Twin anemia-polycythemia sequence

Twin anemia-polycythemia sequence
Twin anemia-polycythemia sequence
	Twin anemia-polycythemia sequence is a monochorionic twin condition characterized by a large intertwin hemoglobin difference
Specialty	Obstetrics

Twin anemia-polycythemia sequence (TAPS) is a form of chronic inter-twin transfusion.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^{[excessive citations]}

Monochorionic twin pregnancy complication[]

^[1]^[2]^[3]^[4]^[5]^[6]

Diagnosis and staging[]

Diagnosis by Doppler ultrasound measurement of the Middle Cerebral Artery—Peak Systolic Velocity (MCA-PSV)

Different stages of TAPS are identified using the criteria as shown in the following tables.^[4]

Postnatal classification[]

Postnatal stage	Intertwin hemoglobin difference (g/dL)
Stage 1	>8.0 g/dL
Stage 2	>11.0 g/dL
Stage 3	>14.0 g/dL
Stage 4	>17.0 g/dL
Stage 5	>20.0 g/dL

Treatment[]

^[4]^[7]^[8]^[9]^[10]^[12]

The use of the so-called Solomon technique or dichorionization in fetoscopic laser therapy for twin-to-twin transfusion syndrome is proven to be beneficial in preventing post-laser TAPS.^{[citation needed]} With this technique, not only all anastomoses are coagulated (closed) but also a line is drawn between those in order to coagulate anastomoses that might not (yet) be visible during fetoscopy.^{[citation needed]} It should be stressed that the success of such a technique is highly dependent on the specific situation.^{[citation needed]} For example, when one of the fetuses obstructs the view on the vascular equator (the part of the placenta where the anastomoses need to be coagulated), complete dichorionization by the Solomon technique might not be possible.^{[citation needed]}

Perinatal outcome[]

^[4]^[13]^[14]

References[]

