title: Amnioreduction in the management of polyhydramnios complicating singleton pregnancies.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the contribution of amnioreduction to the management of singleton pregnancies that are complicated by symptomatic polyhydramnios.
  
  
  METHODS
  Retrospective review of all singleton pregnancies that received at least 1 amnioreduction for polyhydramnios from 2000-2012 at a single obstetric unit that provides a statewide service. The indications, procedural techniques, and pregnancy outcomes were evaluated.
  
  
  RESULTS
  One hundred thirty-eight women with polyhydramnios (maximal vertical pocket [MVP], ≥8 cm) had 271 amnioreduction procedures during the study period. The median gestation at the first drain was 31.4 weeks (interquartile range, 28.4-34 weeks) and a median of 1 procedure (interquartile range, 1-2 procedures) was performed per pregnancy. Sixty-three women (45.6%) required >1 amnioreduction. The median volume removed per pregnancy was 2100 mL (interquartile range, 1500-4260 mL). The median duration from the first amnioreduction until delivery was 26 days (interquartile range, 15-52.5 days). There was no significant association between gestation at delivery and the volume per procedure or total volume that was removed. Earlier gestation at first drain was associated positively with earlier gestations at delivery. In 4.1% of amnioreduction procedures (11/271 procedures), there was an unplanned preterm birth within 48 hours. The median gestation at delivery was 36.4 weeks (interquartile range, 34-38 weeks). The final diagnoses were gastrointestinal malformations (21%), idiopathic polyhydramnios (20.3%), chromosomal anomaly (15.2%), syndromic condition (13.7%), and neurologic condition (8%).
  
  
  CONCLUSIONS
  Amnioreduction has a useful role in the management of polyhydramnios in singleton pregnancies. Complications are uncommon, and delivery typically occurs near term.
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia; Women and Infants Research Foundation, Perth, WA, Australia.
authors.forename: Jan Elizabeth
authors.initials: JE
authors.lastname: Dickinson
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Yan Yan
authors.initials: YY
authors.lastname: Tjioe
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Jude
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kirk
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Franke
authors.affiliation: Women and Infants Research Foundation, Perth, WA, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nathan
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D046128:Fetal Therapies / Q000379:methods*; D006801:Humans; D016014:Linear Models; D008297:Male; D006831:Polyhydramnios / Q000000981:diagnostic imaging / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D013396:Suction; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D016216:Ultrasonography, Prenatal
keywords: amnioreduction; fetus; polyhydramnios; pregnancy