Clinical and placental characteristics in four new cases of twin anemia–polycythemia sequence

Weingertner, Anne Sophie; Köhler, Anne; Köhler, M.; Bouffet, N.; Hunsinger, M. C.; Mager, C.; Hornecker, F.; Neumann, M.; Schmerber, E.; Tanghe, M.; Viville, B.; Favre, R.

doi:10.1002/uog.7508

Cited by 41 publications

(48 citation statements)

References 61 publications

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“…If extensive vascular communications or large-caliber communications were noted, the case was considered ‘atypical.' These criteria used to designate ‘typical' placental findings were consistent with multiple published descriptions of placental findings in isolated TAPS [6,7,8,9,10,11]. …”

Section: Methodssupporting

confidence: 58%

“…Among TTTS patients that underwent laser surgery and were subsequently noted to have residual patent anastomoses, the reported prevalence of post-laser TAPS is 20-44% [26,27,28]. Typical pathological findings in TAPS placentas were few small-caliber artery-vein (AV) anastomoses, with artery-artery (AA) anastomoses found only in 10-20% of cases; non-TAPS monochorionic placentas, in comparison, rarely have small anastomoses and virtually all have AA anastomoses [6,7,8,9,10,11]. When present, AA communications tend to be much smaller in caliber in TAPS placentas [7,10].…”

Section: Discussionmentioning

confidence: 99%

“…Unlike TTTS, which is due to hemodynamic imbalances between the two fetuses, the pathogenesis of TAPS is attributed to a chronic net transfusion from donor to recipient, presumably at a slow enough rate to allow for hemodynamic equilibration and thus preventing development of classic TTTS [3,6]. As such, the pathologic findings of TAPS placentas have been said to be characterized by relatively few small-caliber (<1 mm) arteriovenous (AV) communications as compared to larger AV communications in TTTS placentas [6,7,8,9,10]. …”

Section: Introductionmentioning

confidence: 99%

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Pre-Operative Twin Anemia/Polycythemia in the Setting of Twin-Twin Transfusion Syndrome (TTTS)

et al. 2015

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Introduction: Twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS) are classified as distinct clinical disorders associated with unbalanced blood flow through placental vascular communications. Typically, TAPS placentas demonstrate few <1 mm arteriovenous (AV) communications, and at fetoscopy the twins are visibly pale and plethoric. Materials and Methods: In a cohort of TTTS patients who underwent laser surgery, those with preoperative findings suggestive of anemia/polycythemia (AP) were compared to those with TTTS alone. AP was defined as middle cerebral artery peak systolic velocity in one twin >1.5 multiples of the median (MoM), and <1.0 MoM in the other. Results: Of 369 TTTS patients, 9 (2.4%) met criteria for preoperative AP. The mean number (±SD) of AV communications in the TTTS + AP group was 5.6 ± 5.7, compared with 8.8 ± 4.8 in the TTTS-alone group (p = 0.013). Five TTTS + AP patients (56%) had a few thin AV communications (mean 2.8 ± 1.6); all 5 had visibly pale and plethoric twins. The remaining 4 (44%) had large or numerous anastomoses (mean 10.5 ± 6.8); none had fetal skin color discordance. Discussion: Preoperative AP affected 2% of TTTS patients. Of these, approximately half had placental and skin color findings typically reported with isolated TAPS.

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Section: Methodssupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pre-Operative Twin Anemia/Polycythemia in the Setting of Twin-Twin Transfusion Syndrome (TTTS)

et al. 2015

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“…The efficacy of an intrauterine blood transfusion for fetal anemia in donor twins may be transient and can also cause complications due to hyperviscosity in the recipient twin [8]. Recently, FLP of placental vascular anastomoses, which produced a favorable outcome in mid-trimester twin-twin transfusion syndrome [10], was reported to be effective for iatrogenic or spontaneous TAPS [2,11,12,13]. …”

