Twin anemia-polycythemia sequence in a case of monoamniotic twins
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Twin anemia-polycythemia sequence in a case of monoamniotic twins. / Diehl, W; Glosemeyer, P; Tavares De Sousa, M; Hollwitz, B; Ortmeyer, G; Hecher, K.
in: ULTRASOUND OBST GYN, Jahrgang 42, Nr. 1, 01.07.2013, S. 108-11.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Twin anemia-polycythemia sequence in a case of monoamniotic twins
AU - Diehl, W
AU - Glosemeyer, P
AU - Tavares De Sousa, M
AU - Hollwitz, B
AU - Ortmeyer, G
AU - Hecher, K
N1 - Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd.
PY - 2013/7/1
Y1 - 2013/7/1
N2 - Twin anemia-polycythemia sequence (TAPS) complicates up to 6% of monochorionic diamniotic twin pregnancies, typically in the late second or third trimester. The presence of only a few and very small arteriovenous vascular anastomoses characterizes the underlying angioarchitecture at the chorionic plate in cases of TAPS. In monoamniotic twins, large vascular anastomoses can usually be seen at the placental vascular equator, and therefore one would not expect the development of TAPS in monoamniotic twins. We report a case of TAPS in a monoamniotic pregnancy at 26 + 5 weeks' gestation which responded favorably to fetoscopic laser coagulation of the small placental anastomoses, resolving severe anemia in one twin and polycythemia in the other. The pregnancy continued until 32 + 5 weeks, when worsening cord entanglement with increased resistance and the development of postsystolic notches in the umbilical artery of one twin prompted delivery by Cesarean section. There was only a moderate difference in neonatal hemoglobin concentrations, with the former polycythemic twin needing a single partial volume exchange transfusion. The postnatal course of the neonates was uneventful, according to their gestational age at birth. To our knowledge this is the first case report describing successful laser therapy for TAPS in monoamniotic twins.
AB - Twin anemia-polycythemia sequence (TAPS) complicates up to 6% of monochorionic diamniotic twin pregnancies, typically in the late second or third trimester. The presence of only a few and very small arteriovenous vascular anastomoses characterizes the underlying angioarchitecture at the chorionic plate in cases of TAPS. In monoamniotic twins, large vascular anastomoses can usually be seen at the placental vascular equator, and therefore one would not expect the development of TAPS in monoamniotic twins. We report a case of TAPS in a monoamniotic pregnancy at 26 + 5 weeks' gestation which responded favorably to fetoscopic laser coagulation of the small placental anastomoses, resolving severe anemia in one twin and polycythemia in the other. The pregnancy continued until 32 + 5 weeks, when worsening cord entanglement with increased resistance and the development of postsystolic notches in the umbilical artery of one twin prompted delivery by Cesarean section. There was only a moderate difference in neonatal hemoglobin concentrations, with the former polycythemic twin needing a single partial volume exchange transfusion. The postnatal course of the neonates was uneventful, according to their gestational age at birth. To our knowledge this is the first case report describing successful laser therapy for TAPS in monoamniotic twins.
KW - Adult
KW - Anemia
KW - Cesarean Section
KW - Female
KW - Fetoscopy
KW - Gestational Age
KW - Humans
KW - Infant, Newborn
KW - Laser Coagulation
KW - Placenta
KW - Polycythemia
KW - Polyhydramnios
KW - Pregnancy
KW - Pregnancy Outcome
KW - Pregnancy, Twin
KW - Twins, Monozygotic
U2 - 10.1002/uog.12418
DO - 10.1002/uog.12418
M3 - SCORING: Journal article
C2 - 23361996
VL - 42
SP - 108
EP - 111
JO - ULTRASOUND OBST GYN
JF - ULTRASOUND OBST GYN
SN - 0960-7692
IS - 1
ER -