Amnioreduction
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Overall, amnioreduction is an easy procedure. The rationale behind it is that the normalizing of fluid levels reduces maternal discomfort, improves uteroplacental perfusion (especially in the setting of presumed twin-twin transfusion syndrome [TTTS]), and prolongs pregnancy. [1]
Amnioreduction may be performed manually or with vacuum-assisted devices (vacuum tubing and vacuum bottles). Needles of differing gauges may be used (typically 18 or 20 gauge), and varying amounts of fluid may be removed at varying rates, depending on the clinical situation.
A maternal goal in singleton pregnancies is improving maternal dyspnea. [2] Overall, however, the most common application of or indication for amnioreduction is in the setting of twin-to-twin transfusion syndrome (TTTS), where it is performed to reduce fluid volume in the recipient twin and thereby increase blood flow to the donor twin by decreasing pressure inside the amniotic cavity. [3]
Amnioreduction reduces uterine distention and decreases risk for preterm premature rupture of membranes and preterm delivery. [4] Amnioreduction can also be performed to reduce fluid levels and pressure in cases in which an amniotic sac prolapses before cervical cerclage placement, with the goal of allowing the amniotic sac to retract back into the uterine cavity. [5]
Contraindications for amnioreduction include the following:
Maternal or fetal bleeding disorders
Preterm labor
Suspected chorioamnionitis
The procedure should be discontinued if the needle punctures the fetus or the umbilical cord.
Coviello D, Bonati F, Montefusco SM, Mastromatteo C, Fabietti I, Rustico M. Amnioreduction. Acta Bio Medica Ateneo Parmense. 2004. 75:31-33.
Piantelli G, Bedocchi L, Cavicchioni O, et al. Amnioreduction for treatment of severe polyhydramnios. Acta Bio Medica Ateneo Parmense. 2004. 75:56-58.
Fisk NM, Tannirandorn Y, Nicolini U, Talbert DG, Rodeck GH. Amniotic pressure in disorders of amniotic fluid volume. Obstet Gynecol. 1990. 76:210-214.
Queenan JT, Gadow EC. Polyhydramnios. Am J Obstet Gynecol. 1970. 108:349-355.
Makino Y, Makino I, Tsujioka H, Kawarabayashi T. Amnioreduction in patients with bulging prolapsed membranes out of the cervix and vaginal orifice in cervical cerclage. J Perinat Med. 2004. 32.
Jan E Dickinson. Amnioreduction therapy for twin-twin transfusion syndrome. Quintero RA. Twin-Twin Transfusion Syndrome. Informa Healthcare; 2007. 891-97.
Leung W, Jouannic J, Hyett J, Rodeck C, Jauniaux E. Procedure-related complications of rapid amniodrainage in the treatment of polyhydramnios. Ultrasound Obstet Gynecol. 2003. 23:154-158.
ACOG Committee Opinion No. 402: Antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2008 Mar. 111(3):805-7. [Medline].
Beloosesky R, Ross MG. Polyhydramnios [database online]. UpToDate. Accessed December 17, 2011:
Abdalla N, Piórkowski R, Stanirowski P, Pazura M, Cendrowski K, Sawicki W. Can ultrasound be helpful in selecting optimal management methods for pregnancies complicated by placental non-trophpblastic tumors?. J Ultrason. 2017 Jun. 17 (69):116-122. [Medline]. [Full Text].
Dickinson JE, Tjioe YY, Jude E, Kirk D, Franke M, Nathan E. Amnioreduction in the management of polyhydramnios complicating singleton pregnancies. Am J Obstet Gynecol. 2014 Oct. 211(4):434.e1-7. [Medline].
Kleine RT, Bernardes LS, Carvalho MA, de Carvalho MH, Krebs VL, Francisco RP. Pregnancy outcomes in severe polyhydramnios: no increase in risk in patients needing amnioreduction for maternal pain or respiratory distress. J Matern Fetal Neonatal Med. 2016 Dec. 29 (24):4031-4. [Medline].
Chai H, Fang Q, Huang X, Zhou Y, Luo Y. Prenatal management and outcomes in mirror syndrome associated with twin-twin transfusion syndrome. Prenat Diagn. 2014 Jul 9. [Medline].
Roberts D, Neilson JP, Kilby MD, Gates S. Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev. 2014 Jan 30. 1:CD002073. [Medline].
Glennon CL, Shemer SA, Palma-Dias R, Umstad MP. The History of Treatment of Twin-to-Twin Transfusion Syndrome. Twin Res Hum Genet. 2016 Jun. 19 (3):168-74. [Medline].
Jenny E Halfhill, DO Resident Physician, Department of Obstetrics and Gynecology, Western Pennsylvania Hospital
Jenny E Halfhill, DO is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Osteopathic Association
Disclosure: Nothing to disclose.
Ronald Lee Thomas, MD Associate Professor, Department of Obstetrics and Gynecology, Drexel University College of Medicine; Director, Division of Maternal-Fetal Medicine and Obstetrical Services, Director, Department of Obstetric/Gynecological Ultrasound, Allegheny General Hospital, West Penn Allegheny Health System
Ronald Lee Thomas, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Pennsylvania Medical Society, Society for Maternal-Fetal Medicine, Allegheny County Medical Society, Johns Hopkins Medical and Surgical Association
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Carl V Smith, MD The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, Senior Associate Dean for Clinical Affairs, University of Nebraska Medical Center
Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Council of University Chairs of Obstetrics and Gynecology, Nebraska Medical Association
Disclosure: Nothing to disclose.
Amnioreduction
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