AMNIOTIC SEPTOSTOMY FOR THE TREATMENT OF TWIN OLIGOHYDRAMNIOS-POLYHYDRAMNIOS SEQUENCE

Objective: To report our experience with intentional puncture of the i ntervening membrane ('septostomy') for the treatment of the twin oligo hydramnios-polyhydramnios sequence (TOPS), Methods: 12 patients were d iagnosed with TOPS based on ultrasonographic findings, A 20- to 22-gau ge spinal needle was used to puncture the membrane between the twins w ithout any attempt at amnioreduction in 9 patients, while the procedur e was combined with amnioreductions in 3 patients, Results: Gestationa l 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' fe tus occurred in all cases following a single procedure, Three of the 2 4 fetuses died in utero and 1 died on the fifth day of life, for a com bined 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). Con clusion: Amniotic septostomy is a promising new method for the managem ent of TOPS and is associated with survival rates that are better than , or comparable to, more invasive modalities, A multicenter trial comp aring septostomy to other modalities is warranted.