Endoscopic documentation of unintentional perforation of the dividing membrane during amnioreduction for twin-twin transfusion syndrome

Objective: The purpose of this report is to document endoscopically the occ urrence of unintentional piercing of the dividing membrane in a monochorion ic twin pregnancy with twin-twin transfusion syndrome (TTTS), Materials and Methods:The dividing membrane was visualized endoscopically during laser t herapy in a patient with TTTS who had previously undergone therapeutic amni ocentesis, The donor twin had no visible bladder, but the amniotic fluid vo lume had normalized after amniocentesis. Results: The suspected membrane pe rforation was identified endoscopically during laser surgery. Five areas of vascular communications were identified and photocoagulated, Conclusions: Sonographic evidence of normalization of the amniotic fluid volumes after t herapeutic amniocentesis with persistent nonvisualization of the bladder of the donor twin should not be interpreted as a sign of improvement of TTTS, but rather as indirect evidence of unintentional perforation of the dividi ng membrane, This complication can be confirmed endoscopically, Copyright ( C) 2001 S. Karger AG, Basel.