Effect of indomethacin on amniotic fluid prostaglandin and aldosterone levels in a fetus with Bartter syndrome

renal agenesis should be confirmed or excluded. Moreover, the major concern after exclusion of renal agenesis is prevention of compression deformities and pulmonary hypoplasia due to anhydramnios. Amnioinfusion is indicated both to restore amniotic cavity fluid volume and to improve ultrasound visualisation (Hofmeyr et al., 1996). In our case, amnioinfusion allowed visualisation of an intact urinary system and may have helped restore its function by resuming amniotic fluid turnover, although the amniotic fluid index remained low until term. The major concern after amniotic fluid leakage is an increased risk of spontaneous abortion (Brumfield et al., 1996), congenital malformations, mainly talipes equinovarus (Sundberg et al., 1997), and hazards that are associated with early PPROM, for example, pulmonary hypoplasia and perinatal infections (KurkinenRaty et al., 1998). However, PPROM after genetic amniocentesis seems to carry a significantly better perinatal outcome compared to spontaneous PPROM at the same gestational age (Borgida et al., 2000). The management of amniotic fluid leakage after invasive diagnostic methods is controversial and some authors suggest amnioinfusion whereas others suggest expectant management. The residual volume of amniotic fluid is an important indicator for intervention. Restoration of amniotic fluid volume in cases in which oligohydramnios develops improves the perinatal outcome substantially (Locatelli et al., 2000). High-pressure amnioinfusion has been suggested to be a risk factor for amniotic fluid embolism (Dragich et al., 1991), so volume restoration must take into account the normal amniotic fluid volume for gestational age. Having this in mind, we used 80 mL of normal saline in a single session. A technical difficulty can arise when there is no identifiable amniotic fluid pool to place the catheter. When this happens, one may perform cordocentesis, then withdraw the needle tip until it just slips out of the cord and commence infusion of normal saline until a sufficient amount of fluid is present for ultrasound visualisation (Hofmeyr et al., 1996). Our technique was similar, as we placed the needle between coils of the umbilical cord, but we avoided puncturing the cord as this would increase the risk of complications. Amnioinfusions for restoration of amniotic fluid volume have been described as early as 16 weeks’ gestation and may improve perinatal outcome (Locatelli et al., 2000). The intervention in our case was carried out earlier, during the 15th gestational week, and we assume that it was beneficial for fetal survival and well-being. There are reports of fetuses surviving after PPROM during CVS with only expectant management, but the prognosis is usually poor (Vernet et al., 1994). Development of talipes suggests that our case would probably have had an adverse outcome if left undiagnosed and untreated. The deformity was relatively mild, indicating that it was an early complication of anhydramnios, which might have progressed with pulmonary hypoplasia and/or intrauterine death. The present case shows that there may be a possibility of PPROM after CVS. Women should be asked even for subtle signs of amniotic fluid leakage, as this may be occult. Amnioinfusion can be a safe and effective diagnostic and therapeutic tool and should be performed as early as possible in order to eliminate or reduce the complications of oligohydramnios and anhydramnios. A single amnioinfusion may suffice, provided amniotic fluid leakage does not continue.