title: Twin-twin transfusion syndrome presenting as polyhydramnios in both fetuses secondary to spontaneous microseptostomy.
abstract: The presence of polyhydramnios and oligohydramnios is pathognomonic for twin-twin transfusion syndrome (TTTS). However, polyhydramnios of both twins can exist in TTTS in the setting of a septostomy of the dividing membrane. In prior reported cases of dual polyhydramnios TTTS, the septostomy was identified through either ultrasound or fetoscopy thus helping to establish the diagnosis of TTTS with an unusual presentation. The presented case is a set of monochorionic, diamniotic twins who presented initially with dual polyhydramnios. Subsequent ultrasound and clinical and pathologic findings were otherwise consistent with TTTS. Unlike prior reported cases, a septostomy of the dividing membrane was never identified with ultrasound or even on post delivery placental examination. However, microseptostomies were demonstrated due to the transfer of indigo carmine between the amniotic sacs at amniocentesis. Thus in the setting of TTTS concern, the diagnosis should be considered with dual polyhydramnios even if a septostomy cannot be identified.
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester, New York.
authors.forename: David N
authors.initials: DN
authors.lastname: Hackney
authors.forename: Nahla
authors.initials: N
authors.lastname: Khalek
authors.forename: Julie
authors.initials: J
authors.lastname: Moldenhauer
authors.forename: Tulin
authors.initials: T
authors.lastname: Ozcan
keywords: microseptostomy; monochorionic; multifetal gestation; polyhydramnios; twin-twin transfusion syndrome