Amniotic fluid is the liquid that surrounds and protects a fetus during the pregnancy. In some cases, when too much amniotic fluid builds up within the uterus, it can lead to complications. This condition, known as polyhydramnios, is diagnosed with the use of an ultrasound. If polyhydramnios becomes severe, the chance of complications increases and may affect maternal and fetal health. Should this occur, maternal-fetal medicine specialist may perform a procedure, called amnioreduction, to help alleviate maternal symptoms and improve pregnancy outcomes.
What is Polyhydramnios?
Polyhydramnios is a condition where excess amniotic fluid builds up in the uterus. It typically occurs in the later stages of pregnancy (particularly in the third trimester) and is usually mild.
While expectant management, or monitoring the condition closely, is usually undertaken in mild or asymptomatic cases, amnioreduction may be used in severe cases of polyhydramnios to reduce fluid levels, which in turn may improve maternal symptoms and decrease other risks.
Polyhydramnios may be caused by many factors such as maternal diabetes, accelerated fetal growth (macrosomia), infections, genetic syndromes, fetal anomalies that interfere with effective fetal swallowing, and others. Despite these potential causes, polyhydramnios is often idiopathic (no cause identified).
Severe polyhydramnios can lead to complications such as preterm labor and preterm delivery, difficulty breathing and abdominal pain in the mother. There are also increased risks of placental complications that may have an impact on fetal health.
What is Amnioreduction?
Amnioreduction is a therapeutic procedure used to reduce the amniotic fluid volume in the uterus. This is done to help relieve symptoms, such as shortness of breath, and reduce risks associated with having excess amniotic fluid, a condition known as polyhydramnios.
Indications for Amnioreduction in Pregnancy
Amnioreduction may be indicated for severe cases of polyhydramnios which are causing significant symptoms such as shortness of breath. Severe polyhydramnios can be caused by conditions such as fetal anomalies that interfere with normal fetal swallowing, poorly controlled diabetes, genetic conditions, and others.
How Amnioreduction Helps Manage Pregnancy Complications
Polyhydramnios has been linked with complications in pregnancy, and when polyhydramnios is severe, it can result in preterm labor and increased risks for the fetus, while also causing shortness of breath and other discomfort for the mother. By reducing the excess fluid through amnioreduction, these risks and symptoms can be decreased.
What are the Risks of Amnioreduction?
Amnioreduction is considered an overall safe procedure and can be successful in relieving symptoms in many cases. However, like any medical procedure, it has some risks, including:
- Premature rupture of membranes (water breaking early)
- Preterm labor (contractions leading to early delivery)
- Cramping
- Infection (rare)
- Bleeding or spotting (rare)
- Fetal distress (rare)
How is the Procedure Performed?
Similar to amniocentesis, amnioreduction procedures involve inserting a needle through the abdomen, guided by ultrasound. Your doctor will determine the appropriate amount of amniotic fluid which will then be removed over the course of 30-60 minutes. You are closely monitored during the procedure, and an ultrasound is used to check on the baby. You may be observed for a short time after the procedure before going home. More than one procedure may be necessary.
What to expect after the procedure:
- Cramping or mild discomfort at the needle site may occur but should be temporary.
- You should avoid strenuous activity for a few days.
- You will need to follow up for an ultrasound within a few days to a week to recheck the fluid levels.
When should I seek medical attention after amnioreduction?
After your amnioreduction procedure, it’s important to monitor your symptoms. Contact your healthcare provider if you experience vaginal bleeding, leakage of fluid (water breaking), significant abdominal pain or cramping/contractions, fever, difficulty breathing, or decrease in fetal movements.
If you have any concerning symptoms during the night or on the weekend, please contact your OB office to speak with the OB physician on call. In case of a medical emergency, call 911, or proceed to the nearest hospital ER for evaluation.
What Happens After Amnioreduction?
Immediately following the amnioreduction procedure, the mother and baby are monitored for complications for a period of time. Post procedure, instructions and information on follow-up appointments will be provided.
Book An Appointment!
If you have been referred by your primary care provider, OB-GYN or other healthcare provider, please call our office to schedule an appointment. Our dedicated team will help you understand what information to provide in advance to ensure you see the care best suited to your condition.