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Fetal Therapy · Nagpur

Amnioreduction in Nagpur
Relief for Polyhydramnios

When too much amniotic fluid builds up around your baby, it can cause real discomfort — and real risk. Amnioreduction is a safe, ultrasound-guided procedure that drains the excess fluid, restoring balance and protecting your pregnancy. Performed at Mayflower Fetal Medicine Centre under the expert care of Dr. Kunda Shahane.

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20,000+
Fetuses Evaluated
14+
Years Fetal Medicine
GE Voluson
Signature Expert
FMF
London Certified
👩‍⚕️
Dr. Kunda Shahane
MBBS · MS (Obs & Gynae) · FIFM · FMF (London) — Central India's First Fetal Medicine Specialist
Amnioreduction is one of several fetal therapy procedures Dr. Kunda Shahane performs under real-time ultrasound guidance at Mayflower Clinic — bringing advanced interventional fetal care to Nagpur, Vidarbha, and Central India. Patients from Amravati, Akola, Wardha, Yavatmal, and Chandrapur come here to avoid the need to travel to Mumbai or Pune.
Pioneer of Fetal Therapy, Vidarbha IIFM — Indian Institute of Fetal Medicine GE Voluson Signature Expert
Understanding the Procedure

What Is Amnioreduction?

Amnioreduction is an ultrasound-guided procedure in which a fine needle is inserted into the amniotic sac and excess amniotic fluid is carefully drained. It is the primary treatment for severe polyhydramnios — a condition where the baby is surrounded by too much fluid — and is also used in selected cases of twin-to-twin transfusion syndrome (TTTS).

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What Is Polyhydramnios?

The baby swallows amniotic fluid throughout pregnancy — this is how normal fluid levels are maintained. Polyhydramnios occurs when this balance breaks down: either too much fluid is produced, or the baby cannot swallow it effectively. It is diagnosed when the amniotic fluid index (AFI) rises above 24 cm, or the deepest vertical pocket (MVP) exceeds 8 cm on ultrasound.

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What Does Amnioreduction Do?

A needle is placed into the amniotic cavity under continuous ultrasound monitoring. Excess fluid is slowly drained — typically 500 mL to 2,000 mL per session — until the AFI or MVP reaches a safe, normal range. This relieves maternal discomfort, reduces the risk of preterm labour, and improves conditions inside the uterus. The procedure is performed at Mayflower Clinic in Nagpur and takes 20–45 minutes.

Amniotic Fluid Classification — How Is Severity Graded?

Category AFI (Amniotic Fluid Index) MVP (Deepest Vertical Pocket) Clinical Significance
Normal 8–24 cm 2–8 cm No intervention required
Mild Polyhydramnios 25–29 cm 8–11 cm Close monitoring; address underlying cause
Moderate Polyhydramnios 30–34 cm 12–15 cm Detailed fetal assessment; amnioreduction may be indicated
Severe Polyhydramnios ≥ 35 cm ≥ 16 cm Amnioreduction strongly indicated; maternal distress, preterm risk

* AFI and MVP measurements are performed on the GE Voluson Signature Expert. Dr. Kunda Shahane uses both measurements together with clinical symptoms to determine the need for and timing of amnioreduction.

Why It Happens

What Causes Polyhydramnios?

Finding the cause of polyhydramnios is as important as treating the fluid — because the underlying condition determines the risk to the baby and the management plan. Dr. Kunda Shahane performs a detailed fetal assessment alongside AFI measurement to identify or exclude each of these causes.

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Gestational Diabetes
~25% of cases
  • Most common identifiable cause
  • Elevated fetal blood glucose increases fetal urine output
  • Managing GDM reduces fluid accumulation
  • GTT screen is essential if not already done
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Fetal GI / Swallowing Anomalies
Structural cause
  • Oesophageal or duodenal atresia
  • Fetal swallowing disorder
  • Neuromuscular conditions (arthrogryposis)
  • Cleft palate affecting swallowing
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Chromosomal Anomalies
Genetic cause
  • Trisomy 21 (Down syndrome)
  • Trisomy 18 and 13
  • Associated with impaired swallowing
  • NIPT or amniocentesis may be advised
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Twin-to-Twin Transfusion (TTTS)
MCDA twins
  • Recipient twin overproduces urine
  • Leads to severe polyhydramnios in recipient sac
  • Amnioreduction used alongside laser evaluation
  • Only affects monochorionic twins
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Fetal Infections
TORCH-related
  • CMV, toxoplasmosis, parvovirus B19
  • Can impair fetal neurological function
  • Affects swallowing reflex
  • Maternal TORCH serology may be needed
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Idiopathic
30–40% of cases
  • No cause found after full evaluation
  • Generally carries better prognosis
  • Mild-to-moderate idiopathic cases may resolve
  • Still requires serial AFI monitoring
Indications

When Is Amnioreduction Needed?