Section: Discussionmentioning

confidence: 99%

Therapy by Laser Equatorial Placental Dichorionization for Early-Onset Spontaneous Twin Anemia-Polycythemia Sequence

et al. 2013

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We report a case of twin anemia-polycythemia sequence (TAPS) treated by fetoscopic laser equatorial placental dichorionization, also known as the ‘Solomon technique', at 24 weeks of gestation. TAPS was present despite the absence of fetoscopically visualized chorionic anastomoses from the donor to the recipient twin. The goal of this procedure was to prevent post-laser TAPS in cases of twin-twin transfusion syndrome. The surgery and subsequent intrauterine blood transfusion to the donor twin could result in the survival of both twins without hematologic or neurological complications. Following the surgery, a placental injection test revealed no residual anastomoses. At present, laser therapy is not always feasible for TAPS, primarily because of its difficulty. However, laser therapy using the Solomon technique could be a viable approach for early-onset TAPS, especially in difficult situations in which undetectable vascular anastomoses related to TAPS are present.

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“…Se ha descrito que la SAP puede darse de manera espontánea (5-6% de los embarazos monocoriales) o secundario a coagulación laser (13%) (11). En los casos de complicaciones precoces o tardías de la terapia láser, ya sea STFF o SAP, se ha descrito la persistencia, o recanalización, de comunicaciones vasculares.…”

Section: Discussionunclassified

Complicaciones Tardías De La Terapia Láser Como Tratamiento De La Transfusión Feto-Fetal: Caso Clínico

et al. 2011

Rev. chil. obstet. ginecol.

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RESUMENPresentamos la descripción del diagnóstico y manejo de una secuencia anemia-policitemia (SAP) que se presenta como complicación de una terapia láser exitosa en un embarazo gemelar monocorial cursando una transfusión feto-fetal (TFF) severa. Describimos la manifestación de esta complicación tardía de la terapia láser de la TFF severa y realizamos una revisión de la literatura internacional al respecto. A pesar del éxito de la introducción de la terapia láser en cuanto a la sobrevida y secuelas neonatales, recientemente se han descrito una serie de complicaciones de presentación tempranas o tardías. Entre las tardías, destacan la muerte de uno o ambos gemelos, recidiva de la TFF, y aparición de una SAP. Varios autores han descrito que la SAP sería secundaria a la presencia, o persistencia, de comunicaciones vasculares extremadamente pequeñas de flujo lento, las cuales llevan a una discordancia en los niveles de hemoglobina entre ambos gemelos, sin diferencias en sus volúmenes sanguíneos. PALABRAS CLAVE: Gemelar, transfusión feto-fetal, secuencia anemia-policitemia SUMMARYWe describe the diagnosis and management of twin anemia-polycythemia sequence (TAPS), which occurs as a late complication of successful laser therapy in twin monochorionic pregnancies developing severe twin to twin transfusion syndrome (TTTS). We offer a description of this late complication of laser therapy in this condition and a review of the related medical literature. Despite the successful introduction of laser therapy on the survival and neonatal sequelae, various early and late complications related to this procedure have been recently described. Among the late, stands out the death of one or both twins, recurrence of TTTS, and the appearance of TAPS. With regards TAPS, several authors have reported that it would be secondary to the presence, o persistence, of extremely small slow flow vascular communications, which lead to discrepancies in the hemoglobin levels between the twins, with no differences in blood volume.

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Clinical and placental characteristics in four new cases of twin anemia–polycythemia sequence

Abstract: K E Y W O R D S:

Cited by 41 publications

References 61 publications

Pre-Operative Twin Anemia/Polycythemia in the Setting of Twin-Twin Transfusion Syndrome (TTTS)

Pre-Operative Twin Anemia/Polycythemia in the Setting of Twin-Twin Transfusion Syndrome (TTTS)

Therapy by Laser Equatorial Placental Dichorionization for Early-Onset Spontaneous Twin Anemia-Polycythemia Sequence

Complicaciones Tardías De La Terapia Láser Como Tratamiento De La Transfusión Feto-Fetal: Caso Clínico

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