Amniotic septostomy for the treatment of twin oligohydramnios-polyhydramnios sequence

• Published in: Fetal diagnosis and therapy Vol. 13; no. 2; p. 86
• Main Authors: Saade, G R, Belfort, M A, Berry, D L, Bui, T H, Montgomery, L D, Johnson, A, O'Day, M, Olson, G L, Lindholm, H, Garoff, L, Moise, Jr, K J
• Format: Journal Article
• Language: English
• Published: Switzerland 01-03-1998
• Subjects: Amnion - surgery; Diseases in Twins; Female; Fetal Death; Fetofetal Transfusion - diagnostic imaging; Fetofetal Transfusion - surgery; Gestational Age; Humans; Oligohydramnios - surgery; Polyhydramnios - surgery; Pregnancy; Pregnancy Outcome; Ultrasonography, Prenatal
• ISSN: 1015-3837
• DOI: 10.1159/000020812

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