Amniotic septostomy for the treatment of twin oligohydramnios-polyhydramnios sequence.
OBJECTIVE
To report our experience with intentional puncture of the intervening membrane ('septostomy') for the treatment of the twin oligohydramnios-polyhydramnios sequence (TOPS).


METHODS
12 patients were diagnosed with TOPS based on ultrasonographic findings. A 20- to 22-gauge spinal needle was used to puncture the membrane between the twins without any attempt at amnioreduction in 9 patients, while the procedure was combined with amnioreductions in 3 patients.


RESULTS
Gestational age was 23.1 +/- 3.3 weeks at the time of septostomy and 31.1 +/- 4.4 weeks at delivery. Rapid accumulation of fluid around the 'stuck' fetus occurred in all cases following a single procedure. Three of the 24 fetuses died in utero and 1 died on the fifth day of life, for a combined survival of 83.3%. In the survivors, the septostomy to delivery interval ranged between 0.6 and 13 weeks (mean +/- SD 8.3 +/- 4.8).


CONCLUSIONS
Amniotic septostomy is a promising new method for the management of TOPS and is associated with survival rates that are better than, or comparable to, more invasive modalities. A multicenter trial comparing septostomy to other modalities is warranted.
Saade
G R
GR
Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston 77555-1062, USA. gsaade@marlin.utmb.edu
Belfort
M A
MA
Berry
D L
DL
Bui
T H
TH
Montgomery
L D
LD
Johnson
A
A
O'Day
M
M
Olson
G L
GL
Lindholm
H
H
Garoff
L
L
Moise
K J
KJ
D000650:Amnion / Q000601:surgery*; D004200:Diseases in Twins; D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D016104:Oligohydramnios / Q000601:surgery*; D006831:Polyhydramnios / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016216:Ultrasonography, Prenatal