Not all cases of polyhydramnios require drainage. Dr. Kunda Shahane evaluates each case individually, balancing the severity of fluid excess, the underlying cause, gestational age, and the mother's symptoms before recommending intervention.

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Significant Maternal Symptoms
Severe abdominal distension, shortness of breath, difficulty walking, or inability to sleep due to pressure — when symptoms are significantly affecting daily life and quality of pregnancy.
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Preterm Labour Risk
Severe polyhydramnios stretches the uterus and raises the risk of preterm contractions, premature rupture of membranes, and early labour — amnioreduction is used to reduce uterine distension and prolong the pregnancy.
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Severe Polyhydramnios on Scan
AFI ≥ 35 cm or MVP ≥ 16 cm, even in the absence of dramatic symptoms — the degree of fluid excess itself justifies intervention to prevent uterine overdistension and associated risks.
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TTTS — Recipient Twin
In twin-to-twin transfusion syndrome, amnioreduction from the recipient twin's sac relieves pressure, reduces preterm labour risk, and can serve as a bridging treatment while laser ablation referral is arranged.
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Serial Drainage
When fluid rapidly re-accumulates after a first session — as is common with certain structural causes or uncontrolled GDM — repeat amnioreduction every 1–3 weeks may be planned to maintain a safe fluid level.
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Diagnostic Assistance
In select cases, draining fluid improves ultrasound visualisation of the baby's anatomy — allowing better assessment of suspected structural anomalies that were obscured by the excessive fluid volume.
Step-by-Step

How Is Amnioreduction Performed?

The procedure is performed by Dr. Kunda Shahane in the procedure room at Mayflower Fetal Medicine Centre. There is no hospitalisation required for straightforward cases — you are monitored for a period after the procedure and discharged home the same day.

1
Pre-Procedure Assessment
Dr. Kunda Shahane performs a detailed real-time ultrasound on the GE Voluson Signature Expert. The AFI and MVP are accurately measured, the fetal position is assessed, the placental location is mapped, and the ideal needle entry point is selected — away from the baby, the umbilical cord, and the placenta.
2
Skin Preparation & Local Anaesthetic
The abdomen is cleaned with antiseptic solution. Local anaesthetic is injected into the skin and underlying tissue at the planned needle entry site. This minimises discomfort during needle insertion.
3
Needle Insertion Under Continuous Ultrasound Guidance
Under real-time GE Voluson Signature Expert imaging, a fine 18–22 gauge needle is guided into the amniotic cavity. The entire needle path is visible on screen at every moment — this is the critical difference between skilled fetal medicine-guided procedures and standard obstetric procedures.
4
Controlled Fluid Drainage
Amniotic fluid is drained slowly and steadily — typically 500 mL to 2,000 mL per session. The rate of drainage is controlled throughout. The fetal heart rate is monitored continuously. The procedure continues until the AFI reaches the target range (usually 12–15 cm) or the woman's symptoms are relieved.
5
Needle Withdrawal & Final Ultrasound Check
Once the target AFI is reached, the needle is withdrawn smoothly. A final ultrasound scan confirms the new fluid level, checks fetal wellbeing, and verifies normal fetal heart activity. The entry point is covered with a small sterile dressing.
6
Post-Procedure Monitoring & Discharge
You rest at the clinic for 30–60 minutes. The fetal heart rate is monitored during this time. If all is well, you are discharged with written instructions. A follow-up AFI scan is typically scheduled within 1–3 weeks. Most women feel significant relief from pressure, breathlessness, and discomfort within a few hours.
Expert Evaluation

What Dr. Kunda Shahane Evaluates

Amnioreduction is not simply a fluid drainage procedure — it is always preceded by a comprehensive fetal assessment. Dr. Kunda Shahane's evaluation determines whether the procedure is indicated, at what volume to drain, and whether the polyhydramnios may be concealing an underlying fetal problem that requires separate management.

