WOMEN AND NEWBORN HEALTH SERVICE

King Edward Memorial Hospital

CLINICAL GUIDELINES
WOMEN AND NEWBORN HEALTH
OBSTETRICS ANDSERVICE
MIDWIFERY
King Edward Memorial Hospital
INTRAPARTUM CARE
FETAL COMPROMISE (ACUTE): MANAGEMENT IF SUSPECTED
ACUTE
AMNIOINFUSION
Keywords: amnioinfusion, oligohydramnios, intrauterine transfusion, variable decelerations

AIM

To prevent frequency or severity of variable decelerations in the presence of oligohydramnios

leading to improved neonatal and maternal outcomes.

BACKGROUND INFORMATION

Oligohydramnios can cause intrapartum compression of the umbilical cord. This can result in variable
decelerations of the fetal heart rate which may be associated with fetal hypoxia, acidosis and increased
incidence of operative delivery. In the presence of oligohydramnios the use of intrapartum
amnioinfusion has be shown to significantly improve neonatal outcomes and decrease the rate of
1
caesarean section, without increasing the rate of postpartum endometriosis.

Evidence shows that amnioinfusion in the presence of thick meconium liquor during labour does not
reduce the risk of moderate or severe meconium aspiration syndrome, perinatal death, or other major
2
maternal or neonatal disorders. Routine use of amnioinfusion in the presence of thick meconium liquor
is not recommended in facilities with standard antenatal surveillance. However, in settings with limited
2, 3, 4, 5
facilities for perinatal surveillance use of amnioinfusion for the ‘high risk’ fetus is beneficial.

KEY POINTS
6, 7
1. Normal saline and Hartman’s solutions are both suitable for use with amnioinfusion. However,
Hartman’s solution approximates amniotic fluid the closest in electrolyte and pH composition and
8
may be the most suitable solution to use.
2. The infusion solution should be at room temperature for term pregnancies, however it is
recommended the solution should be warmed (via a blood warmer) for a preterm fetus.
3. The infusion should be immediately ceased if any complications transpire, or if intrauterine
baseline pressure increases by more than 15mm Hg, if there is uterine hypertonus, if
polyhydramnios is confirmed on ultrasound, or if there is maternal or fetal intolerance to the
procedure.

CONTRAINDICATIONS
9
Chorioamnionitis
9
Placental abruption
9
Severe fetal heart rate abnormalities
9
Maternal immunosuppression
10
Multiple pregnancy
10
Non vertex presentation
10
Placenta praevia
10
Maternal infection that may be transmitted to the fetus
10
Uterine scarring
10
Uterine hypertonus
10
Known fetal anomaly incompatible with life
10
Known obstetric or maternal complication

DPMS All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 1 of 4
Ref: 5418
 COMPLICATIONS ASSOCIATED WITH AMNIOINFUSION
4, 5
Uterine hypertonus and uterine overdistension
4, 5
Uterine rupture with a previous scar
4
Placental abruption
4
Chorioamnionitis
4
Non reassuring fetal heart rate
4
Maternal pulmonary embolus
4, 11
Maternal death
11
Amniotic fluid embolism
5
Umbilical cord prolapse

PROCEDURE ADDITIONAL INFORMATION

1 Prior to the procedure

Obtain verbal consent from the woman.
Encourage the woman to empty her bladder.
Ensure there are no contra-indications to
insertion of an intrauterine pressure catheter
or performing an amnioinfusion.
2 Inserting the catheter
2.1 Perform a vaginal examination This confirms presentation, establishes the
dilatation, and excludes the presence of
12
cord.
2.2 Insert an intrauterine pressure catheter
(IUPC) according to manufacturer’s
instructions.
See Clinical Guideline, O&M, Intrapartum
Care: Labour First Stage: Intrauterine
Pressure Catheter Insertion
2.3 Connect the primed intravenous tubing with
the amnioinfusion solution to the infusion port
12
on the IUPC.

3 Infusing the solution

3.1 Bolus infusion
Infuse the initial bolus rate of chosen solution
at 480mL / hour until 500mL is infused.
Note: a staff member must be present at all
times during the bolus infusion.
The solution infused is recommended to be at
2
room temperature. Studies have shown
there is no benefit to warming saline
13
compared to room temperature saline.
Amnioinfusion solution of 37ºC for a preterm
10
gestation is recommended. A blood
warmer may be used in this situation.
Rapid infusion can increase risk for
transporting of amniotic fluid into maternal
11
circulation .

