Amnioreduction Periprocedural Care
- Author: Jenny E Halfhill, DO; Chief Editor: Carl V Smith, MD more...
Patient Education and Consent
Written consent must be obtained from the patient. A clear summary of the risks, benefits, and alternatives must be provided, and the patient must voice understanding. In particular, risks such as preterm labor (and delivery), infection (eg, chorioamnionitis), placental abruption (bleeding), and fetal death must be explained to the patient. An overall risk of 1.5-3.1% is noted in the literature.
Routine subjective comfort measures should be used. If the pregnancy is viable, resources that would allow cesarean delivery if necessary should be immediately available. This preparation should include placing the patient on nil per os (NPO) and, potentially, administering antenatal corticosteroids as indicated and appropriate according to standard guidelines. Anesthesia standby may be appropriate (for supports ranging from intravenous [IV] sedation to general anesthesia).
The procedure may be performed manually or with vacuum-assisted devices (eg, vacuum tubing and vacuum bottles). The materials necessary for amnioreduction include the following :
- Several 500-mL evacuation containers
- Amniocentesis tray
- Hard-walled arterial tubing with a 3-way stopcock
- Specimen collection containers
- Needles, typically 18 or 20 gauge
- Syringe, 50 mL
- Sterile cover sheet
- Local anesthetic
- Sterile gloves and towels
- Fetal monitoring equipment
- Ultrasound machine
Maternal sedation with benzodiazepines may reduce movement and improve comfort. A local anesthetic (eg, lidocaine) is injected into the skin and subcutaneous tissue to reduce the pain associated with needle insertion.
Positioning should be optimized to permit prolonged maintenance of a stable surgical field. Proper positioning of the patient and the draining mechanisms will decrease complications. The patient should be supine in a left lateral tilt position to reduce compression of the vena cava, and support pillows should be used to enhance maternal comfort.
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:
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].
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].