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AFI & MVP Measurement
Precise measurement of amniotic fluid index and maximum vertical pocket using the GE Voluson Signature Expert — determines severity and the target volume to drain.
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Fetal Heart Rate Monitoring
Continuous fetal heart rate assessment before, throughout, and after the procedure — any sign of fetal distress is identified immediately and the procedure paused or completed accordingly.
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Fetal Anatomy Assessment
Detailed evaluation of the fetal upper GI tract (oesophagus, stomach, duodenum), brain, spine, and kidneys — to identify structural causes of polyhydramnios such as oesophageal or duodenal atresia.
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Doppler Blood Flow Studies
Umbilical artery, middle cerebral artery (MCA), and ductus venosus Doppler — assesses whether the fetus is adapting normally to the fluid excess and detects any compromise in placental or fetal circulation.
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Placental Mapping
Precise identification of placental location, cord insertion, and the safest needle entry path — avoids the placenta entirely and reduces risk of placental trauma or bleeding during the procedure.
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Twin Assessment (TTTS)
In twin pregnancies, both twins' fluid levels, bladder filling, growth, and Doppler are evaluated together — to stage TTTS accurately and determine whether amnioreduction, expectant management, or urgent laser referral is the appropriate step.
Technology Advantage

Why Ultrasound Guidance Matters

Every amnioreduction at Mayflower Clinic is performed under real-time GE Voluson Signature Expert ultrasound — the most advanced AI-enabled fetal ultrasound system available in India. The quality of ultrasound guidance directly determines the safety of needle placement and the accuracy of fluid measurement.

GE Voluson Signature Expert
India's Most Advanced AI-Enabled Fetal Ultrasound

The GE Voluson Signature Expert provides crystal-clear real-time imaging throughout the procedure — ensuring the needle is visible at every moment, the fetus and placenta are never in the needle path, and fluid measurement is accurate to within millimetres.

Real-Time Needle Visualisation
The entire needle path is visible on screen from insertion to drainage — every millimetre is guided, not estimated.
SonoLyst AI Technology
AI-driven anatomy identification assists in identifying fetal landmarks and confirming safe needle placement zones.
Colour Doppler
Real-time colour flow mapping confirms avoidance of blood vessels, cord loops, and placental edges throughout the procedure.
Precise AFI Measurement
Accurate pre- and post-procedure AFI and MVP measurement ensures the target drainage volume is achieved — not estimated.
Special Indication

Amnioreduction for Twin-to-Twin Transfusion Syndrome (TTTS)

TTTS is a complication exclusive to monochorionic (shared placenta) twin pregnancies. Abnormal blood vessel connections on the placenta cause one twin — the donor — to give blood to the other — the recipient. The recipient overproduces urine, filling its amniotic sac with too much fluid (severe polyhydramnios), while the donor's sac has too little (oligohydramnios). This imbalance, if untreated, is life-threatening for one or both twins.

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Amnioreduction's Role in TTTS

The definitive treatment for Stage II–IV TTTS is fetoscopic laser ablation — a specialised procedure that seals the abnormal placental vessels. However, laser is only available at select tertiary centres. In the interim — or for Stage I TTTS that does not require immediate laser — amnioreduction at Mayflower Clinic provides critical relief.

🩹 What Amnioreduction Achieves in TTTS

  • Drains excess fluid from the recipient's sac
  • Reduces uterine distension and preterm labour risk
  • Relieves severe maternal discomfort
  • May temporarily improve placental blood flow dynamics
  • Buys time while laser referral is arranged for advanced stages
  • May be the definitive treatment for Stage I TTTS in selected cases

📋 Dr. Kunda's TTTS Management Protocol

  • Fortnightly surveillance scans from 16 weeks in all MCDA twins
  • Immediate detailed evaluation if fluid discordance is detected
  • Quintero staging to guide treatment decision
  • Amnioreduction performed at Mayflower for Stage I–II cases
  • Urgent co-ordinated referral for laser ablation in Stage II–IV
  • Close post-procedure surveillance with serial Doppler

For complete information about TTTS, its staging, and management, see our dedicated page: Twin-to-Twin Transfusion Syndrome (TTTS) in Nagpur →

