Amniotic septostomy for the treatment of twin oligohydramnios-polyhydramnios sequence

Fetal Diagn Ther. 1998 Mar-Apr;13(2):86-93. doi: 10.1159/000020812.


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.

MeSH terms

  • 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