Twin anemia-polycythemia sequence in a case of monoamniotic twins

TY - JOUR

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 -