[Rare forms of feto-fetal transfusion in a clinical practice]

To analyze monochorionic twin pregnancies with twin anemia polycythemia sequence (TAPS) and acute peripartal twin to twin syndrome (aTTTS), to compare their prenatal management and perinatal outcome.

Retrospective analysis of monochorionic biamniotic twin pregnancies without signs of chronic TTTS within a period 10/2010 to 10/2013. Further selection of cases with haemoglobin difference in neonates greater than 50 g/l was made, type of feto-fetal haemorrhage was determined and their prenatal and postnatal characteristics were described.

Based on the criteria described above we selected four cases out of 55 monochorionic pregnancies. One case of prenatally diagnosed spontaneous TAPS which fulfilled all the diagnostic criteria with typical angioarchitecture inclusive, one case of spontaneous TAPS diagnosed postnatally, a case of postlaser TAPS with a spontaneous resolution and one unusual case of feto-fetal haemorrhage which does not fully meet criteria of TAPS or aTTTS. All the pregnancies were delivered by caesarean section. All the anaemic neonates required blood transfusion postpartum and two of the polycythemic neonates needed partial exsanguination.

Rare forms of feto-fetal transfusion syndrome form a heterogenous group and it may be difficult to distinguish between TAPS and aTTTS in certain cases. A recommendation for a management of TAPS cases was published in recent literature. However, correct interpretation of dopplerometric measurments belongs to the hands of experienced ultrasonographers in perinatal centers.