Twin Anemia–Polycythemia Sequence in Two Monochorionic Twin Pairs Without Oligo-Polyhydramnios Sequence

Lopriore, Enrico; Middeldorp, Johanna M.; Oepkes, Dick; Kanhai, H. H. H.; Walther, Frans J.; Vandenbussche, Frank P.H.A.

doi:10.1016/j.placenta.2006.01.010

Cited by 255 publications

(195 citation statements)

References 16 publications

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“…The decision stems from the purported etiology of TAPS, which presumably results from the transfer of blood between two monochorionic twins through small placental vascular anastomoses in such a way that one fetus develops anemia and the other twin develops polycythemia, but without the net blood volume inequalities typical of TTTS (Lopriore et al, 2007). Presumably, the syndrome occurs through small caliber AV anastomoses, in contrast to larger size vessels typically seen in TTTS.…”

Section: Should the Rate Of Taps Be Included As A Benchmark For The Pmentioning

confidence: 99%

Laser Treatment of Twin–to–Twin Transfusion Syndrome

2016

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Objective: Laser ablation of all placental vascular anastomoses is the optimal treatment for twin-twin transfusion syndrome (TTTS). However, two important controversies are apparent in the literature: (a) a gap between concept and performance, and (b) controversy regarding whether all the anastomoses can be identified endoscopically and whether blind lasering of healthy placenta is justified. The purpose of this article is: (a) to address the potential source of the gap between concept and performance by analyzing the fundamental steps needed to successfully accomplish the surgery, and (b) to discuss the resulting competency benchmarks reported with the different surgical techniques. Materials and Methods: Laser surgery for TTTS can be broken down into two fundamental steps: (1) endoscopic identification of the placental vascular anastomoses, (2) laser ablation of the anastomoses. The two steps are not synonymous: (a) regarding the endoscopic identification of the anastomoses, the non-selective technique is based upon lasering all vessels crossing the dividing membrane, whether anastomotic or not. The selective technique identifies and lasers only placental vascular anastomoses. The Solomon technique is based on the theory that not all anastomoses are endoscopically visible and thus involves lasering healthy areas of the placenta between lasered anastomoses, (b) regarding the actual laser ablation of the anastomoses, successful completion of the surgery (i.e., lasering all the anastomoses) can be measured by the rate of persistent or reverse TTTS (PRTTTS) and how often a selective technique can be achieved. Articles representing the different techniques are discussed. Results: The non-selective technique is associated with the lowest double survival rate (35%), compared with 60-75% of the Solomon or the Quintero selective techniques. The Solomon technique is associated with a 20% rate of residual patent placental vascular anastomoses, compared to 3.5-5% for the selective technique (p < .05). Both the Solomon and the selective technique are associated with a 1% risk of PRTTTS. Adequate placental assessment is highest with the selective technique (99%) compared with the Solomon (80%) or the 'standard' (60%) techniques (p < .05). A surgical performance index is proposed. Conclusion: The Quintero selective technique was associated with the highest rate of successful ablation and lowest rate of PRTTTS. The Solomon technique represents a historical backward movement in the identification of placental vascular anastomoses and is associated with higher rate of residual patent vascular communications. The reported outcomes of the Quintero selective technique do not lend support to the existence of invisible anastomoses or justify lasering healthy placental tissue.

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Section: Should the Rate Of Taps Be Included As A Benchmark For The Pmentioning

confidence: 99%

Laser Treatment of Twin–to–Twin Transfusion Syndrome

2016

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“…The invasive management of TTTS in monochorionic triplet pregnancies with laser photocoagulation bears the risk of intra-uterine death (Chmait et al, 2009;Diemert et al, 2010;Ishii et al, 2006;Sepulveda et al, 2005;Van Shoubroeck et al, 2004) and TAPS (Lopriore et al, 2007;Robyr et al, 2006). Laser photocoagulation is technically challenging in these pregnancies (Chmait et al, 2009;Diemert et al, 2010;Sepulveda et al, 2005;Van Shoubroeck et al, 2004) and is best performed by teams with extensive experience in the treatment of TTTS in monochorionic twin pregnancies.…”

Section: Resultsmentioning

confidence: 99%

Twin–Twin Transfusion Syndrome and Twin Anemia–Polycythemia Sequence in a Monochorionic Triamniotic Pregnancy

et al. 2013

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Twin-twin transfusion syndrome (TTTS) is an antenatal complication of monochorionic multiple gestations. There have been few studies exploring the role of laser photocoagulation or outcomes following treatment in monochorionic triplet pregnancies with TTTS. We present a case where TTTS and twin anemiapolycythemia sequence (TAPS) complicated a monochorionic triplet pregnancy. Following the laser photocoagulation to treat the TTTS between the triplets, an intra-uterine death occurred in one triplet and TAPS developed in the remaining two triplets. Intervention in this case resulted in a 2-week prolongation of pregnancy and a positive outcome for the remaining fetuses. This case and other published data reviewed in this article suggest that laser photocoagulation has a potential role for TTTS in monochorionic triplet pregnancies.

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“…Estas comunicaciones facilitarían intercambios sanguíneos unidireccionales, lentos y persistentes en el tiempo, lo que asociado a la discrepancia de peso intergemelar, conducirían a la aparición progresiva de anemia en el ex receptor y policitemia en el ex donante (3,6,13). Lopriore y cols (14,15), estimaron que la velocidad del flujo en estas comunicaciones A-V minúsculas debiese ser alrededor de 5-15 mL/24 horas.gemelos se hizo crítica.…”

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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Twin Anemia–Polycythemia Sequence in Two Monochorionic Twin Pairs Without Oligo-Polyhydramnios Sequence

Cited by 255 publications

References 16 publications

Laser Treatment of Twin–to–Twin Transfusion Syndrome

Laser Treatment of Twin–to–Twin Transfusion Syndrome

Twin–Twin Transfusion Syndrome and Twin Anemia–Polycythemia Sequence in a Monochorionic Triamniotic Pregnancy

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

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