Advertisement

Amnioreduction in cases of polyhydramnios: Indications and outcomes in singleton pregnancies without fetal interventions

  • Hadi Erfani
    Affiliations
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States
    Search for articles by this author
  • Gian Esteban Diaz-Rodriguez
    Affiliations
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States
    Search for articles by this author
  • Soroush Aalipour
    Affiliations
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States
    Search for articles by this author
  • Ahmed Nassr
    Affiliations
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States

    Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt
    Search for articles by this author
  • Atefeh Rezaei
    Affiliations
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States
    Search for articles by this author
  • Manisha Gandhi
    Affiliations
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States
    Search for articles by this author
  • Hector Mendez-Figueroa
    Affiliations
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States
    Search for articles by this author
  • Kjersti M. Aagaard
    Affiliations
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States
    Search for articles by this author
  • Alireza A. Shamshirsaz
    Correspondence
    Corresponding author at: Division of Maternal Fetal Medicine, Baylor College of Medicine, Texas Children’s Fetal Center, Texas Children’s Hospital Pavilion for Women, 6651 Main Street, Suite F1020, Houston, TX, United States.
    Affiliations
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States
    Search for articles by this author

      Abstract

      Objective

      To evaluate indications, pregnancy outcomes, and risk of adverse events following amnioreduction procedures in singleton gestations.

      Study design

      Study of all amnioreduction procedures performed on singleton gestations complicated by polyhydramnios between January 2011 and June 2018 at our tertiary and regional referral fetal center. Clinical indications for amnioreduction procedures were categorized as either maternal shortness of breath, perceived abdominal tightness, or preterm uterine contractions with or without cervical change. Our primary outcome(s) of interest were: preterm premature rupture of membranes (PPROM), placental abruption, chorioamnionitis and/or preterm delivery, each in isolation or as a composite.

      Results

      Among 358 patients who underwent amnioreduction in the study period, 251 arose from cases of twin-twin transfusion syndrome (TTTS) and 74 were singletons undergoing additional fetal intervention procedures. Each of the remaining 33 patients underwent a median number of one [range 1–12] amnioreductions over the antepartum interval, yielding a total of 66 amnioreduction procedures. Among the study cohort, there were no instances of PPROM, placental abruption, chorioamnionitis or preterm delivery within the 12 h following the procedure but 10.6% experienced preterm delivery within 48 h of amnioreduction.

      Conclusion

      Our data suggests that among singleton gestations, there was a low risk for preterm delivery in close proximity to the procedure and none experienced rupture of membranes, placental abruption, sepsis, fetal demise or neonatal death. This data may be used in counseling of potential candidates for amnioreduction with singleton pregnancies and symptomatic polyhydramnios.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Magann E.F.
        • Chauhan S.P.
        • Doherty D.A.
        • Lutgendorf M.A.
        • Magann M.I.
        • Morrison J.C.
        A review of idiopathic hydramnios and pregnancy outcomes.
        Obstet Gynecol Surv. 2007; 62: 795-802
        • Biggio Jr., J.R.
        • Wenstrom K.D.
        • Dubard M.B.
        • Cliver S.P.
        Hydramnios prediction of adverse perinatal outcome.
        Obstet Gynecol. 1999; 94: 773-777
        • Dashe J.S.
        • McIntire D.D.
        • Ramus R.M.
        • Santos-Ramos R.
        • Twickler D.M.
        Hydramnios: anomaly prevalence and sonographic detection.
        Obstet Gynecol. 2002; 100: 134-139
        • Abele H.
        • Starz S.
        • Hoopmann M.
        • Yazdi B.
        • Rall K.
        • Kagan K.O.
        Idiopathic polyhydramnios and postnatal abnormalities.
        Fetal Diagn Ther. 2012; 32: 251-255
        • Dickinson J.E.
        • Tjioe Y.Y.
        • Jude E.
        • Kirk D.
        • Franke M.
        • Nathan E.
        Amnioreduction in the management of polyhydramnios complicating singleton pregnancies.
        Am J Obstet Gynecol. 2014; 211 (434.e1-7)
        • Moise Jr., K.J.
        • Dorman K.
        • Lamvu G.
        • Saade G.R.
        • Fisk N.M.
        • Dickinson J.E.
        • et al.
        A randomized trial of amnioreduction versus septostomy in the treatment of twin-twin transfusion syndrome.
        Am J Obstet Gynecol. 2005; 193: 701-707
        • Duncombe G.J.
        • Dickinson J.E.
        • Evans S.F.
        Perinatal characteristics and outcomes of pregnancies complicated by twin-twin transfusion syndrome.
        Obstet Gynecol. 2003; 101: 1190-1196
        • Dickinson J.E.
        • Evans S.F.
        Obstetric and perinatal outcomes from the australian and new zealand twin-twin transfusion syndrome registry.
        Am J Obstet Gynecol. 2000; 182: 706-712
        • Mari G.
        • Roberts A.
        • Detti L.
        • Kovanci E.
        • Stefos T.
        • Bahado-Singh R.O.
        • et al.
        Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome: results of the International Amnioreduction Registry.
        Am J Obstet Gynecol. 2001; 185: 708-715
        • Thompson A.
        • Mone F.
        • McComiskey M.
        • Ong S.
        Amnioreduction in a singleton pregnancy: a systematic review.
        J Obstet Gynaecol. 2013; 33: 764-767
        • Elliott J.P.
        • Sawyer A.T.
        • Radin T.G.
        • Strong R.E.
        Large-volume therapeutic amniocentesis in the treatment of hydramnios.
        Obstet Gynecol. 1994; 84: 1025-1027
        • Leung W.C.
        • Jouannic J.M.
        • Hyett J.
        • Rodeck C.
        • Jauniaux E.
        Procedure-related complications of rapid amniodrainage in the treatment of polyhydramnios.
        Ultrasound Obstet Gynecol. 2004; 23: 154-158
        • Piantelli G.
        • Bedocchi L.
        • Cavicchioni O.
        • Verrotti C.
        • Cavallotti D.
        • Fieni S.
        • et al.
        Amnioreduction for treatment of severe polyhydramnios.
        Acta Biomed. 2004; 75 Suppl 1: 56-58
        • Kleine R.T.
        • Bernardes L.S.
        • Carvalho M.A.
        • de Carvalho M.H.
        • Krebs V.L.
        • Francisco R.P.
        Pregnancy outcomes in severe polyhydramnios: no increase in risk in patients needing amnioreduction for maternal pain or respiratory distress.
        J Maternal-Fetal Neonat Med. 2016; 29: 4031-4034
        • Stojic S.
        • Novakov-Mikic A.
        • Bogavac M.
        • Mandic A.
        Amnioreduction in treatment of increased amniotic fluid volume.
        Med Pregl. 2004; 57: 579-583