Middle Cerebral Artery Doppler Velocimetry for the Diagnosis of Twin Anemia Polycythemia Sequence: A Systematic Review

Abstract

Twin anemia polycythemia sequence (TAPS) is a rare complication of monochorionic diamniotic (MCDA) twins. Middle cerebral artery peak systolic velocity (MCA-PSV) measurements are used to screen for TAPS while fetal or neonatal hemoglobin levels are required for definitive diagnosis. We sought to perform a systematic review of the efficacy of MCA-PSV in diagnosing TAPS. Search criteria were developed using relevant terms to query the Pubmed, Embase, and SCOPUS electronic databases. Publications reporting diagnostic characteristics of MCA-PSV measurements (i.e., sensitivity, specificity or receiver operator curves) were included. Each article was assessed for bias using the Quality Assessment of Diagnostic Accuracy Studies II (QUADAS II) tool. Results were assessed for uniformity to determine whether meta-analysis was feasible. Data were presented in tabular form. Among publications, five met the inclusion criteria. QUADAS II analysis revealed that four of the publications were highly likely to have bias in multiple areas. Meta-analysis was precluded by non-uniformity between definitions of TAPS by MCA-PSV and neonatal or fetal hemoglobin levels. High-quality prospective studies with consistent definitions and ultrasound surveillance protocols are still required to determine the efficacy of MCA-PSV in diagnosing TAPS. Other ultrasound findings (e.g., placenta echogenicity discordance) may augment Doppler studies.

Comprensión del avance tecnológico y la implementación de terapias en la gestación múltiple.

“…Las modalidades de tratamiento varían según la edad gestacional e incluyen manejo expectante, cirugía láser fetoscópica, transfusión intrauterina, reducción selectiva y parto prematuro (28). Secuencia de perfusión arterial reversa gemelar.…”

Perinatal outcomes of fetoscopic selective laser photocoagulation for spontaneous twin‐anemia polycythemia sequence

“…TAPS was staged according to traditional MCA peak systolic velocity (PSV) criteria as described by Brock et al 19 . Patients with spontaneous TAPS stages II–IV were offered fetoscopic laser photocoagulation in addition to options of IUT or selective reduction.…”