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Accurate and Simple Evaluation of Vascular Anastomoses in Monochorionic Placenta using Colored Dye

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Published on: September 5, 2011

Twin anemia polycythemia sequence from a prenatal perspective.

Léonardo Gucciardo¹, Liesbeth Lewi, Pascal Vaast

¹Department of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium.

Prenatal Diagnosis

|April 8, 2010

Summary

Spontaneous twin anemia polycythemia sequence (TAPS) is rare in monochorionic twins, with a 2% prevalence. Screening using middle cerebral artery peak systolic velocity (MCA-PSV) is recommended for early detection and management.

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Area of Science:

Perinatology
Maternal-Fetal Medicine
Neonatology

Background:

Monochorionic twins share placental vasculature, predisposing them to intertwin complications.
Twin anemia polycythemia sequence (TAPS) is a chronic, slow intertwin transfusion not always evident with standard TTTS screening.

Observation:

A retrospective analysis identified 3 cases of spontaneous TAPS in 142 monochorionic twin pregnancies without twin-to-twin transfusion syndrome (TTTS).
TAPS diagnosis relied on discordant MCA-PSV and evidence of chronic transfusion imbalance (elevated reticulocytes or placental anastomoses).

Findings:

The estimated prevalence of prenatal TAPS was 2%.
Prenatal management included intrauterine transfusion and circulatory interruption via cord coagulation or laser separation.
Outcomes were managed based on individual case characteristics.

Implications:

TAPS is an uncommon but significant prenatal finding in monochorionic twins.
Screening for TAPS using MCA-PSV measurements is advisable in routine prenatal surveillance.
Early detection and intervention can potentially improve outcomes for affected twins.