Nursing of patients undergoing amnioreduction by fast and negative pressure drainage / 中国实用护理杂志

[Objective] To summarize the perioperative nursing points during the amnioreduction by fast and negative pressure drainage.[Methods] Amniodrainage and associated nursing care were performed in 93 hydramnios cases of pregnant women from January 2006 to December 2010,and the nursing key points were summarized.[Results] Operations were performed successfully in 93 hydramnios cases of pregnant women.No complications occurred in 92 eases 3 d after operation.Bellyache and uterine contraction occurred in one case 2h after operation,which indicated placental abruption,two dead fetuses were got out by cesarean section.[Conclusions] The nursing key points included preoperative psychological nursing by interpretation of the operation,monitoring fetal heart sounds and close observation of contrac-tions in pregnant women.Careful perioperative nursing for patients with hydramnios is important to improve the success rate and reduce postoperative complications.

The Cause, Diagnosis, and Management of Polyhydramnios / 대한주산의학회잡지

Amniotic fluid plays an important role in fetal development and growth. Amniotic fluid volume should be maintained adequately throughout gestational periods. Polyhydramnios is a relatively common obstetrical problem, but is associated with poor perinatal outcome both in mother and fetus. For the proper management of polyhydramnios, it is important to find out accurate causes, but it is not easy even if obstetricians perform thorough prenatal assessments. It is also important to understand the regulation of amniotic fluid volume. Based on these backgrounds, this article will briefly review mechanisms of the regulation of amniotic fluid, and will also review diagnosis, etiologies, managements and prognosis of polyhydramnios.

One case of monoamniotic twin pregnancy with cord entanglement and fetus survival at 32+4 weeks after successful medical amnioreduction and intensive ultrasound surveillance / 대한산부인과학회지

Monoamniotic twin pregnancies are relatively rare, but perinatal mortality is high about 30-70%. The major cause of fetal death is cord accident, congenital anomalies, twin-twin transfusion syndrome, and intrauterine growth restriction. Especially cord entanglement occurs; perinatal mortality is about 50%. So the active management of monoamniotic twins to reduce the complication of cord entanglement is important. This is a case of monoamniotic twin pregnancy with cord entanglement and both fetuses survival by elective cesarean section at 32+4 weeks after medical amnioreduction and intensive fetal surveillance.

Twin-twin transfusion syndrome; TTTS / 대한산부인과학회지

Twin-twin transfusion syndrome (TTTS) is a complex cardiovascular disease affecting monochorionic (MC) twin pregnancies, and has a high perinatal mortality rate. Its pathogenesis remains poorly understood, but TTTS involves unbalanced transfusion of blood from a donor to a recipient along one or more placental arteriovenous anastomosis in absence of adequate compensatory superficial counter-transfusion. Recent data demonstrated laser ablation to be better than amnioreduction, especially when the condition develops before 26 weeks of gestation.

Three cases of Twin-to-Twin Transfusion Syndrome which were managed with maternal digitalization / 대한산부인과학회잡지

Twin-to-twin transfusion syndrome (TTTS) is one of the complications showing high mortality rate in monochorionic twins with vascular communication in the placenta. Clinical manifestations of TTTS are usually characterized by polyhydramnios, circulatory overload, cardiac failure and fetal hydrops in the recipient twin and symmetrical fetal growth restriction, oligohydramnios, hypovolemia and anemia in the donor twin. TTTS occurres in 10-35% of monochorionic twins. We report three cases of TTTS with fetal hydrops in which amnioreduction was serially attempted and maternal digoxin treatment was tried for the therapeutic purpose.

Experiences of Amnioreduction and Emergency Cerclage for Advanced Cervical Incompetence / 대한산부인과학회잡지

Cervical incompetence is one of the main contributors to repeated pregnancy loss and preterm delivery. Typically it results in progressive cervical dilatation, leading to a painless second or early third trimester abortion. Emergency cerclage can be used in the setting of advanced cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure, various techniques have been developed to replace the fetal membranes into the uterine cavity. We performed six successful cases of emergency cerclage combined with amnioreduction in advanced incompetent internal os of cervix (IIOC). Interval from emergency cerclage to delivery was 8.1 +/- 2.4 weeks (range 4-10 weeks) and we delivered viable fetuses in all but one. Hereby we report our experiences with a brief review of literature.

A Case of Amnioreduction in Prolapsed Membranes After McDonald Cerclage / 대한산부인과학회잡지

Incompetent internal os of cervix is treated with McDonald or Shirodkar cerclage after 14 weeks of gestation. In rare case, after 20 weeks of gestation fetal membrane is bulging into vaginal cavity, but cerclage in that period is risk factor for preterm labor and preterm premature rupture of membranes. So many complications are reported in that period. So many experiences for reducing fetal membranes into uterine cavity were performed. We report a case of amnioreduction in prolapsed fetal membranes after McDonald cerclage, and delivered in 33 weeks of gestation with brief review of literature.

A Case of Twin Pregnancy with One Anencephalic Fetus / 대한산부인과학회잡지

Congenital anomalies occur in 2-3% of neonates but this incidence increases in multiple pregnancies, especially when fetuses are monozygotic. when pregnancies are affected with one anomalous fetus combined to a normal one, the proper management and counseling is difficult.We experienced a twin pregnancy in which one anencephalic fetus was combined to a normal one. Karyotype analysis was normal in both fetus. After close counseling we decided to continue the pregnancy. Intermittent amnioreduction was done for persistent polyhydramnios. At 29 weeks of gestation membrane was ruptured prematurely and we delivered by cesarean section due to breech-cephalic presentation. The birth weight of the normal and anencephalic fetuses were 1070 gm and 1050 gm, respectively. The anencephalic fetus died immediately after birth but the healthy one showed good crying and movement and its Apgar score was 6 in 1 minute and 8 in 5 minute. Although the infant needed intensive care for 90 days in the nursery room finally discharged in good condition. We report a case of twin pregnancy in which anencephaly was associated with a normal fetus, so after close counseling we opted to continue the pregnancy resulting in the delivery of a viable fetus.