Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion Syndrome
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....
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| Format: | Article |
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MDPI AG
2020-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/7/2085 |
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| author | Patrick Greimel Philipp Klaritsch Holger Simonis Bence Csapó Maximilian Pohl Daniel Schneditz |
| author_facet | Patrick Greimel Philipp Klaritsch Holger Simonis Bence Csapó Maximilian Pohl Daniel Schneditz |
| author_sort | Patrick Greimel |
| collection | DOAJ |
| description | 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 (<i>p</i> < 0.001)) and an increase in mean placental thickness (from 16.8 ± 6.4 mm to 31.83 ± 8.64 mm (<i>p</i> < 0.001)). There was a positive correlation between changes in placental thickness and the amount of amniodrainage during intervention (Pearson’s Rho 0.73; <i>p</i> = 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% (<i>p</i> < 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% (<i>p</i> < 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. |
| first_indexed | 2024-03-10T18:43:28Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T18:43:28Z |
| publishDate | 2020-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-4e5b06eca5684e93909fe206f37232a72023-11-20T05:41:28ZengMDPI AGJournal of Clinical Medicine2077-03832020-07-0197208510.3390/jcm9072085Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion SyndromePatrick Greimel0Philipp Klaritsch1Holger Simonis2Bence Csapó3Maximilian Pohl4Daniel Schneditz5Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, AustriaDepartment of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, AustriaDepartment of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, AustriaDepartment of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, AustriaOtto Loewi Research Center, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, AustriaOtto Loewi Research Center, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, AustriaTwin-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 (<i>p</i> < 0.001)) and an increase in mean placental thickness (from 16.8 ± 6.4 mm to 31.83 ± 8.64 mm (<i>p</i> < 0.001)). There was a positive correlation between changes in placental thickness and the amount of amniodrainage during intervention (Pearson’s Rho 0.73; <i>p</i> = 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% (<i>p</i> < 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% (<i>p</i> < 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.https://www.mdpi.com/2077-0383/9/7/2085twin-to-twin transfusion syndromefetoscopyamniodrainagehemodilutionintrauterine pressure |
| spellingShingle | Patrick Greimel Philipp Klaritsch Holger Simonis Bence Csapó Maximilian Pohl Daniel Schneditz Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion Syndrome Journal of Clinical Medicine twin-to-twin transfusion syndrome fetoscopy amniodrainage hemodilution intrauterine pressure |
| title | Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion Syndrome |
| title_full | Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion Syndrome |
| title_fullStr | Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion Syndrome |
| title_full_unstemmed | Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion Syndrome |
| title_short | Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion Syndrome |
| title_sort | amniodrainage induced circulatory dysfunction in women treated for twin to twin transfusion syndrome |
| topic | twin-to-twin transfusion syndrome fetoscopy amniodrainage hemodilution intrauterine pressure |
| url | https://www.mdpi.com/2077-0383/9/7/2085 |
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