Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Zenz, A.
Maternal complications and hemodynamic effects following intrauterine interventions for complicated monochorionic pregnancies
– a retrospective study
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2018. pp. 51
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Greimel Patrick
- Klaritsch Philipp
- Altmetrics:
- Abstract:
- Purpose: Twin-to-twin transfusion syndrome (= TTTS) is a complication of monochorionic twin pregnancies on the basis of placental anastomoses between the two fetuses. Through these anastomoses significant volume shifts may arise leading to discordant amniotic fluid levels, hemodynamic changes, stepwise deterioration and eventually intrauterine death (IUFD) of one or both fetuses. The only causative treatment of TTTS consists of intrauterine laser photocoagulation of the placental anastomoses or selective feticide by cord occlusion in the case of unfavorable prognosis to save at least one child. An important part of intrauterine interventions is the amniodrainage at the end of the procedure. Following large-volume drainage maternal hemodynamic changes have been reported. These included signs of hemodilution and hypovolemia as well as impaired kidney function. The underlying pathophysiology is currently not entirely clear. Methods: This study is a retrospective data analysis of 80 intrauterine interventions in complicated monochorionic twin pregnancies performed at the Department of Obstetrics and Gynecology at the Medical University of Graz between 2010 and 2016. Maternal parameters such as drained volume of amniotic fluid, hemoglobin, hematocrit, albumin, blood pressure, heart rate and volume of diuresis pre- and postoperative and intervention-related complications were analyzed. Results: The average drainage volume was 1400 ml (range 0 - 4040 ml). A significant decrease of maternal hemoglobin, hematocrit and albumin between pre- and postoperative could be described. Maternal systolic and diastolic arterial blood pressure and heart rate showed a significant change postoperatively. A correlation between volume of amnioreduction and change of hemoglobin, hematocrit and albumin could be demonstrated. The maternal diuresis showed a significant decrease between six and twelve hours postoperatively. There was a significant negative correlation between maternal BMI (Body-Mass-Index) and postoperative arterial blood pressure changes. A significant correlation between amount of drained amniotic fluid and pPROM (preterm premature rupture of membrane) as one of the most important complications of intrauterine interventions could be illustrated. The total rate of maternal complications following intrauterine interventions was 4% (n=3). Conclusion: Severe maternal complications due to intrauterine interventions are extremely rare. Hemodynamic changes occur far more frequently, which still keep the exact pathophysiological background open at present.