Acute Polyhydramnios in Twin Pregnancy a Retrospective Study with Special Reference to therapeutic Amniocentesis

Abstract

Acute polyhydramnios in monozygotic twin pregnancy causes severe maternal discomfort and carries a high risk of premature labor. During the years 1980 to 1987, 36 patients with this complication were delivered in Sweden, giving an incidence of 1/20,000 births, or 1/200 twin births. In 18 patients (group A) who were treated with one or more amniotic taps, the delivery was postponed by 2 weeks, as compared with one week in 18 conservatively treated patients (group B). The peri- and neonatal death rate was 47% in group A and 58% in group B. Our own experience is that amniotic taps are safe if the amniotic fluid is removed slowly under prophylactic tocolysis. It gives symptomatic relief to the mother and may postpone labor until the gestational age of the twins is more compatible with survival.

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome

“…The survival with AR is significantly better in the NIH trial (60%) than in the Eurofoetus trial (41%) and consistent with single institution series [6][7][8][9][10][11][12] , a prospective randomized trial 15,16 , and registries (60-65%) 34,35 . This may be due to the standardized aggressive protocol used for serial AR in the NIH trial.…”

“…Numerous treatment options for TTTS have been reported, including amnioreduction (AR) [6][7][8][9][10][11][12] , intertwin septostomy [13][14][15][16] , non-selective fetoscopic laser [17][18][19][20] selective fetoscopic laser photocoagulation (SFLP) [21][22][23][24][25][26][27][28] , and cord coagulation [29][30][31][32] , all of which have improved survival rates compared to the untreated natural history of TTTS. It has been controversial which of these treatment options would provide the best outcome in specific cases of TTTS.…”

Amniotic Septostomy for the Treatment of Twin Oligohydramnios-Polyhydramnios Sequence

“…In most cases, the polyhydramnios recurs after a few days to weeks and repeated decompression amniocenteses are required. However, several reported series include a number of cases in which the stuck twin syndrome resolved after a single amniocentesis or suddenly following an amniocentesis that was the last in a series, with no need for additional therapy [5,9,21,22]. Equalization of amniotic fluid volumes following a single amniocentesis was first reported by Wax et al [23] in a patient diagnosed at 27 4 / 7 weeks' gestation.…”

“…[Reprinted from 40, with permission. ] Due to differing diagnostic criteria and ascertainment bias, the estimated incidence of this syndrome in twin gestations has ranged widely between 1 and 26% [2,[4][5][6]. The data on perinatal mortality have also been affected by diagnostic inconsistencies and the general improvements in perinatal survival through the years.…”

Management of Twin–Twin Transfusion Syndrome: Laying the Foundation for Future Interventional Studies

“…However, the incidence may have been under-estimated due to different diagnostic criteria of early studies with more recent studies suggesting an incidence as high as 35% of monochorionic pregnancies (Radestad & Thomassen, 1990;Urig et al, 1990). TTTS accounts for 15-77% of perinatal mortality in twins (Steinberg et al, 1990;Weir et al, 1979).…”