DECOMPRESSION AMNIOCENTESIS POLICY The removal of amniotic fluid via amniocentesis is used to treat severe and symptomatic polyhydramnios. The goal of this procedure is to relieve maternal symptoms and discomfort as well as reduce the risk of premature delivery. Applicability: Decompression Amniocentesis primarily occurs in the Diagnostic Ambulatory Program procedure room unless requested otherwise by Maternal Fetal Medicine. PROCEDURE 1.0 Preparation Registered Nurse • Gather the Supplies Required for the Procedure o Automatic Blood Pressure Machine o Oxygen saturation monitor o External Fetal Monitor o Ultrasound machine o Multipurpose Room Procedure Box (contents include): 1. pre-vac wound drainage bottle (600mLs) 10. 18G spinal needle 90mm 2. amniocentesis tray 11. 18G spinal needle 152mm 3. sterile bowl 12. 20G spinal needle 90mm 4. surgical scrub (chlorhexidine) 13. 20G spinal needle 152mm 5. 4x4 gauze 14. 10cc syringe 6. 2% xylocaine (no epi) 10cc each 15. sterile orange top specimen container 7. red blunt needle 8. 25G long needle 9. 3cc syringe • Admit the woman to the designated room in Surgical Services or Ultrasound Department. • Complete initial assessment using the BC Perinatal Triage and Assessment Record. • If GA >24 weeks, commence external fetal monitoring (EFM) and continue until 20 minutes of normal fetal heart rate is achieved (if delivery would be performed for fetal indications). • Notify the relevant MFM Obstetrician, resident on-call, and ultrasound technician of the woman’s admission. MFM Obstetrician or Resident On Call • Ensures consent form for amniocentesis decompression is signed. Ultrasound Sonographer • Conducts ultrasound pre-procedure to document fetal position, document FHR, perform amniotic fluid assessment (AFI and DVP) and to scout for most appropriate location to insert needle. WW.17.01 Fetal Maternal Newborn and Family Health Policy & Procedure Manual Effective Date: 24-JUN-2014 Page 1 of 3 Refer to online version – Print copy may not be current – Discard after use DECOMPRESSION AMNIOCENTESIS 2. 0 Decompression Amniocentesis MFM Obstetrician or Resident On Call • Surgical Preparation of amniodecompression location/site • Injection of local anesthetic to site if appropriate • Under ultrasound guidance inserts an 18-20 gauge spinal needle into the amniotic cavity. • Attaches need to drainage bottles and drainage begins. o Replaces drainage bottles under sterile conditions as required. o Total volume to be removed is dependent on diagnosis and need. Usually 1.5 to 3L is removed (2-5 bottles). o 5-10 minutes is required to fill each bottle. Total procedure time is therefore approx 15-45 minutes. • Removes needle when desired volume achieved. Ultrasound Sonographer (or designate) • Provides guidance to Procedurist. Checks FHR every 5-10 minutes. Registered Nurse: • Provides emotional support to patient and accompanying persons. • Aids and assists Procedurist when required. 3. 0 Post decompression Amniocentesis Ultrasound Sonographer (or designate) • Performs post procedure amniotic fluid assessment, documents FHR and position. Registered Nurse: • Observes woman post procedure for signs and symptoms of preterm labour. • If woman is pre-viable (less than 23+0, or requests non-intervention in peri-viable period (23+0 to 25+6 currently), post procedure monitoring is optional is at the discretion of MFM. 4.0 Fetal Monitoring Amniodecompression is classified as high or low risk. Low Risk: Monitor for 45 minutes in the Multipurpose or Procedure room • Cx long and closed, no prior signs of preterm labor or bleeding. • High Risk : Monitor for 3 - 4 hours in the Labour and Delivery Suite. • TPTL or uterine irritability pre-procedure. • Cx is open (> 2cm) and shortened (< 2 cm clinically). • Prior hx of significant bleeding or suspected abruption pre-procedure • Discretion of MFM if risk of PTL is significantly elevated (such as with multiples) DOCUMENTATION • BC Perinatal Triage and Assessment Record • Fetal Monitoring Label • Fluid Balance Record • Physician History and Progress Notes WW.17.01 Fetal Maternal Newborn and Family Health Policy & Procedure Manual Effective Date: 24-JUN-2014 Page 2 of 3 Refer to online version – Print copy may not be current – Discard after use DECOMPRESSION AMNIOCENTESIS REFERENCES Dickinson, J. E., Tjioe, Y. Y., Jude, E., Kirk, D., Franke, M., & Nathan, E. (2014). Amnioreduction in The Management of Polyhydramnios Complicating Singleton Pregnancies. American Journal of Obstetrics and Gynecology. Thompson, A., Mone, F., McComiskey, M., & Ong, S. (2013). Amnioreduction in a singleton pregnancy: A systematic review. Journal of Obstetrics & Gynaecology, 33(8), 764-767. WW.17.01 Fetal Maternal Newborn and Family Health Policy & Procedure Manual Effective Date: 24-JUN-2014 Page 3 of 3 Refer to online version – Print copy may not be current – Discard after use .