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.
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: D Mahieu-Caputo; M Dommergues; A L Delezoide; M Lacoste; Y Cai; F Narcy; D Jolly; M Gonzales; Y Dumez; M C Gubler Journal: Am J Pathol Date: 2000-02 Impact factor: 4.307
Authors: Timothy M Crombleholme; David Shera; Hanmin Lee; Mark Johnson; Mary D'Alton; Flint Porter; Jacquelyn Chyu; Richard Silver; Alfred Abuhamad; George Saade; Laurence Shields; David Kauffman; Joanne Stone; Craig T Albanese; Ray Bahado-Singh; Robert H Ball; Larissa Bilaniuk; Beverly Coleman; Diana Farmer; Vickie Feldstein; Michael R Harrison; Holly Hedrick; Jeffrey Livingston; Robert P Lorenz; David A Miller; Mary E Norton; William J Polzin; Julian N Robinson; Jack Rychik; Per L Sandberg; Istvan Seri; Erin Simon; Lynn L Simpson; Larisa Yedigarova; R Douglas Wilson; Bruce Young Journal: Am J Obstet Gynecol Date: 2007-10 Impact factor: 8.661