Assistance Publique-Hôpitaux de Paris and the University of Geneva.

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We report a case of twin anemia-polycythemia sequence (TAPS) CASE REPORTA 41-year-old woman was referred to our center at 16 + 2 weeks' gestation for twin-to-twin transfusion syndrome (TTTS). After it was diagnosed as Quintero Stage II, we selectively photocoagulated the communicating vessels by laser at 16 + 6 weeks. The recipient had a maximum vertical pocket of 9 cm, and the donor almost no amniotic fluid; the latter's bladder could not be visualized. Both had normal findings on umbilical artery, middle cerebral artery (MCA) and ductus venosus Doppler. The placenta was inserted posterolaterally, on the right. The site of fetoscope entry was on the left side, and three arteriovenous and two venoarterial anastomoses were coagulated. The procedure, conducted with epidural anesthesia, took 45 min.Weekly sonographic surveillance confirmed complete regression of TTTS, but twin anemia-polycythemia sequence (TAPS) was suspected at 18 weeks. From 18 to 24 weeks, sonographic surveillance was performed weekly. At 24 weeks, the suspected TAPS worsened, reaching Lopriore Stage 2; the former donor became polycythemic, with an MCA peak systolic velocity (PSV) < 0.8 multiples of the median (MoM) (16.6 cm/s = 0.52 MoM), and the former recipient became anemic, with an MCA-PSV > 1.7 MoM (80 cm/s = 2.60 MoM)1 . After counseling the parents regarding the different options available (expectant management, intrauterine transfusion (IUT) and laser coagulation), we jointly decided to perform a second laser photocoagulation, which was carried out at 24 + 5 weeks. The site of fetoscope entrance was on the right side of the umbilicus, and a single small arteriovenous anastomosis was coagulated. The procedure took 20 min. One week later we noted an improvement, with the MCA-PSV of the anemic twin decreasing to 58 cm/s (1.72 MoM). The MCA-PSV of the polycythemic twin, 21 cm/s (0.62 MoM), increased more slowly. At 30 weeks, the MCA-PSV had returned to normal for both: 48 cm/s (1.18 MoM) for the previously anemic and 36 cm/s (0.88 MoM) for the previously polycythemic twin (Figure 1).The pregnancy continued normally thereafter. Magnetic resonance imaging was performed at 33 weeks' gestation and showed no cerebral anomaly in either fetus. A prophylactic Cesarean delivery was performed at 36 + 3 weeks. The previous donor/polycythemic twin had a birth weight of 2000 g, Apgar score of 10 at both 1 and 5 min, hemoglobin of 20.2 g/dL and a reticulocyte