AMNIOINFUSION KEMH
Clinical Guidelines: Obstetrics & Midwifery Perth, WA

DPMS Ref: 5418 All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 2 of 4
 PROCEDURE ADDITIONAL INFORMATION

3.2 Maintenance infusion

Then continue the infusion at a rate of The total amount that may be infused should
180mL/hour up to a total of another 500mL of not be more than 1000mL before review by
solutions if tolerated. the team Consultant.
4 Ceasing the infusion
Cease the infusion if: The use of amnioinfusion has been
the intrauterine baseline pressure is associated with increased uterine tone and
increased by more than 15mm Hg.
2 precipitate labours, which though rarely can
11
lead to significant maternal complications.
if the uterus does not rest between
2
contractions.
if polyhydramnios is confirmed on
2
ultrasound.
fetal or maternal intolerance to the
procedure occurs
An obstetric consultant must review and order
a second infusion to be commenced if
14
variable fetal heart rate patterns recur.
Consider using oxytocin if a delay in progress Assessment of the frequency and tone of the
of labour occurs. uterine contractions must be done before a
decision to use an oxytocin is implemented.
5 Observations
15 minutely monitoring of intrauterine Observe for uterine overdistension or
2
pressures and assessment of uterine hypertonic contractions.
2
contractions.
Report any abnormalities to the doctor when
they occur.

6 Documentation
Document time of commencing the infusion
on the MR 250 ‘Integrated Progress Notes’,
and observations on the MR 270 ‘Partogram’.

AMNIOINFUSION KEMH
Clinical Guidelines: Obstetrics & Midwifery Perth, WA

DPMS Ref: 5418 All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 3 of 4
 REFERENCES (STANDARDS)
1. Pitt C, Sanchex-Ramos L, Kaunitz AM, Gaudier F. Propylactic amnioinfusion for Intrapartum Oligohydramnios: A
metanalyis of randomised controlled trials. Obstetrics and Gynecology. 2000;96(5):861-6.
2. Fraser WD, Hofmeyr J, Lede R, et al. Amnioinfusion for the Prevention of the Meconium Aspiration Syndrome. The
New England Journal of Medicine. 2005;535(9):909-17.
3. Hofmeyr GJ, Xu H. Amnioinfusion for meconium-stained liquor in labour. The Cochrane Database of Systematic
reviews. 2010(1).
4. The American College of Obstetricians and Gynecologists. ACOG Committee Opinion Number 346. Amnioinfusion
Does Not Prevent Meconium Aspiration Syndrome. Obstetrics & Gynecology. 2006;108(4):1053-55.
5. Xu H, Hofmeyr J, Fraser WD. Intrapartum amnioinfusion for meconium-stained amniotic fluid: a systematic review of
randomised controlled trials. British Journal of Obstetrics and Gynaecology. 2007;114:383-90.
6. Nageotte MP, Bertucci L, Towers CV, et al. Propylactic Amnioinfusion in Pregnancies Complicated by
Oligohydramnios: a Prospective Study. Obstetrics & Gynecology. 1991;77(5):667-80.
7. Puder KS, Sorokin Y, Bottoms SF, et al. Amnioinfusion: does the choice of solution adversely affect. Obstetrics &
Gynecology. 1994;84(6):956-9.
8. Adama van Scheltema PN, In't Anker PS, Vereechen A, et al. Biochemical Composition of Fluids for Amnioinfusion
during Fetoscopy. Gynecologic and Obstetric Investigation. 2008;66:227-30.
9. Gramellini D, Fieni C, Kaihura G, et al. Antepartum amnioinfusion: a review. The Journal of Maternal-Fetal and
Neonatal Medicine. 2003;14:291-6.
10. Puertas A, Tirado P, Perez I, et al. Trancervical intrapartum amnioinfusion for preterm premature rupture of
membranes. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2007;131(40-4).
11. Dorairajan G, Soundararaghavan S. Maternal death after intrapartum saline amnioinfusion - report of two cases.
British Journal of Obstetrics and Gynaecology. 2005;112:1331-2.
12. Weismiller DG. Transcervical Amnioinfusion. American Family Physician. 1998;57(3):504-10.
13. Glantz JC, Letteney DL. Pumps and warmers during amnioinfusion: Is either necessary? Obstetrics & Gynecology.
1996;87(1):150-55.
14. Persson-Kjerstadius, Forsgren H, Westgren M. Intrapartum amnioinfusion in women with oligohydramnios. Acta
Obstetrics and Gynecology Scandanavia. 1999;78:116-9.

National Standards – 1 Care Provided is Guided by Current Best Practice

Legislation - Nil
Related Policies - Nil
Other related documents – KEMH Clinical Guideline, O&M, Intrapartum Care: Labour First Stage: Intrauterine
Pressure Catheter Insertion
RESPONSIBILITY
Policy Sponsor Medical Director OGCCU
Initial Endorsement April 2002
Last Reviewed September 2014
Last Amended February 2015
Review date September 2017

AMNIOINFUSION KEMH
Clinical Guidelines: Obstetrics & Midwifery Perth, WA

DPMS Ref: 5418 All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 4 of 4