Exchange Amnioinfusion in Conceptus with Laparoschisis(First Experience)

Overview

Objective:
During amnioinfusion exchange (AE) a certain amount of amniotic fl uid is repeatedlyextracted and the same amount of physiological solution is consequently instilled into the amnioticfetal cavity. The aim of this procedure is to dilute the amniotic fl uid that surrounds theeviscerated organs of fetuses with laparoschisis so as to avoid the genesis of fi brous coating onthese organs.Design: Prospective study.Setting: Gynekologicko-pôrodnícka klinika SZU, FNsP akad. L. Dérera, Bratislava, Slovakia.Methods: We have executed AE in fi ve fetuses with laparoschisis since June 2002. Two patientsunderwent the treatment 2 times during the 32nd and 36th weeks of gestation. Two other patientswere treated once during the 32nd week and one patient once during the 36th week. Underultrasound control we used a spinal needle to extract 120-180 ml of dense, cloudy amniotic fl uid.Consequently, we instilled the same amount of physiological solution warmed up to the temperatureof 37 °C into the amniotic cavity through antibacterial fi lter. The fetuses were monitoredcardiotocographically and with the help of ultrasound fl owmetry in umbilical vessels, before andafter the treatment.Results: The AE were successful and without complications in all fi ve cases. All patients deliveredvia elective caesarean section during the 36th – 37th gestation week. One patient delivered 24hours after second AE due to the danger of intrauterine fetal hypoxia that was verifi ed cardiotocographically.The other patients delivered 1-4 weeks after AE.Conclusion: The signifi cance of AE lies primarily in the reduction of the occurence of fi brous coatingon eviscerated organs. It enables postnatal primary surgical closure of the defect in the frontabdominal wall, an earlier onset of intestine peristalsis, transition from parenteral to peroralnutrition and shorter hospitalization.

Key words:
laparoschisis, amnioinfusion exchange, caesarean section