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Re: OB-GYN-L digest 694From: George Saade (george.saade@utmb.edu)Wed Oct 30 09:12:05 1996
This is in reply to some of the questions and comments about twin oligohydramnios/polyhydramnios sequence (I also prefer TOPS to TTTS or any other designation) I have not encountered a higher incidence of velamentous cord insertion in these cases. I am aware that others have reported an increase in VCI (Fries et al. Obstet Gynecol 1993;81:569-74) while others have not (Bajoria et al. Am J Obstet Gynecol 1995;172:856-63). As to the possibility of converting a diamniotic pregnancy into a monoamniotic one, I must say that it was one of the fears we had when we first started. So far, none of those performing the septostomy have had this problem. I must say that in the only report about this problem, most of the disruptions occured spontaneously (Gilbert et al. Obstet Gynecol 1991;78:623-30). There are other case reports and anecdotal occurences of diamniotic twins converting to monoamniotic twins following decompression amniocentesis. I beleive that in these cases, the needle had perforated the intervening membrane without the knowledge of the operator. Without controlling the needle, the hole may have been enlarged inadvertently. Finally, there are at least three articles reporting the experience with single-needle, single-puncture amniocentesis in twin pregnancy without major or unusual complications (Jeanty et al. J Ultrasound Med 1990;9:511-7. Buscaglia et al. Prenat Diagn 1995;15:17-9. Sebire et al. Ultrasound Obstet Gynecol 1996;7:26-31). I am also aware that a number of perinatologists and geneticists use this technique routinely in their practice. I must caution, however, that in our TOPS cases, we used a 22 G needle and performed a single puncture in order to avoid creating a large window in the dividing membrane.
-- George R. Saade, M.D. The University of Texas Medical Branch Galveston, TX Tel: (409)747-0482 Fax: (409)772-2261
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