Perinatal outcome of pregnancy complicated by twin anemia–polycythemia sequence: systematic review and meta‐analysis

Giorgione, Veronica; D’Antonio, Francesco; Manji, Arif; Reed, Keith; Khalil, Asma

doi:10.1002/uog.23585

Cited by 12 publications

(6 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…UA PI > 95%, donor, in the selective reduction group. 29 In our study, all the post-laser TAPS cases were managed expectantly. While a stable and chronic clinical balance between anemic and polycythemic twins can be managed conservatively, authors consider worsening of fetal hemodynamic (worsening delta MCA PSV, UA absent or reversed end diastolic flow velocity, DV absent or reversed a-wave, pulsatile umbilical vein, and hydrops) a trigger for active prenatal fetal intervention.…”

Section: Discussionmentioning

confidence: 87%

“…Some have proposed reversal of the usual sequence of the sequential selective method of coagulation of the intraplacental vessels in order to preserve the vascular volume of the anemic fetus 28 . A recent systematic review investigated the incidence of severe neonatal morbidity stratified by different management options and that was 27.3% in the expectant management groups, 28.7% in the laser group, 38.2% in the IUT group, and 23.3% in the selective reduction group 29 . In our study, all the post‐laser TAPS cases were managed expectantly.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Perinatal outcomes of pregnancies with twin‐anemia polycythemia sequence complicating twin‐to‐twin transfusion syndrome using different twin‐anemia polycythemia sequence diagnostic criteria

et al. 2022

View full text Add to dashboard Cite

Objective To investigate whether the presence of twin‐anemia polycythemia sequence (TAPS) with twin‐to‐twin transfusion syndrome (TTTS) or post‐laser TAPS would change outcomes using different TAPS diagnostic criteria. Methods TTTS cases undergoing laser surgery between 2012 and 2020 were included. Groups included pre‐laser TTTS‐only compared to TTTS + TAPS, and no post‐laser TAPS compared to post‐laser TAPS. Three prenatal TAPS diagnostic criteria were used: group A: middle cerebral artery‐peak systolic velocity (MCA‐PSV) > 1.5 MoM in one twin and <1 MoM in the other twin, group B: inter‐twin MCA‐PSV difference >1 MoM, and group C: inter‐twin MCA‐PSV difference >0.5 MoM. Perinatal outcomes including survival and severe cerebral injury were investigated. Results 174 laser procedures were included. TTTS + TAPS cases were 16 in group A, 17 in group B, and 29 in group C. Post‐laser TAPS cases were 11 in group A, 6 in group B, and 12 in group C. There were no differences in preoperative, operative variables and outcomes including survival and severe cerebral injury between groups using all three TAPS diagnostic criteria. The incidence of TTTS + TAPS was highest in group C (16.7%), then group B (9.8%), followed by group A (9.2%). The incidence of post‐laser TAPS was highest in group C (9%), then group A (8.3%), followed by group B (4.5%). Conclusion Presence of TAPS complicating TTTS and presence of post‐laser TAPS do not seem to be associated with worse perinatal outcomes including postnatal‐ultrasound detected cerebral injury using three different TAPS criteria. Collaborative studies are needed to investigate the validity and the performance of different TAPS criteria.

show abstract

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Perinatal outcomes of pregnancies with twin‐anemia polycythemia sequence complicating twin‐to‐twin transfusion syndrome using different twin‐anemia polycythemia sequence diagnostic criteria

et al. 2022

View full text Add to dashboard Cite

show abstract

“…TAPS is suspected when the donor MCA-PSV is > 1.5 multiples of the median (MoM) and recipient MCA-PSV is < 1.0 MoM 7 or when there is a large (> 0.5 MoM) intertwin difference in MCA-PSV 8 . In pregnancies complicated by TAPS, it remains unclear whether elevated MCA-PSV in the donor twin, reduced MCA-PSV in the recipient twin or both contribute to increased fetal death associated with TAPS 9,10 . Moreover, a proportion of pregnancies complicated by TTTS have elevated MCA-PSV in the donor twin but do not fulfill the abovementioned diagnostic criteria for TAPS; the clinical significance of isolated elevation of MCA-PSV in the donor twin in pregnancies complicated by TTTS remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Elevated middle cerebral artery peak systolic velocity and risk of death in donor twin affected by twin–twin transfusion syndrome but not twin anemia–polycythemia sequence

