#Grand Rounds

Is Amnioinfusion a Possible Treatment for Second-Trimester PPROM?

BACKGROUND AND PURPOSE:

Second trimester preterm prelabor rupture of membranes (PPROM) occurs between 16w0d – 24w0d and is associated with severe adverse perinatal complications, including pulmonary hypoplasia
Data is limited as to whether transabdominal amnioinfusion may result in improved outcomes
Van Kempen et al. (Obstetrics & Gynecology, 2018) examined the effectiveness of amnioinfusion in second-trimester preterm PPROM

Multicenter, open-label, randomized controlled trial (RCT)
- Singleton pregnancies with second trimester PROM
- Oligohydramnios: Defined as single deepest pocket <2cm
Patients underwent either (1:1 ratio)
- Transabdominal amnioinfusion with repeat amnioinfusion weekly until 28w0d if deepest pocket remained <2cm
- No intervention
All patients were received erythromycin
- 250 mg 4x per day for 10 days
Primary outcome: Perinatal mortality
- Mortality defined as fetal demise or neonatal death within 28 days postpartum
Secondary outcomes
- Cause of mortality | Related perinatal outcomes

56 women were randomized
- 28 in the amnioinfusion group | 28 in the non-intervention group
In the amnioinfusion group, 5 women did not undergo amnioinfusion for various reasons such as delivery or sepsis prior to first scheduled amnioinfusion
Median number of amnioinfusions: 2 per woman (range 0 to 8)
Overall perinatal mortality rates were not statistically different
- 64% in the amnioinfusion group
- 75% in the no intervention group
- Relative risk (RR) 0.86 (95% CI, 0.60–1.22, P=.39)
Neonatal survival without morbidity was similar between the two groups
- 27% in the amnioinfusion group
- 23% in the no intervention group
- RR 1.73 (95% CI, 0.38–7.98, P=.48)
There were no differences between groups for the following
- Cesarean section | Chorioamnionitis
- No abruptions or maternal deaths were observied in either group
Safety of amnioinfusion: Complications
- Fetal: Bradycardia | inadvertent needle puncture
- Maternal: Painless contraction | Inadvertent myometrial injection | Severe abdominal pain | Vaginal bleeding

Authors caution that
- Study was only powered to detect a decrease in perinatal mortality from 70% to 35% and therefore smaller clinical differences could still be present
- However, these data support a previous RCT that there is no benefit to amnioinfusion in the setting of second trimester preterm PROM

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