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Pohl, M; Greimel, P; Klaritsch, P; Csapó, B; Simonis, H; Schneditz, D.
Feasibility of continuous intra-uterine pressure measurements during amnioreduction in twin-to-twin transfusion syndrome therapy.
Placenta. 2023; 142: 147-153. Doi: 10.1016/j.placenta.2023.09.003
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Führende Autor*innen der Med Uni Graz
Pohl Maximilian
Schneditz Daniel
Co-Autor*innen der Med Uni Graz
Csapo Bence Daniel
Greimel Patrick
Klaritsch Philipp
Simonis Holger
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Abstract:
INTRODUCTION: This work explores the feasibility of simultaneous and continuous intra-abdominal, intra-uterine, and arterial blood pressure measurements to examine the hemodynamic perturbation expected during therapeutic amnioreduction and to better understand the protective role of the placenta during that treatment. METHODS: Patients with twin-to-twin transfusion syndrome were treated with fetoscopic laser ablation followed by amnioreduction. Intra-abdominal, intra-uterine, and mean arterial pressures were simultaneously recorded during amnioreduction performed in steps of 200 mL. Placental thickness and uterine dimensions were measured before and after amnioreduction by ultrasonography. RESULTS: Useful pressure recordings were obtained between volume reduction steps and short hands-off periods in four studies. Median amnioreduction volume was 1400 mL corresponding to a median uterine volume reduction of 1121 mL. Mean intra-uterine pressure significantly fell from 24.8 to 13.6 mmHg (p = 0.011) and intra-abdominal pressure significantly decreased from 13.4 to 9.2 mmHg after amnioreduction (p = 0.015). Uterine pressure recordings revealed transient contractions (A, in mmHg) following individual amnioreduction steps, which increased with fractional amnioreduction (F, no dimension) (A = 17.23*F + 11.81; r = 0.50, p = 0.001). DISCUSSION: Simultaneous and continuous measurement of intra-abdominal, intra-uterine, and arterial blood pressures during amnioreduction is feasible. The dynamics reveal transient uterine contractions reaching levels comparable to those seen during childbirth which seem to oppose impending maternal hypovolemia by placental steal at the expense of temporarily reducing placental perfusion pressure and underline the importance of uterine and placental interaction.
Find related publications in this database (using NLM MeSH Indexing)
Pregnancy - administration & dosage
Humans - administration & dosage
Female - administration & dosage
Fetofetal Transfusion - surgery
Placenta - diagnostic imaging
Feasibility Studies - administration & dosage
Fetoscopy - administration & dosage
Laser Therapy - administration & dosage
Laser Coagulation - administration & dosage

Find related publications in this database (Keywords)
Twin -to -twin transfusion syndrome
Amnioreduction
Intra-uterine pressure
Intra-abdominal pressure
Placental perfusion pressure
Placental steal
Biomechanics
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