What to Expect

Before, During & After Amnioreduction

Before the Procedure
Preparation
  • No fasting required
  • Wear loose, comfortable clothing
  • Bring all previous scan reports and AFI measurements
  • Bring referral letter from your obstetrician
  • Bring your regular medications
  • A support person is welcome and encouraged
  • Bladder preparation: semi-full or empty — Dr. Kunda's team will advise
  • Expect to be at the clinic for 2–3 hours in total
During the Procedure
The Experience
  • You lie comfortably on the procedure table
  • Warm ultrasound gel is applied to your abdomen
  • Local anaesthetic is given — a brief stinging sensation
  • You may feel pressure but not sharp pain during drainage
  • The room is calm — Dr. Kunda explains each step
  • You can hear and respond throughout
  • Takes 20–45 minutes
  • You will feel the abdomen becoming less tight as fluid drains
After the Procedure
Recovery
  • Rest at the clinic for 30–60 minutes after
  • Fetal heart rate monitored before discharge
  • Mild abdominal soreness at the needle site for 24–48 hours
  • Rest at home for the remainder of the day
  • No vigorous activity for 48 hours
  • Contact the clinic if: contractions, fluid leaking, fever, or reduced fetal movements
  • Follow-up AFI scan in 1–3 weeks
  • Many women feel immediate relief from breathlessness and pressure
Safety & Risks

Safety Profile & Procedure Risks

Amnioreduction is an established, well-tolerated procedure with a known and accepted risk profile. Dr. Kunda Shahane discusses all risks in detail during the pre-procedure consent process and takes every precaution to minimise them through meticulous ultrasound-guided technique.

1–3%
Risk per session: Preterm Labour / PPROM
The most significant procedure-related risk. Premature contractions or premature rupture of membranes in 1–3% of procedures. Higher in serial drainage cases.
<1%
Risk: Chorioamnionitis (Infection)
Infection of the amniotic cavity — rare due to strict aseptic technique, antiseptic preparation, and real-time ultrasound guidance to avoid contamination.
Rare
Fetal Distress During Procedure
Abnormal fetal heart rate during the procedure. Continuously monitored — if any abnormality is detected, the procedure is paused immediately. Extremely rare when performed under real-time guidance.
<1%
Placental Abruption
Separation of the placenta from the uterine wall — avoided by precise Colour Doppler mapping of the placenta before needle insertion. Very rare complication.
Common
Fluid Re-accumulation
Not a risk, but a predictable outcome in many cases — fluid may rebuild over 1–3 weeks. Managed with serial AFI scans and repeat procedures as needed.
Minimal
Maternal Discomfort
Mild abdominal soreness and tenderness at the needle site for 24–48 hours. Usually managed with paracetamol. Significant pain is rare.

Risk figures represent general published data. Individual risk depends on gestational age, severity of polyhydramnios, underlying cause, and number of prior procedures. Dr. Kunda Shahane discusses your specific risk profile in detail before the procedure.

Dr. Kunda Explains

Polyhydramnios — Too Much Amniotic Fluid

In this video, Dr. Kunda Shahane explains what polyhydramnios means, what causes the fluid to build up, and how it is managed — including when amnioreduction is needed. This video is in Hindi for broader patient understanding.

