Name of the Procedure:

Amniocentesis; therapeutic amniotic fluid reduction (includes ultrasound guidance)

Summary

Amniocentesis with therapeutic amniotic fluid reduction is a medical procedure where excess amniotic fluid is removed from the amniotic sac using a needle, guided by ultrasound. This procedure is usually performed during pregnancy to manage conditions associated with high levels of amniotic fluid.

Purpose

The goal of the procedure is to relieve symptoms and potential complications caused by excess amniotic fluid, a condition known as polyhydramnios. Expected outcomes include reduced discomfort for the mother and reduced risk of preterm labor and other pregnancy complications.

Indications

• Diagnosis of polyhydramnios
• Symptoms such as abdominal pain, shortness of breath, or preterm labor risk
• Other ob-gyn indications where reduced amniotic fluid can improve maternal and fetal health

Preparation

• Patients should follow specific dietary instructions if provided by their healthcare provider.
• No fasting is generally required, but patients should arrive with a full bladder if advised for the ultrasound.
• An initial ultrasound assessment is performed to evaluate the amniotic fluid volume and the position of the fetus.

Procedure Description

1. The patient lies on an examination table, and an ultrasound is used to locate the amniotic sac and fetus.
2. The skin on the abdomen is cleaned with an antiseptic solution.
3. A local anesthetic may be applied to numb the area.
4. Under continuous ultrasound guidance, a thin needle is inserted through the abdominal wall into the amniotic sac.
5. Amniotic fluid is carefully withdrawn to reduce the overall fluid volume.
6. The needle is removed, and the site is cleaned and bandaged.

Duration

The procedure typically takes approximately 30 to 45 minutes from start to finish.

Setting

Amniocentesis with therapeutic amniotic fluid reduction is typically performed in a hospital or outpatient clinic with appropriate ultrasound and sterile equipment.

Personnel

• Obstetrician/Gynecologist (OB/GYN) or Maternal-Fetal Medicine Specialist
• Ultrasound technician
• Nurse or medical assistant

Risks and Complications

• Mild cramping or discomfort at the needle insertion site
• Rare risks include infection, amniotic fluid leakage, premature rupture of membranes, or preterm labor.
• Fetal injury is very rare due to real-time ultrasound guidance.

Benefits

• Reduced maternal discomfort and abdominal pressure
• Decreased likelihood of premature labor or birth complications
• Immediate relief of symptoms related to polyhydramnios

Recovery

• Patients are generally observed for a short period after the procedure to ensure stability.
• Instructions may include avoiding heavy lifting or strenuous activity for 24 hours.
• Follow-up ultrasound might be scheduled to monitor amniotic fluid levels and fetal well-being.

Alternatives

• Conservative management with regular monitoring
• Medications to reduce amniotic fluid production (though less commonly used)
• Choice of alternative treatments depends on the severity of polyhydramnios and the associated risks and benefits.

Patient Experience

• During the procedure, the patient may feel pressure or mild discomfort during needle insertion.
• Post-procedure cramping or mild soreness at the site is common.
• Any significant pain or unusual symptoms should be reported to the healthcare provider.

Pain management typically includes over-the-counter pain relievers as advised by the clinician, and supportive measures such as rest and hydration.