Relationship between higher intra-amniotic pressures in polyhydramnios and maternal symptoms

Katsura, Daisuke; Takahashi, Yuichiro; Iwagaki, Shigenori; Chiaki, Rika; Asai, Kazuhiko; Koike, Masako; Yasumi, Shunsuke; Furuhashi, Madoka; Murakami, Takashi

doi:10.1016/j.ejogrb.2019.02.006

Cited by 3 publications

(7 citation statements)

References 9 publications

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“…In polyhydramnios, the intra-amniotic pressure is high, and amnioreduction is often performed to prevent preterm delivery and relieve maternal symptoms [8,9]. We also reported previously that the intraamniotic pressure decreased and reached a plateau during amnioreduction [9]. These results support our hypothesis, and the SDP and AFI after AI should be kept within a normal range because polyhydramnios increases intra-amniotic pressure.…”

Section: Discussionsupporting

confidence: 88%

“…We hypothesized that the changes in the intra-amniotic pressure during AI may be the cause of the reported complications. In polyhydramnios, the intra-amniotic pressure is high, and amnioreduction is often performed to prevent preterm delivery and relieve maternal symptoms [8,9]. We also reported previously that the intraamniotic pressure decreased and reached a plateau during amnioreduction [9].…”

Section: Discussionmentioning

confidence: 69%

“…Regarding the indication of AI, we analyzed the relationship between cases with oligohydramnios and umbilical cord compression. No significant differences were observed in the median intra-amniotic pressure before AI (9 [range, [4][5][6][7][8][9][10][11][12][13] Maternal or fetal adverse events, such as preterm premature rupture of membranes, delivery and fetal death within 48 h, placental abruption, infection, hemorrhage, and peripheral organ injury, were not observed following AI. Moreover, although mild palpitation and tremor caused by ritodrine hydrochloride administration and mild vascular pain caused by magnesium sulfate administration were observed, no adverse events occurred that required treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Reported adverse events occurring due to transabdominal AI include miscarriage, premature rupture of membranes, preterm labor, placental abruption, chorioamnionitis, fetal trauma, and uterine perforation [7]. Previous studies reported the relationship between high intra-amniotic pressure and polyhydramnios and between high intra-amniotic pressure and maternal symptoms such as abdominal distension and dyspnea, threatened premature labor, and preterm labor [8,9]. An increase in the intra-amniotic pressure due to AI may lead to the development of complications, such as premature rupture of membranes and preterm labor.…”

Section: Introductionmentioning

confidence: 99%

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Changes in the Intra-Amniotic Pressure following Transabdominal Amnioinfusion during Pregnancy

et al. 2021

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Objective: The aim of the article was to investigate the changes in intra-amniotic pressure following transabdominal amnioinfusion during pregnancy. Design: This retrospective study included 19 pregnant women who underwent transabdominal amnioinfusion during pregnancy to relieve umbilical cord compression and improve the intrauterine environment or to increase the accuracy of ultrasonography. Materials and Methods: We measured and analyzed the changes in intra-amniotic pressure, single deepest pocket, and the amniotic fluid index before and after amnioinfusion. We also determined the incidence of maternal or fetal adverse events, such as preterm premature rupture of membranes, preterm delivery, fetal death within 48 h, placental abruption, infection, hemorrhage, and peripheral organ injury. Results: A total of 41 amnioinfusion procedures were performed for 19 patients. The median gestational age during the procedure was 24.3 weeks. The median volume of the injected amniotic fluid was 250 mL. The median single deepest pocket and amniotic fluid index after amnioinfusion were significantly higher than those before amnioinfusion (4.0 cm vs. 2.65 cm; p < 0.001 and 13.4 cm vs. 6.0 cm; p < 0.001). However, the median (range) intra-amniotic pressure after amnioinfusion was not significantly different compared to that before amnioinfusion (11 mm Hg vs. 11 mm Hg; p = 0.134). Maternal or fetal adverse events were not observed following amnioinfusion. Conclusion: Intra-amniotic pressure remained unchanged following amnioinfusion. The complications associated with increased intra-amniotic pressure are not likely to develop if the amniotic fluid index and/or single deepest pocket remains within the normal range after amnioinfusion. Studies of groups with and without complications are warranted to clarify the relationship between the intra-amniotic pressure and incidence of complications.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 69%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in the Intra-Amniotic Pressure following Transabdominal Amnioinfusion during Pregnancy

et al. 2021

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“…In contrast to the majority of prior reports, our data were not derived from serial amniodrainage for TTTS but from intraoperative measurements before and during amniodrainage in the recipient’s amniotic cavity immediately after fetoscopic laser ablations. Baseline pressures before amniodrainage were significantly elevated in comparison to data on the intrauterine pressure of healthy controls [ 21 , 22 ]. This indicates a state of intrauterine hypertension during the presence of severe TTTS establishing a type of “intrauterine compartment syndrome” and resembling abdominal compartment syndrome [ 23 ].…”

Section: Discussionmentioning

confidence: 95%

Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion Syndrome

Greimel

Klaritsch

Simonis

et al. 2020

JCM

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Twin-to-twin transfusion syndrome (TTTS) in monochorionic-diamniotic twin pregnancies usually requires fetoscopic laser ablation (FLA) followed by amniodrainage (AD). Perioperative maternal hemodynamic changes and hemodilution have been observed. Little is known about the underlying pathophysiology. We aimed to evaluate the impact of high volume amniodrainage on intrauterine pressure, placental thickness and maternal blood characteristics. A total of 18 cases of TTTS were included in this prospective pilot study. All patients were treated with FLA and subsequent AD. Intrauterine pressure and placental thickness were assessed before, during and after amniodrainage. Maternal hemoglobin, hematocrit and serum albumin were measured at admission and 24 h after the intervention. Amniodrainage led to a decrease in mean intrauterine pressure (from 30.1 ± 8.1 mmHg to 17.6 ± 3.6 mmHg (p < 0.001)) and an increase in mean placental thickness (from 16.8 ± 6.4 mm to 31.83 ± 8.64 mm (p < 0.001)). There was a positive correlation between changes in placental thickness and the amount of amniodrainage during intervention (Pearson’s Rho 0.73; p = 0.001). Hematocrit decreased from 33.4 ± 3.8 (%) to 28.4 ± 3.5 (%), i.e., an increase in relative blood volume by 18 ± 10.2% (p < 0.001). Albumin decreased from 37.9 ± 0.9 g/L to 30.7 ± 2.2 g/L, i.e., an increase in relative plasma volume by 24 ± 8.1% (p < 0.001). Amniodrainage leads to uterine decompression, increased placental thickness and subsequent maternal hemodilution. We propose the term “amniodrainage-induced circulatory dysfunction” for these specific maternal hemodynamic changes in the treatment of twin-to-twin transfusion syndrome.

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Transabdominal amnioinfusion: An evaluation of its adverse events

Nagai

Takahashi

Iwagaki

et al. 2022

European Journal of Obstetrics & Gynecology and Reproductiv

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Relationship between higher intra-amniotic pressures in polyhydramnios and maternal symptoms

Cited by 3 publications

References 9 publications

Changes in the Intra-Amniotic Pressure following Transabdominal Amnioinfusion during Pregnancy

Changes in the Intra-Amniotic Pressure following Transabdominal Amnioinfusion during Pregnancy

Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion Syndrome

Transabdominal amnioinfusion: An evaluation of its adverse events

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