{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T12:08:18Z","timestamp":1783512498616,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T00:00:00Z","timestamp":1593648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Twin-to-twin transfusion syndrome (TTTS) in monochorionic-diamniotic twin pregnancies usually requires fetoscopic laser ablation (FLA) followed by amniodrainage (AD). Perioperative maternal hemodynamic changes and hemodilution have been observed. Little is known about the underlying pathophysiology. We aimed to evaluate the impact of high volume amniodrainage on intrauterine pressure, placental thickness and maternal blood characteristics. A total of 18 cases of TTTS were included in this prospective pilot study. All patients were treated with FLA and subsequent AD. Intrauterine pressure and placental thickness were assessed before, during and after amniodrainage. Maternal hemoglobin, hematocrit and serum albumin were measured at admission and 24 h after the intervention. Amniodrainage led to a decrease in mean intrauterine pressure (from 30.1 \u00b1 8.1 mmHg to 17.6 \u00b1 3.6 mmHg (p &lt; 0.001)) and an increase in mean placental thickness (from 16.8 \u00b1 6.4 mm to 31.83 \u00b1 8.64 mm (p &lt; 0.001)). There was a positive correlation between changes in placental thickness and the amount of amniodrainage during intervention (Pearson\u2019s Rho 0.73; p = 0.001). Hematocrit decreased from 33.4 \u00b1 3.8 (%) to 28.4 \u00b1 3.5 (%), i.e., an increase in relative blood volume by 18 \u00b1 10.2% (p &lt; 0.001). Albumin decreased from 37.9 \u00b1 0.9 g\/L to 30.7 \u00b1 2.2 g\/L, i.e., an increase in relative plasma volume by 24 \u00b1 8.1% (p &lt; 0.001). Amniodrainage leads to uterine decompression, increased placental thickness and subsequent maternal hemodilution. We propose the term \u201camniodrainage-induced circulatory dysfunction\u201d for these specific maternal hemodynamic changes in the treatment of twin-to-twin transfusion syndrome.<\/jats:p>","DOI":"10.3390\/jcm9072085","type":"journal-article","created":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T09:49:11Z","timestamp":1594028951000},"page":"2085","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion Syndrome"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1184-858X","authenticated-orcid":false,"given":"Patrick","family":"Greimel","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7359-4853","authenticated-orcid":false,"given":"Philipp","family":"Klaritsch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1512-2564","authenticated-orcid":false,"given":"Holger","family":"Simonis","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bence","family":"Csap\u00f3","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9031-5257","authenticated-orcid":false,"given":"Maximilian","family":"Pohl","sequence":"additional","affiliation":[{"name":"Otto Loewi Research Center, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0124-1012","authenticated-orcid":false,"given":"Daniel","family":"Schneditz","sequence":"additional","affiliation":[{"name":"Otto Loewi Research Center, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.placenta.2009.02.005","article-title":"The basic and clinical science of twin-twin transfusion syndrome","volume":"30","author":"Fisk","year":"2009","journal-title":"Placenta"},{"key":"ref_2","first-page":"480","article-title":"Natural history of twin-twin transfusion syndrome","volume":"46","author":"Berghella","year":"2001","journal-title":"J. Reprod. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1002\/uog.17520","article-title":"Fetoscopic laser coagulation in 1020 pregnancies with twin-twin transfusion syndrome demonstrates improvement in double-twin survival rate","volume":"50","author":"Diehl","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_4","first-page":"CD002073","article-title":"Interventions for the treatment of twin-twin transfusion syndrome","volume":"2014","author":"Roberts","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Greimel, P., Zenz, A., Csap\u00f3, B., Haeusler, M., Lang, U., and Klaritsch, P. (2019). Maternal Complications and Hemodynamic Changes Following Intrauterine Interventions for Twin-to-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies. J. Clin. Med., 8.","DOI":"10.3390\/jcm8050605"},{"key":"ref_6","first-page":"113","article-title":"Maternal metabolic abnormalities in twin-to-twin transfusion syndrome at mid-pregnancy","volume":"3","author":"Kuhlmann","year":"2000","journal-title":"Twin Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1159\/000080163","article-title":"Amniotic Fluid and Maternal Blood Characteristics in Severe Mid-Trimester Twin\u2013Twin Transfusion Syndrome","volume":"19","author":"Huber","year":"2004","journal-title":"Fetal Diagn. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1002\/uog.3815","article-title":"Maternal hemodynamic changes following treatment by laser coagulation of placental vascular anastomoses and amnioreduction in twin-to-twin transfusion syndrome","volume":"28","author":"Nizard","year":"2006","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1159\/000020894","article-title":"Equalization of amniotic fluid volumes after decompression amniocentesis for treatment of the twin oligohydramnios-polyhydramnios sequence","volume":"14","author":"Bruner","year":"1999","journal-title":"Fetal Diagn. Ther."