Amniotic septostomy for the treatment of the stuck twin sequence

D. Berry, L. Montgomery, A. Johnson, George Saade, K. Moise

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

OBJECTIVE: To report our experience of intentional puncture of the intervening membrane ("septostomy") and subsequent pregnancy outcome for twin gestations complicated by the stuck twin sequence. STUDY DESIGN: Nine patients were diagnosed with a stuck twin sequence based on polyhydramnios in the larger twin and severe oligohydramnios and discordant growth in the smaller twin. A 22 gauge spinal needle was used to perform a diagnostic and limited reduction amniocentesis of the polyhydramniotic sac followed by selective puncture of the membrane between the twins. Immediate and long-term observations were made regarding subsequent fetal growth and pregnancy outcomes. RESULTS: Amniotic septostomy was performed in 5 second trimester and 4 third trimester pregnancies (median gestation: 21.6 weeks, range: 16.9-27.0 weeks). The median discordance based on ultrasound estimates of fetal weight was 34% (10-12%). Immediate decompression of the "stuck twin" occurred in all cases followed by increased fetal movement, and improved umbilical artery velocimetry. Three of the 18 fetuses (17%) died in utero in two of the affected pregnancies. Delivery occurred at a median of 34 weeks' gestation (21.6-3.5.0). The median discordance at delivery as 31.5% (19-44%) suggesting no worsening of growth discrepancy after the septostomy was performed. No incidences of cord entanglement were encountered. CONCLUSIONS: Anmiotic septostomy may be utilized to treat the stuck twin sequence with a perinatal survival of up to 83%.

Original languageEnglish (US)
JournalActa Diabetologica Latina
Volume176
Issue number1 PART II
StatePublished - 1997
Externally publishedYes

Fingerprint

Pregnancy
Therapeutics
Pregnancy Outcome
Punctures
Oligohydramnios
Polyhydramnios
Fetal Movement
Fetal Weight
Umbilical Arteries
Amniocentesis
Membranes
Rheology
Third Pregnancy Trimester
Second Pregnancy Trimester
Growth
Fetal Development
Decompression
Needles
Fetus
Survival

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Berry, D., Montgomery, L., Johnson, A., Saade, G., & Moise, K. (1997). Amniotic septostomy for the treatment of the stuck twin sequence. Acta Diabetologica Latina, 176(1 PART II).

Amniotic septostomy for the treatment of the stuck twin sequence. / Berry, D.; Montgomery, L.; Johnson, A.; Saade, George; Moise, K.

In: Acta Diabetologica Latina, Vol. 176, No. 1 PART II, 1997.

Research output: Contribution to journalArticle

Berry, D, Montgomery, L, Johnson, A, Saade, G & Moise, K 1997, 'Amniotic septostomy for the treatment of the stuck twin sequence', Acta Diabetologica Latina, vol. 176, no. 1 PART II.
Berry D, Montgomery L, Johnson A, Saade G, Moise K. Amniotic septostomy for the treatment of the stuck twin sequence. Acta Diabetologica Latina. 1997;176(1 PART II).
Berry, D. ; Montgomery, L. ; Johnson, A. ; Saade, George ; Moise, K. / Amniotic septostomy for the treatment of the stuck twin sequence. In: Acta Diabetologica Latina. 1997 ; Vol. 176, No. 1 PART II.
@article{a8e80b569d0443508aca74030d96fba2,
title = "Amniotic septostomy for the treatment of the stuck twin sequence",
abstract = "OBJECTIVE: To report our experience of intentional puncture of the intervening membrane ({"}septostomy{"}) and subsequent pregnancy outcome for twin gestations complicated by the stuck twin sequence. STUDY DESIGN: Nine patients were diagnosed with a stuck twin sequence based on polyhydramnios in the larger twin and severe oligohydramnios and discordant growth in the smaller twin. A 22 gauge spinal needle was used to perform a diagnostic and limited reduction amniocentesis of the polyhydramniotic sac followed by selective puncture of the membrane between the twins. Immediate and long-term observations were made regarding subsequent fetal growth and pregnancy outcomes. RESULTS: Amniotic septostomy was performed in 5 second trimester and 4 third trimester pregnancies (median gestation: 21.6 weeks, range: 16.9-27.0 weeks). The median discordance based on ultrasound estimates of fetal weight was 34{\%} (10-12{\%}). Immediate decompression of the {"}stuck twin{"} occurred in all cases followed by increased fetal movement, and improved umbilical artery velocimetry. Three of the 18 fetuses (17{\%}) died in utero in two of the affected pregnancies. Delivery occurred at a median of 34 weeks' gestation (21.6-3.5.0). The median discordance at delivery as 31.5{\%} (19-44{\%}) suggesting no worsening of growth discrepancy after the septostomy was performed. No incidences of cord entanglement were encountered. CONCLUSIONS: Anmiotic septostomy may be utilized to treat the stuck twin sequence with a perinatal survival of up to 83{\%}.",
author = "D. Berry and L. Montgomery and A. Johnson and George Saade and K. Moise",
year = "1997",
language = "English (US)",
volume = "176",
journal = "Acta Diabetologica",
issn = "0940-5429",
publisher = "Springer-Verlag Italia",
number = "1 PART II",

