Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-26T14:23:32.567Z Has data issue: false hasContentIssue false

Chapter 14 - Management of Twin Anaemia-Polycythaemia Sequence

Published online by Cambridge University Press:  11 October 2022

By
Liesbeth Lewi  and
Enrico Lopriore
Edited by
Leanne Bricker ,
Julian N. Robinson  and
Baskaran Thilaganathan
Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
Get access

Summary

Twin anemia-polycythemia sequence (TAPS) is a transfusion imbalance unique to monochorionic twin pregnancies, characterized by anemia in the donor and polycythemia in the recipient. TAPS is caused by a chronic transfer of blood through minuscule anastomoses. TAPS can be diagnosed before birth by measuring the middle cerebral artery peak systolic velocities in both twins. If not detected, TAPS may lead to fetal demise. Although we do not know the best management, fetoscopic laser surgery and intrauterine transfusion of the donor with partial exchange transfusion of the recipient, may improve the outcome and prolong the pregnancy. Therefore, current guidelines recommend that we should screen monochorionic twin pregnancies for the occurrence of TAPS. In this chapter, we address our current understanding of TAPS, as well as the issues that need further research. We also propose a management plan based on the severity of the disease and the gestational age at presentation.

Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
 , pp. 147 - 156
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lewi, L, Jani, J, Cannie, M et al. Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: is there more than meets the eye? Am J Obstet Gynecol 2006;194(3):790–5.Google Scholar
Lopriore, E, Middeldorp, JM, Oepkes, D, Kanhai, HH, Walther, FJ, Vandenbussche, FP. Twin anemia-polycythemia sequence in two monochorionic twin pairs without oligo-polyhydramnios sequence. Placenta 2007;28(1):47–51.CrossRefGoogle ScholarPubMed
Khalil, A, Gordijn, S, Ganzevoort, W et al. Consensus diagnostic criteria and monitoring of twin anemia polycythemia sequence: a Delphi procedure. Ultrasound Obstet Gynecol 2019.Google Scholar
Tollenaar, LSA, Lopriore, E, Middeldorp, JM et al. Prevalence of placental dichotomy, fetal cardiomegaly and starry-sky liver in twin anemia polycythemia sequence. Ultrasound Obstet Gynecol 2019.Google Scholar
Couck, I, Ponnet, S, Deprest, J, Devlieger, R, De Catte, L, Lewi, L. Outcome of selective intrauterine growth restriction in monochorionic twin pregnancies at 16, 20 or 30 weeks according to the new consensus definition. Ultrasound Obstet Gynecol 2020.Google Scholar
Slaghekke, F, Lopriore, E, Lewi, L et al. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial. Lancet 2014;383(9935):2144–51.CrossRefGoogle ScholarPubMed
Couck, I, Valenzuela, I, Russo, F, Lewi, L. Spontaneous regression of twin anemia-polycythemia sequence presenting in the first trimester. Ultrasound Obstet Gynecol 2019.Google Scholar
Tollenaar, LS, Slaghekke, F, Middeldorp, JM et al. Twin anemia polycythemia sequence: current views on pathogenesis, diagnostic criteria, perinatal management, and outcome. Twin Res Hum Genet 2016;19(3):222–33.Google Scholar
Slaghekke, F, Favre, R, Peeters, SH et al. Laser surgery as a management option for twin anemia-polycythemia sequence. Ultrasound Obstet Gynecol 2014;44(3):304–10.CrossRefGoogle ScholarPubMed
Tollenaar, LSA, Lopriore, E, Slaghekke, F et al. High risk of long-term neurodevelopmental impairment in donor twins with spontaneous twin anemia-polycythemia sequence. Ultrasound Obstet Gynecol 2020;55(1):39–46.Google Scholar
Khalil, A, Rodgers, M, Baschat, A et al. ISUOG practice guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 2016;47(2):247–63.Google Scholar
NICE guideline [NG137]: twin and triplet pregnancy 2019. Available from www.nice.org.uk/guidance/ng137Google Scholar
Donepudi, R, Papanna, R, Snowise, S, Johnson, A, Bebbington, M, Moise, KJ, Jr. Does anemia-polycythemia complicating twin–twin transfusion syndrome affect outcome after fetoscopic laser surgery? Ultrasound Obstet Gynecol 2016;47(3):340–4.CrossRefGoogle ScholarPubMed
Tollenaar, LSA, Zhao, DP, Middeldorp, JM, Oepkes, D, Slaghekke, F, Lopriore, E. Can color difference on the maternal side of the placenta distinguish between acute peripartum twin–twin transfusion syndrome and twin anemia-polycythemia sequence? Placenta 2017;57:189–93.Google Scholar
Couck, I, Lewi, L. The placenta in twin-to-twin transfusion syndrome and twin anemia polycythemia sequence. Twin Res Hum Genet 2016;19(3):184–90.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×