},{"key":"ref_10","first-page":"148","article-title":"Studies in Foetal Pathology and Teratology: General Dropsy of the Foetus","volume":"17","author":"Ballantyne","year":"1892","journal-title":"Trans. Edinb. Obstet. Soc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1056\/NEJMoa032597","article-title":"Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome","volume":"351","author":"Deprest","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.1055\/s-0034-1378143","article-title":"Fetoscopic laser therapy for twin-twin transfusion syndrome: Beyond current gestational age limits","volume":"31","author":"Baud","year":"2014","journal-title":"Am. J. Perinatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1038\/sj.jp.7200292","article-title":"Staging of twin-twin transfusion syndrome","volume":"19","author":"Quintero","year":"1999","journal-title":"J. Perinatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1002\/uog.11136","article-title":"Two-dimensional sonographic placental measurements in the prediction of small-for-gestational-age infants","volume":"40","author":"Schwartz","year":"2012","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.3109\/14767058.2014.963047","article-title":"Two-dimensional sonographic assessment of maximum placental length and thickness in the second trimester: A reproducibility study","volume":"28","author":"Milligan","year":"2015","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1111\/hdi.12338","article-title":"Concordance of absolute and relative plasma volume changes and stability of Fcells in routine hemodialysis","volume":"20","author":"Schneditz","year":"2016","journal-title":"Hemodial. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1159\/000490893","article-title":"Intra-Amniotic Pressure of Twin-to-Twin Transfusion Syndrome","volume":"44","author":"Katsura","year":"2018","journal-title":"Fetal Diagn. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1159\/000264299","article-title":"Amniotic fluid pressure in twin-to-twin transfusion syndrome: An objective prognostic factor","volume":"11","author":"Ville","year":"1996","journal-title":"Fetal Diagn. Ther."},{"key":"ref_19","first-page":"284","article-title":"Intra-amniotic pressure reduction in twin-twin transfusion syndrome","volume":"18","author":"Garry","year":"1998","journal-title":"J. Perinatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/j.1479-828X.1995.tb01824.x","article-title":"Twin-twin transfusion syndrome: Intraamniotic pressure measurement in the assessment of volume reduction at serial amniocenteses","volume":"35","author":"Meagher","year":"1995","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1159\/000263555","article-title":"Amniotic fluid pressure during pregnancy","volume":"5","author":"Sideris","year":"1990","journal-title":"Fetal Diagn. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ejogrb.2019.02.006","article-title":"Relationship between higher intra-amniotic pressures in polyhydramnios and maternal symptoms","volume":"235","author":"Katsura","year":"2019","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1097\/MCC.0000000000000665","article-title":"Abdominal compartment syndrome and intra-abdominal hypertension","volume":"25","author":"Pereira","year":"2019","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1055\/s-2007-999270","article-title":"Reduction in the middle cerebral artery pulsatility index after decompression of polyhydramnios in twin gestation","volume":"9","author":"Mari","year":"1992","journal-title":"Am. J. Perinatol."},{"key":"ref_25","first-page":"299","article-title":"Effects of therapeutic amniocentesis on uterine and umbilical artery velocimetry in cases of severe symptomatic polyhydramnios","volume":"5","author":"Guzman","year":"1996","journal-title":"J. Matern. Fetal Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"722","DOI":"10.3109\/14767058.2014.929660","article-title":"Decreased placental thickness and impaired Doppler indices in idiopathic polyhydramnios: A prospective case-control study","volume":"28","author":"Tokmak","year":"2015","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1159\/000091361","article-title":"Hypothesis: The placental \u2018steal\u2019 phenomenon\u2014A possible hazard of amnioreduction","volume":"21","author":"Rodeck","year":"2006","journal-title":"Fetal Diagn. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/MAT.0b013e318243660f","article-title":"Correction of plasma concentrations for effects of hemoconcentration or hemodilution","volume":"58","author":"Schneditz","year":"2012","journal-title":"ASAIO J."},{"key":"ref_29","unstructured":"Rhoades, R., and Bell, D.R. (2013). Medical Physiology: Principles for Clinical Medicine, Lippincott Williams & Wilkins. [4th ed.]."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.placenta.2009.02.009","article-title":"Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy","volume":"30","author":"Burton","year":"2009","journal-title":"Placenta"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/0002-9378(95)90273-2","article-title":"Uterine artery blood flow response to correction of amniotic fluid volume","volume":"173","author":"Bower","year":"1995","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S0301-2115(01)00375-X","article-title":"In vitro placental pressure-flow behaviour is non-linear and depends on the external pressure","volume":"99","author":"Boer","year":"2001","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1111\/j.1742-1241.2007.01517.x","article-title":"Albumin infusion fails to restore circulatory function following paracentesis of tense ascites as assessed by beat-to-beat haemodynamic measurements","volume":"62","author":"Schneditz","year":"2008","journal-title":"Int. J. Clin. Pract."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Schneditz, D., Sauseng, N., P\u00fct\u00fcn, E., Rosenkranz, A.R., and Ribitsch, W. (2020). Supine equilibration of extracellular fluid in peritoneal dialysis varies with intra-abdominal pressure. Perit. Dial Int.","DOI":"10.1177\/0896860819895176"},{"key":"ref_35","first-page":"295","article-title":"Understanding the mechanisms of paracentesis-induced circulatory dysfunction","volume":"16","author":"Such","year":"2004","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/uog.17360","article-title":"Physiological adaptation of maternal plasma volume during pregnancy: A systematic review and meta-analysis","volume":"49","author":"Spaanderman","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/7\/2085\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:46:34Z","timestamp":1760175994000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/7\/2085"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,2]]},"references-count":36,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["jcm9072085"],"URL":"https:\/\/doi.org\/10.3390\/jcm9072085","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,2]]}}}