}

TY - JOUR

T1 - Amniotic septostomy for the treatment of the stuck twin sequence

AU - Berry, D.

AU - Montgomery, L.

AU - Johnson, A.

AU - Saade, George

AU - Moise, K.

PY - 1997

Y1 - 1997

N2 - OBJECTIVE: To report our experience of intentional puncture of the intervening membrane ("septostomy") and subsequent pregnancy outcome for twin gestations complicated by the stuck twin sequence. STUDY DESIGN: Nine patients were diagnosed with a stuck twin sequence based on polyhydramnios in the larger twin and severe oligohydramnios and discordant growth in the smaller twin. A 22 gauge spinal needle was used to perform a diagnostic and limited reduction amniocentesis of the polyhydramniotic sac followed by selective puncture of the membrane between the twins. Immediate and long-term observations were made regarding subsequent fetal growth and pregnancy outcomes. RESULTS: Amniotic septostomy was performed in 5 second trimester and 4 third trimester pregnancies (median gestation: 21.6 weeks, range: 16.9-27.0 weeks). The median discordance based on ultrasound estimates of fetal weight was 34% (10-12%). Immediate decompression of the "stuck twin" occurred in all cases followed by increased fetal movement, and improved umbilical artery velocimetry. Three of the 18 fetuses (17%) died in utero in two of the affected pregnancies. Delivery occurred at a median of 34 weeks' gestation (21.6-3.5.0). The median discordance at delivery as 31.5% (19-44%) suggesting no worsening of growth discrepancy after the septostomy was performed. No incidences of cord entanglement were encountered. CONCLUSIONS: Anmiotic septostomy may be utilized to treat the stuck twin sequence with a perinatal survival of up to 83%.

AB - OBJECTIVE: To report our experience of intentional puncture of the intervening membrane ("septostomy") and subsequent pregnancy outcome for twin gestations complicated by the stuck twin sequence. STUDY DESIGN: Nine patients were diagnosed with a stuck twin sequence based on polyhydramnios in the larger twin and severe oligohydramnios and discordant growth in the smaller twin. A 22 gauge spinal needle was used to perform a diagnostic and limited reduction amniocentesis of the polyhydramniotic sac followed by selective puncture of the membrane between the twins. Immediate and long-term observations were made regarding subsequent fetal growth and pregnancy outcomes. RESULTS: Amniotic septostomy was performed in 5 second trimester and 4 third trimester pregnancies (median gestation: 21.6 weeks, range: 16.9-27.0 weeks). The median discordance based on ultrasound estimates of fetal weight was 34% (10-12%). Immediate decompression of the "stuck twin" occurred in all cases followed by increased fetal movement, and improved umbilical artery velocimetry. Three of the 18 fetuses (17%) died in utero in two of the affected pregnancies. Delivery occurred at a median of 34 weeks' gestation (21.6-3.5.0). The median discordance at delivery as 31.5% (19-44%) suggesting no worsening of growth discrepancy after the septostomy was performed. No incidences of cord entanglement were encountered. CONCLUSIONS: Anmiotic septostomy may be utilized to treat the stuck twin sequence with a perinatal survival of up to 83%.

UR - http://www.scopus.com/inward/record.url?scp=33748611329&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33748611329&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:33748611329

VL - 176

JO - Acta Diabetologica

JF - Acta Diabetologica

SN - 0940-5429

IS - 1 PART II

ER -