Prevention of premature birth by a transabdominal puncture procedure before the birth. Drainage of amniotic sac

Amniotic fluid is a major factor of the intrauterine environment, and devia tion from the normal volume is associated with an increased perinatal morbi dity and mortality. Polyhydramnios occurs in 0.2 to 1.6% of pregnancies. It may be due to a number of congenital anomalies, an abnormal karyotype, mat ernal diabetes, Rh-disease or intrauterine infections potentially requiring noninvasive or invasive measures. However, the most common indication for prenatal intervention due to polyhydramnios is the Twin-Twin-Transfusion Sy ndrom (TTTS). Treatment of polyhydramnios may focus on correction of the ca usative lesion, or symptomatic relief through drainage of amniotic fluid. M aternal administration of cyclooxygenase inhibitors represents a further, n on-invasive therapeutic option. Indomethacin, Sulindac, or Nimesulide reduc e the fetal urine output thus decreasing amniotic fluid volume over time wi thout the risks associated with invasive procedures. However, potentially s erious ductal constriction as well asa delay in the onset of amniotic fluid reduction have limited its application. Percutaneous amniotic fluid draina ge may provide immediate reduction of intrauterine pressure, but is associa ted with a complication rate of 1 to 1.5%. The hemodynamic characteristics of monochorionic pregnancies complicated by TTTS have led to the developmen t of endoscopic laser coagulation of placental vascular anastomoses as a de finitive treatment. Treatment is only required in a small minority of pregn ancies pregnancies with polyhydramnios. Mild cases can be managed expectati vely. Intrauterine pressure increases with an excessive increase in amnioti c fluid Volume (AFI > 400 mm or MVP > 150 mm) leads to the elevation of int rauterine pressure. Complications such as preterm premature rupture of memb ranes and preterm labor may lead to premature delivery. The main goal of pr enatal treatment of polyhydramnios is thus the improvement of fetal outcome through prolongation of gestation and/or the alleviation of maternal sympt oms.