title: Endoscopic documentation of unintentional perforation of the dividing membrane during amnioreduction for twin-twin transfusion syndrome.
abstract: OBJECTIVE
  The purpose of this report is to document endoscopically the occurrence of unintentional piercing of the dividing membrane in a monochorionic twin pregnancy with twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  The dividing membrane was visualized endoscopically during laser therapy in a patient with TTTS who had previously undergone therapeutic amniocentesis. The donor twin had no visible bladder, but the amniotic fluid volume had normalized after amniocentesis.
  
  
  RESULTS
  The suspected membrane perforation was identified endoscopically during laser surgery. Five areas of vascular communications were identified and photocoagulated.
  
  
  CONCLUSIONS
  Sonographic evidence of normalization of the amniotic fluid volumes after therapeutic amniocentesis with persistent nonvisualization of the bladder of the donor twin should not be interpreted as a sign of improvement of TTTS, but rather as indirect evidence of unintentional perforation of the dividing membrane. This complication can be confirmed endoscopically.
authors.affiliation: Florida Institute for Fetal Diagnosis and Therapy, St. Joseph's Women's Hospital, Tampa, Fla., USA.
authors.forename: R
authors.initials: R
authors.lastname: Cooper
authors.forename: P W
authors.initials: PW
authors.lastname: Bornick
authors.forename: M
authors.initials: M
authors.lastname: Allen
authors.forename: R
authors.initials: R
authors.lastname: Quintero
mesh_terms: D000328:Adult; D000649:Amniocentesis / Q000009:adverse effects*; D000653:Amniotic Fluid / Q000000981:diagnostic imaging; D005321:Extraembryonic Membranes / Q000293:injuries*; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000601:surgery*; D005332:Fetoscopy; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging; D053685:Laser Therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D014463:Ultrasonography