Amnioinfusion

What is amnioinfusion?

Amnioinfusion is a technique healthcare providers use to add amniotic fluid to your uterus. It’s most commonly performed during labor when a fetus shows signs of a slow or irregular heart rate due to low amniotic fluid. Low amniotic fluid can compress the umbilical cord and cause other delivery complications. During amnioinfusion, your healthcare provider inserts saline or sodium lactate (lactated Ringer’s solution) into your uterus with a catheter. This fluid replaces lost amniotic fluid and helps stabilize the fetal heart rate and prevent them from losing oxygen.

What is amniotic fluid?

Amniotic fluid is a substance that surrounds the fetus in your uterus. It protects them from infection and umbilical cord compression and cushions its movements while its in the uterus. Amniotic fluid also helps develop your the fetus's digestive and respiratory system and regulates its temperature. Not having enough amniotic fluid can cause health problems in your baby or complications during labor and delivery.

What is the umbilical cord?

An umbilical cord is your the fetus's lifeline in the uterus. It connects the fetus to the placenta. A compressed cord can cause complications because it deprives the fetus of oxygen, blood and nutrients.

What conditions does amnioinfusion treat?

Adding amniotic fluid is only done under certain conditions. Amnioinfusion is performed when you have a condition called oligohydramnios (low amniotic fluid). It’s also used as a treatment for:

• Umbilical cord compression. A compressed umbilical cord can lead to fetal distress. This is stress to the baby during labor or delivery.
• Preterm premature rupture of the membranes (especially before the third trimester of pregnancy). This may help the environment inside the uterus and prevent you from going into preterm labor.
• Prevent meconium aspiration syndrome (the extra fluid can dilute meconium). Meconium is the fetus's first stool. Swallowing meconium is OK, but breathing it in can cause complications.

Your healthcare provider can discuss the risks and benefits of amnioinfusion with you based on your medical history and pregnancy.

When should amnioinfusion be done?

Healthcare providers use amnioinfusion in specific instances when your amniotic fluid is too low. Low amniotic fluid affects the uterine environment and can cause fetal distress.

There are circumstances where amnioinfusion should not be done, including:

• The fetus is in serious distress. When minutes count, amnioinfusion just delays delivery.
• You have an active genital herpes infection or other infection in your uterus.
• You have placenta previa or suspected placental abruption.
• The fetus is breech or is in any other position other than head down.

Can they replace amniotic fluid?

Yes, healthcare providers can replace amniotic fluid with saline during an amnioinfusion procedure. The procedure is only used in certain circumstances.

How is an amnioinfusion performed?

Fluid is placed through your uterus using an intrauterine pressure catheter (IUPC). This is attached to a three-way device that connects the IUPC to a fetal monitor and an infusion pump (a device that delivers fluids). Intravenous tubing is used to transfer the saline solution.

An IUPC is placed after your provider confirms that the fetus is in a head-first position in your uterus. Your cervix must also be dilated at least 1 to 2 centimeters. Since an IUPC connects to a monitor, it can also measure uterine contractions and fetal heart rate.

Room temperature saline or lactated Ringer’s solution is inserted through the tubing and into your uterus. The exact recommendations may vary depending on your condition, but you can expect to receive fluids for 10 to 30 minutes.

Your healthcare provider will continue to measure your amniotic fluid levels to ensure the fluid is being retained.

After amnioinfusion, you may have mild discomfort or pain.

What are the advantages of amnioinfusion?

Other than improving the fetal heart rate and other signs of distress, amnioinfusion can help:

• Lower your risk of needing a c-section.
• Decrease your risk of needing forceps, a vacuum or other instruments.
• Improve blood and oxygen flow to the fetus via the umbilical cord.
• Help delay labor to avoid complications of premature birth.
• Reduce the amount of meconium-stained amniotic fluid.
• Improve Apgar scores.
• Decrease chances of infection (postpartum endometritis) due to not having amniotic fluid.

What are the risks or complications of amnioinfusion?

Overall, amnioinfusion seems to be a safe and effective technique. Like all procedures, there are some risks involved. Complications of amnioinfusion could include:

• Chorioamnionitis (infection of your placenta and amniotic fluid).
• Umbilical cord prolapse.
• Polyhydramnios (too much amniotic fluid).
• Preterm labor.
• Prolonged labor.
• Uterine overdistention (enlarged uterus).
• Perforated uterus.

How successful is amnioinfusion?

Most amnioinfusion procedures are successful. They tend to be more successful when you have less amniotic fluid. This means people who need more fluid replaced tend to see better outcomes. For example, when the initial amniotic fluid index is less than 4 centimeters, the procedure is successful 63% of the time. When the fluid index is 4 to 8 cm, the success rate decreases to 44%. Amniotic fluid index is a measurement providers use to assess the amount of amniotic fluid in your uterus.

When should I see my healthcare provider?

Your healthcare provider can discuss amnioinfusion with you. It's not as well-studied as other procedures that have been in practice for many decades. Your provider can discuss the risks and benefits of amnioinfusion with you and determine the best course of treatment based on your medical condition.

Contact your pregnancy care provider if you feel fluid leaking from your vagina during pregnancy. They can determine if you're leaking amniotic fluid. It's also important to keep and attend all your prenatal visits so your provider can monitor your baby's health and better detect complications caused by low amniotic fluid.

A note from Cleveland Clinic

Amnioinfusion is a procedure to replace amniotic fluid lost during labor. Having enough amniotic fluid ensures your pregnancy and delivery are healthy and safe. The procedure involves inserting saline or sodium lactate into your uterus. It's only performed in specific circumstances, like when the fetus shows signs of distress during labor or when low amniotic fluid is detected in a prenatal ultrasound. Talk to your pregnancy care provider if you have any questions about amnioinfusion or your amniotic fluid levels during pregnancy. They can discuss the process with you and help you understand what to expect.