Amniotic septostomy for the treatment of twin oligohydramnios-polyhydramnios sequence

George R. Saade, Michael A. Belforf, David L. Berry, The Hung Bui, Lynn D. Montgomery, Anthony Johnson, Mary O'Day, Gay Le Olson, Henry Lindholm, Leena Garoff, Kenneth J. Moise

Research output: Contribution to journalArticlepeer-review

112 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)86-93
Number of pages8
JournalFetal Diagnosis and Therapy
Issue number2
StatePublished - 1998


  • Amniocentesis
  • Feta-fetal transfusion
  • Septostomy
  • Stuck twin
  • Twin oligohydramnios-polyhydramnios sequence, treatment
  • Twin-twin transfusion

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Embryology
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology


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