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In the case that the fluid does not reaccumulate, the reduction of amniotic fluid stabilizes the pregnancy. Otherwise, the treatment is repeated as necessary. There is no standard procedure for how much fluid is removed each time. There is a danger that if too much fluid is removed, the recipient twin could die.
In the first trimester, the main sources of amniotic fluid are fetal lung secretions, transportation of maternal plasma across the fetal membranes, and the surface of the placenta. By the second trimester, the fetal kidneys start to produce urine which becomes the main source of the amniotic fluid for the remainder of the pregnancy. [4]
It is characterized by changes in fetal movement, growth, heart rate, and presence of meconium stained fluid. [4] Risk factors for fetal distress/non-reassuring fetal status include anemia, restriction of fetal growth, maternal hypertension or cardiovascular disease, low amniotic fluid or meconium in the amniotic fluid, or a post-term pregnancy.
At 13 weeks pregnant, Vogas felt a "pop." She ran to the bathroom and realized her water had broken. An ultrasound showed that Wally's amniotic sac had ruptured, and he had very little amniotic fluid.
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Amniotic fluid is removed from the mother by an amniocentesis procedure, where a long needle is inserted through the abdomen into the amniotic sac, using ultrasound guidance such that the fetus is not harmed. Amniocentesis is a low risk procedure, with risk of pregnancy loss between 1 in 1,500 – 1 in 700 procedures.
Sulindac has been used experimentally in some monoamniotic twins, lowering the amount of amniotic fluid and thereby inhibiting fetal movement. This is believed to lower the risk of cord entanglement and compression. However, the potential side effects of the drug have been insufficiently investigated. [1] [4]
[1] [4] If everything is stable, vaginal delivery may be tried, otherwise cesarean section is recommended. [1] In those less than 36 weeks pregnant, corticosteroids may be given to speed development of the baby's lungs. [1] Treatment may require blood transfusion or emergency hysterectomy. [2] Placental abruption occurs in about 1 in 200 ...