Obstetrical results in women who underwent intrauterine invasive procedures during the pregnancy

OBJECTIVE: The aim of this study was retrospective analysis of the results of pregnancies among women who had intrauterine invasive procedures (IIP)--amnioinfusion, amnioreduction, cordocentesis and shunts, based on the materials from Polish Mother's Memorial Hospital Research Institute in 2000-2003. MATERIAL AND METHODS: 320 women performed IIP: amnioinfusions due to the oligohydramnion (frequently connected with congenital fetal abnormalities) or premature rupture of membranes. Amnioreduction due to the polihydramnion (also in a twin pregnancy with TTTS syndrome). Implantation of shunts in fetal abnormalities--hydrocephalus, megabladder, CALM. Cordocentesis--diagnostic or therapeutic in a fetal immunisatio anty-Rh factor and fetal arrhythmias. RESULTS: The total percentage of pregnancy failure after IIP was 53.2%. The best results were in the groups with hydrocephalus and immunisatio anty Rh factor, the worst in the group of patients with severe oligohydramnion due to the congenital abnormalities of fetuses' kidney. The most frequent early complications after IIP were premature rupture of membranes (12.2%), fetal hypoxia (13.7%) and premature constrictions of uterus (8.4%). 21.3% of patients delivered in less than 5 days after IIP ( delivery or abortion) due to the early complications or after resolving the obstetrical situation, e.g. the genetic reason of fetal abnormalities or lethal abnormalities. More complications were connected with amnioinfusion than with amnioreduction. Cordocentesis seemed not to be connected with more often appearing of fetal hypoxia. CONCLUSION: (1) IIP are connected with a big percentage of pregnancy failure, but it is more a result of fetal serious disease than a intrauterine procedure. (2) Performing an amnioinfusion or cordocentesis in severe oligohydramnion gives a quick diagnosis of fetal potential abnormalities and makes it possible to outlook the fetal prognosis. (3) Patients should be as early as possible qualificated to IIP to avoid complications caused by the primary fetal disease. (4) Patients for IIP should be carefully selected and prepared. They need very strict observation for a fetal well-being and monitoring the infective factors after the procedure.