Novel Insights from Clinical Practice Received: April 16, 2014 Accepted after revision: July 7, 2014 Published online: January 21, 2015

Fetal Diagn Ther 2015;37:148–153 DOI: 10.1159/000365812

Twin Anemia-Polycythemia Sequence after Laser Surgery for Twin-Twin Transfusion Syndrome and Maternal Morbidity Kosuke Taniguchi a Masahiro Sumie a Rika Sugibayashi a Seiji Wada a Kentaro Matsuoka b Haruhiko Sago a  

 

 

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Center of Maternal-Fetal, Neonatal and Reproductive Medicine and b Departments of Pathology, National Center for Child Health and Development, 2–10–1 Okura, Setagaya-ku, Tokyo, Japan  

 

Established Facts • Twin anemia-polycythemia sequence (TAPS) is characterized by large inter-twin hemoglobin value differences without inter-twin amniotic fluid discordance. • There is limited data on the maternal and fetal prognosis of TAPS.

Novel Insights

Key Words Twin anemia-polycythemia sequence · Twin-twin transfusion syndrome · Fetoscopic laser photocoagulation

Abstract Twin anemia-polycythemia sequence (TAPS) is characterized by large inter-twin hemoglobin value differences without inter-twin amniotic fluid discordance. The management of post-laser TAPS remains controversial. Hence, more studies on TAPS, together with the associated maternal compli-

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cations and outcome of the fetuses and infants are needed. Between 2003 and 2012, we performed 287 cases of fetoscopic laser photocoagulation for twin-twin transfusion syndrome. Among the 114 who were placed under our care until delivery, three cases of TAPS occurred. In one case, we conducted intrauterine intravenous transfusion, while in the other two cases, we adopted expectant management. We performed an emergency caesarean section at 27–30 weeks of gestation in all cases due to a severe condition of anemia in the TAPS donor. Two cases with antenatal TAPS stage 4 had severe maternal complications; one had minute pulmo-

Haruhiko Sago, MD, PhD Center of Maternal-Fetal, Neonatal and Reproductive Medicine National Center for Child Health and Development 2–10–1 Okura, Setagaya-ku, Tokyo 157-8535 (Japan) E-Mail sagou-h @ ncchd.go.jp

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• Post-laser TAPS in a higher stage can cause severe maternal complications.

Introduction

Twin anemia-polycythemia sequence (TAPS) is a novel form of feto-fetal transfusion in monochorionic twins first reported by Lopriore et al. [1]. It was characterized by large inter-twin hemoglobin value differences without intertwin amniotic fluid discordance. The etiology of TAPS is postulated to be slow feto-fetal transfusion through minuscule anastomoses [2]. TAPS can occur not only spontaneously but also iatrogenically after fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). TAPS is estimated antenatally by fetal middle cerebral artery peak systolic velocity (MCA-PSV) measurements by Doppler ultrasonography [2]. As the management of antenatal TAPS remains undetermined, more studies of TAPS and the associated maternal complications, as well as outcome of the fetuses and infants, are needed. Between 2003 and 2012, we performed 287 cases of FLP for TTTS of which 114 cases were placed under our care until delivery. Prenatal care with weekly ultrasound examination, including pulsed Doppler assessment, was provided for all the mothers. Subsequently, three cases of TAPS were discovered. The diagnosis of TAPS was based on MCA-PSV >1.5 Multiples of the Median (MoM) in the donor fetus that coincided with a decreased MCA-PSV

Twin anemia-polycythemia sequence after laser surgery for twin-twin transfusion syndrome and maternal morbidity.

Twin anemia-polycythemia sequence (TAPS) is characterized by large inter-twin hemoglobin value differences without inter-twin amniotic fluid discordan...
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