Amnioinfusion before 26 weeks' gestation for severe fetal growth restriction with oligohydramnios: Preliminary pilot study

Takahashi, Yuichiro; Iwagaki, Shigenori; Chiaki, Rika; Iwasa, Tomotake; Takenaka, Motoki; Kawabata, Ichiro; Itoh, Mitsuaki

doi:10.1111/jog.12224

Cited by 14 publications

(17 citation statements)

References 23 publications

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“…All hypercoiled cords were detected by ultrasound examination before birth, and median UCI was 0.76 (range 0.71-0.93). FD occurred in six cases (cases [9][10][11][12][13][14]. In addition to the early gestational age, the estimated body weight was very small (296, 417, 339 and 322 g) in four cases (cases 9, 10, 12 and 14, respectively).…”

Section: Resultsmentioning

confidence: 97%

“…Takahashi et al reported improvement of abnormal UA and DV Doppler by AI when umbilical cord problems were present. 13 A previous study suggested the efficacy of AI for avoiding umbilical cord compression and increasing umbilical blood flow. In the present study, a hypercoiled cord and decreased amniotic fluid were detected in all cases of temporary DV-RAV.…”

Section: Discussionmentioning

confidence: 99%

“…Warm saline was infused by gravity. 13 The volume of AI was determined based on the ultrasound image that indicated sufficient amniotic fluid around the cord. The upper limit of the infusion volume was set at 200 mL (before gestational week 24) to 300 mL (after gestational week 24).…”

Section: Methodsmentioning

confidence: 99%

“…8,9 On the other hand, an intermittent or disappearing DV-RAV has been described in some reports. [10][11][12][13] These findings occurred spontaneously, after administration of betamethasone or after transabdominal amnioinfusion (AI). The mechanism of improvement in DV Doppler remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Hypercoiled cord can cause a reversible abnormal Doppler in ductus venosus in cases of fetal growth restriction

Iwagaki

Takahashi

Chiaki

et al. 2018

J of Obstet and Gynaecol

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Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hypercoiled cord can cause a reversible abnormal Doppler in ductus venosus in cases of fetal growth restriction

Iwagaki

Takahashi

Chiaki

et al. 2018

J of Obstet and Gynaecol

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“…First, early-onset fetal growth restriction that shows umbilical venous fluctuation and reverse ductus venosus flow, which were observed in this case, is the strongest predictive factor for intrauterine fetal death [9]. Second, almost one-half of the reported cases of early-onset fetal growth restriction were complicated with severe oligohydramnios and destined to die [10]. We believe that in the present case the tadalafil therapy contributed to the improved intrauterine environment and to the extension of the pregnancy to 32 week’s gestation, and finally to the uncomplicated post-delivery course.…”

Section: Discussionmentioning

confidence: 99%

Early-onset fetal growth restriction treated with the long-acting phosphodiesterase-5 inhibitor tadalafil: a case report

et al. 2016

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BackgroundSevere early-onset fetal growth restriction occurs in 0.4 % of all pregnancies, and the prognoses of these patients are dismal. Severely growth-restricted fetuses (far below 500 g) are thought to be nonviable. Since there have not been effective treatments for such fetal patients, obstetricians have simply tried to identify the optimal timing for their delivery. There are a few reports suggesting that the phosphodiesterase type 5 inhibitor sildenafil has some limited beneficial effects on fetal growth, but there are no such reports on tadalafil, another derivative phosphodiesterase type 5 inhibitor which has a much longer half-life than sildenafil. Here we present a case in which the administration of tadalafil to the mother revived the arrested growth and severe oligohydramnios of the very prematurely growth-restricted fetus.Case presentationWe describe a case of early-onset fetal growth restriction with oligohydramnios in a 41-year-old primigravida Japanese woman who was treated with tadalafil (20-mg tablet daily) from 22 weeks’ gestational age. Ten days after the initiation of the tadalafil therapy, the amniotic fluid level rose and the weight of the fetus began to increase. A 1024-g baby boy was delivered by cesarean at 32 weeks’ gestation. The z-score for fetal head circumference had increased from −2.2 to −1.2, whereas the z-score of the femur legth was decreased to −4.3, indicating that tadalafil preferentially increased the blood flow to important organs.ConclusionsWe achieved two positive results by administering tadalafil to the mother carrying a severely growth-restricted fetus with oligohydramnios. First, the z-scores of head circumference and abdominal circumference had at first declined but started to rise after the tadalafil administration. Second, the amniotic fluid, which was emptied before the tadalafil treatment, recovered to normal range with this treatment. Tadalafil administration to mothers could be a promising therapy to reverse severe fetal growth restriction and oligohydramnios.

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An experience of second-trimester anhydramnios salvaged by single amnioinfusion

Kondoh

Chigusa

et al. 2017

J Med Ultrasonics

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Second-trimester anhydramnios, which is primarily caused by ruptured membranes, placental dysfunction, or congenital renal malformations, is associated with high perinatal morbidity and mortality. Although amnioinfusion temporarily increases amniotic fluid volume, it does not generally provide a fundamental solution. We describe a case of second-trimester anhydramnios with an umbilical cord factor, wherein single amnioinfusion may have successfully broken a vicious circle involving non-reassuring fetal status. A 34-year-old primigravid woman was referred to our hospital because of anhydramnios at 22 weeks' gestation. Single amnioinfusion improved the fetal circulatory failure, and the patient delivered a healthy full-term newborn. Single amnioinfusion may be a therapeutic approach to improve the prognosis of pregnancy when second-trimester anhydramnios results from umbilical cord factors.

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Amnioinfusion before 26 weeks' gestation for severe fetal growth restriction with oligohydramnios: Preliminary pilot study

Abstract: In cases of extremely severe FGR before 26 WG with oligohydramnios and circulatory failure, amnioinfusion might be a promising, innovative tool.

Cited by 14 publications

References 23 publications

Hypercoiled cord can cause a reversible abnormal Doppler in ductus venosus in cases of fetal growth restriction

Hypercoiled cord can cause a reversible abnormal Doppler in ductus venosus in cases of fetal growth restriction

Early-onset fetal growth restriction treated with the long-acting phosphodiesterase-5 inhibitor tadalafil: a case report

An experience of second-trimester anhydramnios salvaged by single amnioinfusion

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