Amnioreduction Periprocedural Care

Updated: Jan 24, 2019
  • Author: Jenny E Halfhill, DO; Chief Editor: Carl V Smith, MD  more...
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Periprocedural Care

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. [6] An overall risk of 1.5-3.1% is noted in the literature. [7]

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Preprocedural Planning

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. [8] Anesthesia standby may be appropriate (for supports ranging from intravenous [IV] sedation to general anesthesia).

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Equipment

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 [9] :

  • 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

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Patient Preparation

Maternal sedation with benzodiazepines may reduce movement and improve comfort. [6] 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. [6] 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.

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