-1.43)) and maternal or neonatal morbidity. The overall chance of surviving without long-term respiratory or neurodevelopmental disability was 4/56 (7.1%); 4/28 (14.3%) in the amnioinfusion group and 0/28 in the expectant group ( RR 9.0 (95% CI, 0.51-159.70)). Conclusions This pilot study found no major differences in maternal, perinatal or pregnancy outcomes. The study was not designed to show a difference between the groups and the number of survivors was too small to draw any conclusions about long-term outcomes. It does, however, signal that a larger definitive study to evaluate amnioinfusion for improvement in healthy survival is needed. The pilot suggests that, with appropriate funding, such a study is feasible. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: This study aims to treat patients with preterm premature rupture of the membranes (PPROM) and anhydramnion using continuous amnioinfusion through a subcutaneously implanted port system. Methods: An amniotic fluid replacement port system was implanted in seven patients with PPROM and anhydramnion starting at the 20th week of gestation (range, 14-26 weeks) for long-term amnioinfusion. Saline solutions (2 L/day; Jonosteril®, Sterofundin®, isotonic NaCl 0.9% solution, lactated Ringer's solution) and a hypotonic aqueous composition with reduced chloride content similar to the electrolyte concentration of human amniotic fluid were used for the continuous amnioinfusion. Results: The mean duration of the PPROM delivery interval continued for 49 days (range, 9-69 days), with 3 weeks of amnioinfusion via the port system (range, 4-49). The newborns showed no signs of lung hypoplasia. Conclusion: Long-term lavage of the amniotic cavity via a subcutaneously implanted port system in patients with PPROM and anhydramnion may help prolong the pregnancy and avoid fetal lung hypoplasia. A hypotonic aqueous composition with reduced chloride content similar to human amniotic fluid can be safely used for amnioinfusion. Prospective randomized studies are ongoing. [ABSTRACT FROM AUTHOR]

Background & Objective: Meconium stained amniotic fluid (MSAF) is associated with significant morbidity and mortality. Amnioinfusion can decrease complications of MSAF. The objective was to study role of Amnioinfusion on outcome of babies born with MSAF. Methods: Design: Prospective Interventional Study Setting: Medical college and SSG Hospital, Baroda, Gujarat. Study Period: from 1st March 2003 to 31st December 2003 Inclusion criteria: evidence of Thick MSAF AND station of the head is zero or above. Patients were grouped randomly in to two groups. In Group A amnioinfusion was performed while in Group B amnioinfusion was not done. Amnioinfusion was done by inserting foley catheter transcervically and infusing normal saline or ringer lactate at the rate of 100ml/min till the coming liquor became clear. Outcome was studied. Results: Out of total 227 babies with thick MSAF amnioinfusion was performed in 52 patients (Group A), rest 175 patients were controls (Group B). Incidence of MAS was significantly lower 7.7% in Group A compared to 25.7% of Group B (P < 0.005). There was significantly lower incidence of birth asphyxia 1.92% in Group A compared to 34.8% in Group B (P value < 0.0001). Incidence of HIE was significantly lower in group A. Incidence of Air leaks and PPHN was similar in both groups. Rate of NICU admission was significantly lower in group A (13.4%) compared to group (51.4%), P value < 0.001. Mortality in Group A was much lower 5.8% compared to 14.85% in Group B (p =0.08). Amnioinfusion did not increase risk of maternal or neonatal sepsis. Conclusion: Amnioinfusion significantly decreases complications of MSAF and improves perinatal survival. [ABSTRACT FROM AUTHOR]

Fetal lower urinary tract obstruction (LUTO) encompasses a heterogeneous group of congenital pathologies and generally results in oligohydramnios. Fetal intervention (e.g. vesicoamniotic shunting, fetal cystoscopy) has traditionally been reserved for cases with a favorable renal profile, while those with unfavorable renal function have been offered termination or expectant management with the latter leading to high incidence of marked pulmonary hypoplasia, neonatal morbidity and mortality. Here, we describe two cases, which were not candidates for traditional intervention based on abnormal fetal renal function, who elected to proceed with serial amnioinfusions for fetal pulmonary palliation to attenuate the risk of pulmonary hypoplasia. [ABSTRACT FROM PUBLISHER]

Objective:To investigate the effects of transabdominal amnioinfusion (TA) on the histology of amnion (A) and umbilical cord (UC).Study Design:From a cohort of 56 singleton pregnancies with premature rupture of membranes (PROM) at 24.6 weeks, we excluded those who did not develop severe oligohydramnios (n=12). Of the 44 patients, 29 consented to TA and 15 declined the procedure. TA was performed with normal saline solution.Result:Women who consented to TA underwent a median of three procedures had a gestational age at PROM of 18.7 weeks and at delivery of 26.1 weeks, with a latency of 50 days. Compared with subjects who declined the procedure, TA had a beneficial effect on clinical variables, mediated primarily by a longer latency. TA was not associated with identifiable effects on the histologic features of A or UC.Conclusion:A and UC histology is not significantly affected by exposure to saline solution even for prolonged periods of time.Journal of Perinatology (2008) 28, 97–101; doi:10.1038/sj.jp.7211876; published online 29 November 2007 [ABSTRACT FROM AUTHOR]

The article presents a case study of a 33-year-old pregnant woman with pre-term premature rupture of membranes (PPROM) and anhydramnios. It says that the patient was treated with four amnioinfusion sessions using ceftriaxone and isotonic sodium chloride solution. It explores the implementation of amnioinfusion and mentions its potential in managing PPROM pregnancy.