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Q&A

Labor

Poster Session 4

(1193) The Yield of Amnioinfusion in the Prevention of Postpartum Hemorrhage

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Keren Zloto, MD

    Sheba Medical Center
    Tel Aviv, Israel, Israel

    • Coauthor(s)

  • ES

    Eyal Sivan, MD

    Physician
    Sheba Medical Center, Tel-Hashomer
    Ramat-Gan, Israel, Israel

  • RY

    Rakefet Yoeli, MD

    Sheba Medical Center, Tel-Hashomer
    Kiriat Ono, HaMerkaz, Israel

  • SM

    Shali Mazaki-Tovi, MD

    Physician
    Chaim Sheba Medical center, Tel HaShomer
    Ramat Gan, HaMerkaz, Israel

  • Suneet P. Chauhan, MD

    Professor
    University of Texas-Houston Medical School
    Houston, TX, United States

  • Michal Fishel Bartal, MD (she/her/hers)

    Maternal Fetal Medicine Faculty
    McGovern Medical School at UTHealth Houston, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
    Houston, TX, United States

Objective:

Previous report highlighted the role of amnioinfusion in the prevention of uterine atony (Wetta et al., AJOG 2013). However, whether or not amnioinfusion decreases the risk of postpartum hemorrhage (PPH) is unknown.  This study aimed to determine whether amnioinfusion reduces the risk of PPH.

Study Design:

This was a retrospective study of all laboring individuals at a single tertiary center between 01/2013 and 12/2022 at ≥ 34 weeks. Individuals with planned cesarean delivery (CD), known major fetal anomalies, stillbirth, or missing delivery records were excluded. The primary outcome was a composite outcome including any of the following: PPH (estimate blood loss of >1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours from delivery) blood transfusion, need for uterotonic (in addition to oxytocin), mechanical tamponade, surgical management of PPH, or relaparotomy or hysterectomy. Multivariable regression models were used to estimate adjusted odd risks (aOR), controlling for variables identified in the univariate analysis.

Results:

Of 109,989 deliveries during the study period, 89,321 (81%) met the inclusion criteria. Of those, 4,452 (5%) had amnioinfusion during labor. Laboring individuals with amnioinfusion, compared to those without, were more commonly nulliparous (61.2% vs. 34.7%; P< 0.01), had polyhydramnios (3.8% vs. 2.7%; P< 0.01), had a higher rate of labor induction (56.0% vs. 28.8%; P< 0.01), and had a higher CD rate (35.3% vs. 10.4%; P< 0.01). Following a multivariable regression, there was no difference in the rate of composite outcome among individuals that had an amnioinfusion versus those that did not. The rates of infectious morbidity, including surgical site infection and postpartum fever, were higher among individuals with amnioinfusion than those without (Table). 

Conclusion:

Among laboring individuals ≥ 34 weeks, intrapartum amnioinfusion was not associated with a significant reduction in the rate of postpartum hemorrhage, though amnioinfusion was associated with a higher likelihood of infectious morbidity.