^ Jump up to: ^a ^b Lopriore, E.; Middeldorp, J.M.; Oepkes, D.; Kanhai, H.H.; Walther, F.J.; Vandenbussche, F.P.H.A. (2007). "Twin Anemia–Polycythemia Sequence in Two Monochorionic Twin Pairs Without Oligo-Polyhydramnios Sequence". Placenta. 28 (1): 47–51. doi:10.1016/j.placenta.2006.01.010. PMID 16516289.
^ Jump up to: ^a ^b Lopriore, E; Deprest, J; Slaghekke, F; Oepkes, D; Middeldorp, J M.; Vandenbussche, F P. H. A.; Lewi, L (2008). "Placental Characteristics in Monochorionic Twins With and Without Twin Anemia–Polycythemia Sequence". Obstetrics & Gynecology. 112 (4): 753–758. doi:10.1097/aog.0b013e318187e1ff. PMID 18827116. S2CID 33703154.
^ Jump up to: ^a ^b Lewi, Liesbeth; Jani, Jacques; Blickstein, Isaac; Huber, Agnes; Gucciardo, Leonardo; Mieghem, Tim Van; Doné, Elisa; Boes, Anne-Sophie; Hecher, Kurt (2008). "The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study". American Journal of Obstetrics and Gynecology. 199 (5): 514.e1–514.e8. doi:10.1016/j.ajog.2008.03.050. PMID 18533114.
^ Jump up to: ^a ^b ^c ^d ^e Slaghekke, F.; Kist, W.J.; Oepkes, D.; Pasman, S.A.; Middeldorp, J.M.; Klumper, F.J.; Walther, F.J.; Vandenbussche, F.P.H.A.; Lopriore, E. (2010). "Twin Anemia-Polycythemia Sequence: Diagnostic Criteria, Classification, Perinatal Management and Outcome". Fetal Diagnosis and Therapy. 27 (4): 181–190. doi:10.1159/000304512. PMID 20339296.
^ Jump up to: ^a ^b Robyr, Romaine; Lewi, Liesbeth; Salomon, Laurent J.; Yamamoto, Masami; Bernard, Jean-Pierre; Deprest, Jan; Ville, Yves (2006). "Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome". American Journal of Obstetrics and Gynecology. 194 (3): 796–803. doi:10.1016/j.ajog.2005.08.069. PMID 16522415.
^ Jump up to: ^a ^b Habli, Mounira; Bombrys, Annette; Lewis, David; Lim, Foong-Yen; Polzin, William; Maxwell, Rose; Crombleholme, Timothy (2009). "Incidence of complications in twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: a single-center experience". American Journal of Obstetrics and Gynecology. 201 (4): 417.e1–417.e7. doi:10.1016/j.ajog.2009.07.046. PMID 19788973.
^ Jump up to: ^a ^b Lopriore, E.; Hecher, K.; Vandenbussche, F.P.H.A.; Wijngaard, J.P.H.M. van den; Klumper, F.J.; Oepkes, D. (2008). "Fetoscopic laser treatment of twin-to-twin transfusion syndrome followed by severe twin anemia-polycythemia sequence with spontaneous resolution". American Journal of Obstetrics and Gynecology. 198 (2): e4–e7. doi:10.1016/j.ajog.2007.08.073. PMID 18226611.
^ Jump up to: ^a ^b Herway, C.; Johnson, A.; Moise, K.; Moise, K. J. (2009-05-01). "Fetal intraperitoneal transfusion for iatrogenic twin anemia–polycythemia sequence after laser therapy". Ultrasound in Obstetrics and Gynecology. 33 (5): 592–594. doi:10.1002/uog.6334. ISSN 1469-0705. PMID 19402103.
^ Jump up to: ^a ^b Lopriore, E.; Wijngaard, J.P.H.M. van den; Middeldorp, J.M.; Oepkes, D.; Walther, F.J.; Gemert, M.J. van; Vandenbussche, F.P.H.A. (2007). "Assessment of Feto-fetal Transfusion Flow Through Placental Arterio-venous Anastomoses in a Unique Case of Twin-to-Twin Transfusion Syndrome". Placenta. 28 (2–3): 209–211. doi:10.1016/j.placenta.2006.03.006. PMID 16678896.
^ Jump up to: ^a ^b Weingertner, A. S.; Kohler, A.; Kohler, M.; Bouffet, N.; Hunsinger, M. C.; Mager, C.; Hornecker, F.; Neumann, M.; Schmerber, E. (2010-04-01). "Clinical and placental characteristics in four new cases of twin anemia–polycythemia sequence". Ultrasound in Obstetrics and Gynecology. 35 (4): 490–494. doi:10.1002/uog.7508. ISSN 1469-0705. PMID 20069657.
^ https://www.tapssupport.com
^ Genova, L.; Slaghekke, F.; Klumper, F.J.; Middeldorp, J.M.; Steggerda, S.J.; Oepkes, D.; Lopriore, E. (2013). "Management of Twin Anemia-Polycythemia Sequence Using Intrauterine Blood Transfusion for the Donor and Partial Exchange Transfusion for the Recipient". Fetal Diagnosis and Therapy. 34 (2): 121–126. doi:10.1159/000346413. PMID 23713060. S2CID 28413969.
^ Lopriore, E.; Slaghekke, F.; Kersbergen, K. J.; de Vries, L. S.; Drogtrop, A. P.; Middeldorp, J. M.; Oepkes, D.; Benders, M. J. (2013-06-01). "Severe cerebral injury in a recipient with twin anemia–polycythemia sequence". Ultrasound in Obstetrics & Gynecology. 41 (6): 702–706. doi:10.1002/uog.12337. ISSN 1469-0705. PMID 23124777.
^ Luminoso, D.; Figueira, C. O.; Marins, M.; Peralta, C. F. A. (2013-12-01). "Fetal brain lesion associated with spontaneous twin anemia–polycythemia sequence". Ultrasound in Obstetrics & Gynecology. 42 (6): 721–722. doi:10.1002/uog.12574. ISSN 1469-0705. PMID 23897836.

External links[]

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[elsevier47-1] Jump up to: ^a ^b Lopriore, E.; Middeldorp, J.M.; Oepkes, D.; Kanhai, H.H.; Walther, F.J.; Vandenbussche, F.P.H.A. (2007). "Twin Anemia–Polycythemia Sequence in Two Monochorionic Twin Pairs Without Oligo-Polyhydramnios Sequence". Placenta. 28 (1): 47–51. doi:10.1016/j.placenta.2006.01.010. PMID 16516289.

[wkhealth753-2] Jump up to: ^a ^b Lopriore, E; Deprest, J; Slaghekke, F; Oepkes, D; Middeldorp, J M.; Vandenbussche, F P. H. A.; Lewi, L (2008). "Placental Characteristics in Monochorionic Twins With and Without Twin Anemia–Polycythemia Sequence". Obstetrics & Gynecology. 112 (4): 753–758. doi:10.1097/aog.0b013e318187e1ff. PMID 18827116. S2CID 33703154.

[elsevier514-3] Jump up to: ^a ^b Lewi, Liesbeth; Jani, Jacques; Blickstein, Isaac; Huber, Agnes; Gucciardo, Leonardo; Mieghem, Tim Van; Doné, Elisa; Boes, Anne-Sophie; Hecher, Kurt (2008). "The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study". American Journal of Obstetrics and Gynecology. 199 (5): 514.e1–514.e8. doi:10.1016/j.ajog.2008.03.050. PMID 18533114.

[karger181-4] Jump up to: ^a ^b ^c ^d ^e Slaghekke, F.; Kist, W.J.; Oepkes, D.; Pasman, S.A.; Middeldorp, J.M.; Klumper, F.J.; Walther, F.J.; Vandenbussche, F.P.H.A.; Lopriore, E. (2010). "Twin Anemia-Polycythemia Sequence: Diagnostic Criteria, Classification, Perinatal Management and Outcome". Fetal Diagnosis and Therapy. 27 (4): 181–190. doi:10.1159/000304512. PMID 20339296.

