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).

CONCLUSION:

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: G R Saade, M A Belfort, D L Berry, T H Bui, L D Montgomery, A Johnson, M O'Day, G L Olson, H Lindholm, L Garoff, K J Moise Jr
• Journal: Fetal diagnosis and therapy (Fetal Diagn Ther) 1998 Mar-Apr Vol. 13 Issue 2 Pg. 86-93 ISSN: 1015-3837 [Print] Switzerland
• PMID: 9650653 (Publication Type: Journal Article)

Topics

• Amnion (surgery)
• Diseases in Twins
• Female
• Fetal Death
• Fetofetal Transfusion (diagnostic imaging, surgery)
• Gestational Age
• Humans
• Oligohydramnios (surgery)
• Polyhydramnios (surgery)
• Pregnancy
• Pregnancy Outcome
• Ultrasonography, Prenatal