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Objective: To determine the effect of large amount of amnioreduction in symptomatic hydramnios pregnancy.
Methods: Twenty-two patients diagnosed with symptomatic hydramnios in period of January 1996 to August 2007 at the Department of Obstetrics and Gynecology, Chonnam National University Hospital, were analyzed retrospectively. The number of singleton pregnancy was 15, and twin pregnancy was 7. Hydramnios was defined as an amniotic fluid index of 25 cm or more. Amniotic fluid was reduced in a rate of 1 L/20 min in average through intravenous catheter after amniocentesis.
Result: The mean gestational age at diagnosis of hydramnios was 29±5.5 weeks. The mean interval from initial diagnosis to delivery was 24.3±23.5 days. The underlying causes of hydramnios were congenital malformation in 13 cases (37.5%) and idiopathic in 5 cases (22.7%). 29 fetal chromosome analyses were done with amniotic fluid: 24 fetuses (82.4%) were normal, 5 fetuses (13.8%) were abnormal karyotype. Overall, 34 times of amnioreduction were performed in twenty-two patients. Amnioreduction was done once in 16 patients (72.7%), two times in 1 patient (4.5%), three times in 4 patients (18.7%) and four times in 1 patient (4.5%). Symptoms were relieved in all patients after amnioreduction: abdominal discomfort and chest tightness were relieved in 34 out of 34 times of amnioreduction (100%), sleep disturbance in 25 out of 25 (100%) and dyspnea in 3 out of 3 (100%). Uterine contraction was relived in 16 out of 22 (72.7%). Complications of amnioreduction were in total 16 out of 34 (47.1%): preterm labor in 9 (26.4%), preterm delivery in 5 (13.8%). The number of cases with neonatal death was 10 (34.4%).
Conclusion: Amnioreduction for symptomatic hydramnios pregnancy appears to be beneficial. However, since the procedure was associated with high incidence of complications including preterm labor, use of prophylatic tocolytic before amnioreduction should be recommended to prevent preterm labor.