[elsevier796-5] Jump up to: ^a ^b Robyr, Romaine; Lewi, Liesbeth; Salomon, Laurent J.; Yamamoto, Masami; Bernard, Jean-Pierre; Deprest, Jan; Ville, Yves (2006). "Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome". American Journal of Obstetrics and Gynecology. 194 (3): 796–803. doi:10.1016/j.ajog.2005.08.069. PMID 16522415.

[elsevier417-6] Jump up to: ^a ^b Habli, Mounira; Bombrys, Annette; Lewis, David; Lim, Foong-Yen; Polzin, William; Maxwell, Rose; Crombleholme, Timothy (2009). "Incidence of complications in twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: a single-center experience". American Journal of Obstetrics and Gynecology. 201 (4): 417.e1–417.e7. doi:10.1016/j.ajog.2009.07.046. PMID 19788973.

[elsevier2008-7] Jump up to: ^a ^b Lopriore, E.; Hecher, K.; Vandenbussche, F.P.H.A.; Wijngaard, J.P.H.M. van den; Klumper, F.J.; Oepkes, D. (2008). "Fetoscopic laser treatment of twin-to-twin transfusion syndrome followed by severe twin anemia-polycythemia sequence with spontaneous resolution". American Journal of Obstetrics and Gynecology. 198 (2): e4–e7. doi:10.1016/j.ajog.2007.08.073. PMID 18226611.

[wiley592-8] Jump up to: ^a ^b Herway, C.; Johnson, A.; Moise, K.; Moise, K. J. (2009-05-01). "Fetal intraperitoneal transfusion for iatrogenic twin anemia–polycythemia sequence after laser therapy". Ultrasound in Obstetrics and Gynecology. 33 (5): 592–594. doi:10.1002/uog.6334. ISSN 1469-0705. PMID 19402103.

[elsevier209-9] Jump up to: ^a ^b Lopriore, E.; Wijngaard, J.P.H.M. van den; Middeldorp, J.M.; Oepkes, D.; Walther, F.J.; Gemert, M.J. van; Vandenbussche, F.P.H.A. (2007). "Assessment of Feto-fetal Transfusion Flow Through Placental Arterio-venous Anastomoses in a Unique Case of Twin-to-Twin Transfusion Syndrome". Placenta. 28 (2–3): 209–211. doi:10.1016/j.placenta.2006.03.006. PMID 16678896.

[wiley490-10] Jump up to: ^a ^b Weingertner, A. S.; Kohler, A.; Kohler, M.; Bouffet, N.; Hunsinger, M. C.; Mager, C.; Hornecker, F.; Neumann, M.; Schmerber, E. (2010-04-01). "Clinical and placental characteristics in four new cases of twin anemia–polycythemia sequence". Ultrasound in Obstetrics and Gynecology. 35 (4): 490–494. doi:10.1002/uog.7508. ISSN 1469-0705. PMID 20069657.

[tapsregistry1-11] ttps://www.tapssupport.com

[12] Genova, L.; Slaghekke, F.; Klumper, F.J.; Middeldorp, J.M.; Steggerda, S.J.; Oepkes, D.; Lopriore, E. (2013). "Management of Twin Anemia-Polycythemia Sequence Using Intrauterine Blood Transfusion for the Donor and Partial Exchange Transfusion for the Recipient". Fetal Diagnosis and Therapy. 34 (2): 121–126. doi:10.1159/000346413. PMID 23713060. S2CID 28413969.

[13] Lopriore, E.; Slaghekke, F.; Kersbergen, K. J.; de Vries, L. S.; Drogtrop, A. P.; Middeldorp, J. M.; Oepkes, D.; Benders, M. J. (2013-06-01). "Severe cerebral injury in a recipient with twin anemia–polycythemia sequence". Ultrasound in Obstetrics & Gynecology. 41 (6): 702–706. doi:10.1002/uog.12337. ISSN 1469-0705. PMID 23124777.

[14] Luminoso, D.; Figueira, C. O.; Marins, M.; Peralta, C. F. A. (2013-12-01). "Fetal brain lesion associated with spontaneous twin anemia–polycythemia sequence". Ultrasound in Obstetrics & Gynecology. 42 (6): 721–722. doi:10.1002/uog.12574. ISSN 1469-0705. PMID 23897836.

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show v t Twin conditions
Zygosity	Twin
Monochorionic twins	Twin-to-twin transfusion syndrome Twin reversed arterial perfusion Monoamniotic twins
Conjoined twins	Parasitic twin Craniopagus parasiticus Fetus in fetu
Other	Vanishing twin Chimerism Mixed twins