Twin anemia polycythemia sequence from a prenatal perspective

Gucciardo, Léonardo; Lewi, Liesbeth; Vaast, P.; Dębska, Marzena; Catte, Luc De; Mieghem, Tim Van; Doné, Elisa; Devlieger, Roland; Deprest, Jan

doi:10.1002/pd.2491

Cited by 68 publications

(58 citation statements)

References 13 publications

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“…These results are consistent with prenatal cordocentesis and postnatal hematological comparisons previously reported in monochorionic twin gestations [6,8,14,15,16,17,18,19]. The reasons why only a small subgroup of TTTS patients would show markedly discordant MCA-PSV values are unclear, but could potentially be associated with the types of anastomoses leading to one condition versus the other.…”

Section: Discussionsupporting

confidence: 80%

“…Since this report, additional cases of spontaneous TAPS have been described with a prevalence of approximately 2-6% of all monochorionic twin pregnancies [3,16,17,19,20]. A prospective observational study of monochorionic twin gestations demonstrating the spontaneous occurrence of TAPS reported an incidence of 5% in a cohort of monochorionic twins identified at 11 weeks of gestation and followed through delivery; among those pregnancies that were still ongoing after 24 weeks of gestation, the incidence was 6% [17].…”

Section: Discussionmentioning

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: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…Para hacer el diagnóstico posnatal, recientemente se ha sugerido considerar la diferencia de hemoglobina entre ambos gemelos mayor de 8 g/dL sumado al menos a uno de los siguientes: relación de recuento reticulocitario entre gemelo donante/receptor > 1,7 y/o placenta con anastomosis vasculares menores a 1 mm. Si bien prenatalmente, la SAP se presenta como un cuadro bastante menos frecuente que el STFF (2% vs. 10%, respectivamente), con los datos posnatales, este cuadro alcanza el 4% de los embarazos monocoriales (10).…”

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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“…TAPS is believed to develop when a chronic net transfusion of red blood cells through very small unidirectional anastomoses takes place. In contrast to TTTS, pregnancies affected by TAPS do not exhibit a severe amniotic fluid discordance and -if present -is by definition less pronounced than in TTTS (Gucciardo et al, 2010;Slaghekke et al, 2009). As in TTTS, laser surgery can be used to coagulate the intertwin anastomoses and thus interrupt the transfusion process and halt the progress of the disease.…”

Section: The Placenta In Tapsmentioning

confidence: 99%

The Placenta in Twin-to-Twin Transfusion Syndrome and Twin Anemia Polycythemia Sequence

Couck

Lewi

2016

Twin Res Hum Genet

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Twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS) are complications unique to monochorionic twin pregnancies and their shared circulation. Both are the result of the transfusion imbalance in the intertwin circulation. TTTS is characterized by an amniotic fluid discordance, whereas in TAPS, there is a severe discordance in hemoglobin levels. The article gives an overview of the typical features of TTTS and TAPS placentas.

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Twin anemia polycythemia sequence from a prenatal perspective

Abstract: In monochorionic twin pregnancies, TAPS is an uncommon prenatal finding. Nonetheless, its incidence seems high enough to recommend screening for this disease by MCA-PSV measurements.

Cited by 68 publications

References 13 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)

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

The Placenta in Twin-to-Twin Transfusion Syndrome and Twin Anemia Polycythemia Sequence

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