title: Amniotic septostomy for the treatment of twin oligohydramnios-polyhydramnios sequence.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston 77555-1062, USA. gsaade@marlin.utmb.edu
authors.forename: G R
authors.initials: GR
authors.lastname: Saade
authors.forename: M A
authors.initials: MA
authors.lastname: Belfort
authors.forename: D L
authors.initials: DL
authors.lastname: Berry
authors.forename: T H
authors.initials: TH
authors.lastname: Bui
authors.forename: L D
authors.initials: LD
authors.lastname: Montgomery
authors.forename: A
authors.initials: A
authors.lastname: Johnson
authors.forename: M
authors.initials: M
authors.lastname: O'Day
authors.forename: G L
authors.initials: GL
authors.lastname: Olson
authors.forename: H
authors.initials: H
authors.lastname: Lindholm
authors.forename: L
authors.initials: L
authors.lastname: Garoff
authors.forename: K J
authors.initials: KJ
authors.lastname: Moise
mesh_terms: 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