The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on therapeutic amnioinfusion for oligohydramnios during pregnancy in November 2006. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.
The guidance was considered for reassessment in November 2009 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.
During pregnancy, the level of amniotic fluid increases rapidly to reach a peak at about 36 weeks gestation after which time it may start to gradually decrease. Oligohydramnios is the presence of an abnormally low volume of amniotic fluid (AF) surrounding the fetus. It may be due to an excess loss of fluid or a decrease in fetal urine production or excretion. The condition can occur at any stage of pregnancy but it is most common in the last trimester.
Amnioinfusion is used to increase the volume of amniotic fluid around the fetus during pregnancy. Under ultrasonic guidance, a needle is inserted into the uterine cavity and saline or Ringer's lactate is infused until the level of amniotic fluid is normal. The procedure may be repeated if oligohydramnios recurs (serial amnioinfusion).
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.