Frequently Asked Questions

Amnioreduction — Your Questions Answered

What is amnioreduction and when is it done?
Amnioreduction is an ultrasound-guided procedure in which excess amniotic fluid is drained from the uterus through a fine needle inserted into the amniotic cavity. It is performed when polyhydramnios (too much amniotic fluid) is severe enough to cause significant maternal discomfort, raise the risk of preterm labour, or when the fluid level is so high that it poses a risk to the pregnancy. It is also used in twin-to-twin transfusion syndrome (TTTS) to drain fluid from the recipient twin's sac.
Is amnioreduction the same as amniocentesis?
The two procedures use a similar technique — both involve inserting a needle into the amniotic cavity under ultrasound guidance — but they serve different purposes. Amniocentesis is a diagnostic procedure: a small sample of fluid (15–20 mL) is taken for chromosomal or genetic testing. Amnioreduction is a therapeutic procedure: a large volume of excess fluid (500–2,000 mL) is drained to treat polyhydramnios and relieve its consequences. Amnioreduction takes longer and the needle may be slightly larger.
How long does the effect of amnioreduction last?
The duration of the effect depends entirely on the underlying cause of polyhydramnios. In some cases — particularly idiopathic polyhydramnios or well-controlled gestational diabetes — a single session can maintain normal fluid levels for several weeks or until delivery. In other cases — particularly structural fetal anomalies or uncontrolled GDM — fluid may re-accumulate within 1–3 weeks, requiring repeat procedures. Dr. Kunda Shahane schedules serial AFI scans after the procedure to monitor fluid levels and plan further intervention if needed.
Does my baby need to be monitored after amnioreduction?
Yes. Fetal heart rate is monitored at the clinic for 30–60 minutes after the procedure before discharge. A follow-up ultrasound with AFI measurement is typically scheduled within 1–3 weeks. You should also monitor your baby's movements at home and contact the clinic immediately if movements reduce significantly, if you experience contractions, if fluid leaks from your vagina, or if you develop fever or abdominal pain. Dr. Kunda Shahane provides clear written instructions at discharge.
Can amnioreduction cause labour to start?
It is possible, but not common. There is approximately a 1–3% risk of triggering preterm labour or premature rupture of membranes per procedure — this risk is higher with serial (repeat) procedures. The risk must always be weighed against the risk of leaving severe polyhydramnios untreated, which itself raises the risk of preterm labour from uterine overdistension. Dr. Kunda Shahane explains this balance in detail as part of the pre-procedure discussion.
I have been told my baby may have a swallowing problem causing the fluid. What does this mean?
When a baby has a gastrointestinal obstruction — such as oesophageal atresia (a gap in the food pipe) or duodenal atresia (a blockage in the small intestine) — they cannot swallow amniotic fluid normally, so it builds up as polyhydramnios. These are structural anomalies that are identified on a detailed anomaly scan. Dr. Kunda Shahane will explain the finding clearly, refer you for appropriate paediatric surgical planning, and discuss how the polyhydramnios will be managed during the rest of the pregnancy. Amnioreduction may be used to keep fluid at a manageable level until delivery and planned surgical repair of the obstruction.
I am coming from outside Nagpur — what should I bring?
Bring all previous ultrasound reports (especially any AFI measurements), your obstetric/ANC case file, any blood test reports, and a referral letter from your obstetrician if available. Wear loose, comfortable clothing. Plan to stay in Nagpur for the day of the procedure and ideally the following day. Contact us in advance via WhatsApp (+91-8087471244) so we can schedule your appointment and the procedure on the same or consecutive days to minimise your travel. Most patients from Amravati, Akola, Wardha, and Yavatmal visit Nagpur for the procedure and return home the following day.
Doctor's Note
"When a mother comes to me struggling to breathe because of the pressure of too much fluid — unable to sleep on either side, unable to walk comfortably — and we perform amnioreduction and she can breathe again within the hour: that is one of the most immediate and visible forms of relief this speciality offers. But amnioreduction is never just fluid drainage. It is always a thorough investigation first. The fluid is telling us something — and we have a responsibility to find out what. Whether it is a baby with a swallowing problem, a twin pregnancy with TTTS, or simply a case of gestational diabetes that needs better control: the fluid is a message. We drain it carefully, and we listen to what it is saying."
Dr. Kunda Shahane — MBBS, MS (Obs & Gynae), FIFM, FMF (London)
Central India's First Fetal Medicine Specialist · Founder, IIFM · Mayflower Fetal Medicine Centre, Nagpur
Explore Further

Related Services at Mayflower Clinic

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TTTS — Twin-to-Twin Transfusion
Diagnosis, staging & management of TTTS in Nagpur
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Fetal Blood Transfusion
Intrauterine transfusion for fetal anaemia — first in Vidarbha
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Amniocentesis
Diagnostic fluid sampling for chromosomal testing
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Colour Doppler Scan
Fetal blood flow assessment — umbilical, MCA, ductus venosus
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High-Risk Pregnancy Care
Expert surveillance & management for complex pregnancies
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All Interventional Procedures
Full range of fetal therapy offered at Mayflower Clinic

Referred for Amnioreduction?
Consult Dr. Kunda Shahane in Nagpur

Whether you have been referred by your obstetrician or have concerns about too much amniotic fluid, Dr. Kunda Shahane offers expert evaluation, precise measurement, and ultrasound-guided amnioreduction at Mayflower Fetal Medicine Centre — serving Nagpur, Vidarbha, and all of Central India.

📅 Book Appointment on WhatsApp 📞 Call 0712-669-2706
Mayflower Fetal Medicine Centre · Dhantoli, Nagpur · Monday–Saturday, 10am–6pm · Sunday: Closed
PCPNDT Act Notice: Mayflower Fetal Medicine Centre strictly complies with the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994. Sex determination and sex-selective practices are strictly prohibited and punishable by law. Our ultrasound and fetal medicine services are used exclusively for medical diagnosis and fetal wellbeing. Disclosure of fetal sex is illegal and is not performed at this centre.
Medical Disclaimer: This content is for general information only and does not constitute medical advice. Amnioreduction is a clinical procedure — its appropriateness, timing, and risks depend on your individual clinical circumstances. Please consult Dr. Kunda Shahane or your treating obstetrician for advice specific to your pregnancy.