Espinoza,

Agarwal,

Johnson

et al. 2024

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

ObjectiveTo determine the association of high middle cerebral artery peak systolic velocity (MCA‐PSV) with fetal demise in donor twins among pregnancies complicated by twin‐to‐twin transfusion syndrome (TTTS) in the absence of twin anemia polycythemia sequence (TAPS).MethodsThis prospective cohort study included TTTS cases that underwent laser surgery between 2011 and 2022 at a single center. TAPS cases were excluded from the study. The primary objective was to explore the association of high MCA‐PSV (>1.5 multiples of the median) with fetal demise of the donor twin among pregnancies complicated by TTTS. Secondary objectives were: 1) to evaluate if donor or recipient MCA‐PSV is associated with an increased risk for their corresponding fetal death using receiving operator characteristic curve analysis; and 2) to compare the proportion of fetuses with low MCA pulsatility index among donor twins with high MCA‐PSV and in those with normal MCA‐PSV to evaluate the contribution of blood flow redistribution to high MCA‐PSV. Multivariable and Poisson regression analysis were performed to explore the association of isolated high donor MCA‐PSV and fetal demise, adjusted for TTTS stage, selective fetal growth restriction (sFGR), and other confounders. p<0.05 was considered significant.ResultsOut of 660 TTTS cases, donor MCA‐PSV was unavailable in 48 (7.3%) cases. Of the remaining 612 patients, 9 (1.5%) were lost to follow‐up, and 96 TAPS cases were excluded. High donor MCA‐PSV was seen in 6.5% (33/507) of the study population. High donor MCA‐PSV was an independent risk factor for donor fetal demise (adjusted relative risk (aRR) of 4.52; 95% CI: 2.72‐7.50), adjusted for confounders. Regression analysis restricted to each Quintero TTTS stage demonstrated that high donor MCA‐PSV was an independent risk factor for donor fetal demise in Quintero stage II (aRR of 14.21; 95% CI: 1.09‐186.2) and Quintero stage III (aRR of 3.41; 95% CI: 1.82‐6.41). Donor MCA‐PSV was associated with donor fetal demise (AUC: 0.69; p<0.001), but recipient MCA‐PSV was not associated with its corresponding fetal demise (AUC: 0.54; p=0.44). A higher proportion of donor twins in the group with high MCA‐PSV had a low MCA pulsatility index than in those with normal MCA‐PSV (33.3% vs. 15.5%; p=0.016).ConclusionsElevated donor MCA‐PSV without TAPS prior to laser surgery is associated with a 4‐fold increased risk for donor fetal demise, adjusted for sFGR, TTTS stage, and other confounders. Doppler evaluation of donor MCA‐PSV prior to laser surgery can further stratify TTTS staging to evaluate the risk for donor fetal demise.This article is protected by copyright. All rights reserved.

show abstract

“…Mothers with multiple pregnancies may be more vulnerable to a range of complications during pregnancy [ 8 ], including but not limited to gestational hypertension [ 9 ], gestational diabetes mellitus [ 10 ], antepartum hemorrhage [ 11 ], preterm birth [ 12 ], and anemia [ 13 ]. Pregnancy complications can cause adverse outcomes for mother and child, and even have long-term adverse effects on offspring [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of offspring from multiple gestations: a two-sample Mendelian randomization study on multi-system diseases using UK Biobank and FinnGen databases

Jiang,

Du,

et al. 2023

J Transl Med

View full text Add to dashboard Cite

Background Assisted reproductive technologies (ART) have increased the incidence of multiple births, which can have a negative impact on maternal and offspring health. The study aimed to investigate the association between genetically predicted multiple birth and the risk of 42 common diseases of the nervous, psychiatric, cardiovascular, respiratory, digestive, and endocrine systems. Methods The study utilized two-sample Mendelian randomization (MR) analysis to explore the potential causal relationship between genetically predicted multiple birth and the genetically predicted risk of diseases. The study used the FinnGen and UK Biobank datasets for analysis. Results The study found no significant causal relationship between multiple birth and psychiatric disorders. However, the lower limits of the 95% confidence intervals for bipolar affective disorder and anxiety disorders were not robust, indicating a need for further investigation. The study found that multiple birth may be a strong risk factor for infantile cerebral palsy, and caution is necessary in both natural and ART multiple births. The study revealed a potential causal relationship between multiple birth and coronary heart disease, ischemic heart disease, and deep vein thrombosis, which may be related to abnormal intrauterine environments in multiple pregnancies. Surprisingly, multiple birth appears to have a protective effect against some respiratory diseases, such as chronic obstructive pulmonary disease and asthma. Conclusions The study highlights the need for caution regarding the risk of infantile cerebral palsy, cardiovascular diseases, and psychiatric disorders in multiple birth. Our study can lead to the development of preventive strategies and improved clinical management for affected infants.

show abstract

Perinatal outcome of pregnancy complicated by twin anemia–polycythemia sequence: systematic review and meta‐analysis

Cited by 12 publications

References 73 publications

Perinatal outcomes of pregnancies with twin‐anemia polycythemia sequence complicating twin‐to‐twin transfusion syndrome using different twin‐anemia polycythemia sequence diagnostic criteria

Perinatal outcomes of pregnancies with twin‐anemia polycythemia sequence complicating twin‐to‐twin transfusion syndrome using different twin‐anemia polycythemia sequence diagnostic criteria

Elevated middle cerebral artery peak systolic velocity and risk of death in donor twin affected by twin–twin transfusion syndrome but not twin anemia–polycythemia sequence

Long-term outcomes of offspring from multiple gestations: a two-sample Mendelian randomization study on multi-system diseases using UK Biobank and FinnGen databases

Contact Info

Product

Resources

About