Arterio-Arterial Anastomoses do not Prevent the Development of Twin Anemia-Polycythemia Sequence

Meir, Hélène van; Slaghekke, Femke; Lopriore, Enrico; Wijngaarden, Wim J. van

doi:10.1016/j.placenta.2009.11.009

Cited by 28 publications

(17 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both have few small unidirectional artery-to-vein anastomoses without compensating artery-to-artery anastomosis [29,30] , suggesting that TAPS results from a chronic net transfusion across these tiny anastomoses. To all rules there are exceptions, and rare cases with only a small bidirectional anastomosis have been reported [31] as we describe here a case with small vein-to-vein anastomosis ( fig. 3 ).…”

Section: Fetal Complications In Monochorionic Twin Pregnanciesmentioning

confidence: 87%

Monochorionic Diamniotic Twin Pregnancies: Natural History and Risk Stratification

et al. 2010

View full text Add to dashboard Cite

About 30% of monochorionic twin pregnancies are complicated by twin-to-twin transfusion syndrome (TTTS), isolated discordant growth, twin anemia-polycythemia sequence, congenital defects or intrauterine demise. About 15% will be eligible for invasive fetal therapy, either fetoscopic laser treatment for TTTS or fetoscopic or ultrasound-guided umbilical cord coagulation for a severe congenital defect in one twin or severe discordant growth with imminent demise of the growth-restricted twin. Ultrasound examination in the first and early second trimester can differentiate the monochorionic twins at high risk for adverse outcome from those likely to be uneventful, which may be useful for patient counselling and planning of care.

show abstract

Section: Fetal Complications In Monochorionic Twin Pregnanciesmentioning

confidence: 87%

Monochorionic Diamniotic Twin Pregnancies: Natural History and Risk Stratification

et al. 2010

View full text Add to dashboard Cite

show abstract

“…In 2007, we described a case of postlaser TAPS which occurred despite the presence of a small AA anastomosis [11] . Recently, we also detected an AA anastomosis in a spontaneous TAPS case [13] . In a series of 26 TAPS placentas injected at our center to date (from spontaneous TAPS cases and postlaser cases), a small AA anastomosis was found in 3 cases.…”

Section: Pathogenesismentioning

confidence: 96%

Twin Anemia-Polycythemia Sequence: Diagnostic Criteria, Classification, Perinatal Management and Outcome

Slaghekke

Kist²,

Oepkes³

et al. 2010

Fetal Diagn Ther

Self Cite

342

339

View full text Add to dashboard Cite

Monochorionic twins share a single placenta with intertwin vascular anastomoses, allowing the transfer of blood from one fetus to the other and vice versa. These anastomoses are the essential anatomical substrate for the development of several complications, including twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). TTTS and TAPS are both chronic forms of fetofetal transfusion. TTTS is characterized by the twin oligopolyhydramnios sequence, whereas TAPS is characterized by large intertwin hemoglobin differences in the absence of amniotic fluid discordances. TAPS may occur spontaneously in up to 5% of monochorionic twins and may also develop after incomplete laser treatment in TTTS cases. This review focuses on the pathogenesis, incidence, diagnostic criteria, management options and outcome in TAPS. In addition, we propose a classification system for antenatal and postnatal TAPS.

show abstract

“…AA anastomoses are rare in TAPS cases and occur in 10-20% of TAPS placentas. AA anastomoses are considered to protect against the development of TTTS or TAPS because of the bidirectional blood flow, allowing inter-twin equilibration of blood volumes (de Villiers et al, 2012;Lopriore, van den Wijngaard et al, 2007;Suzuki, 2010;van Meir et al, 2010).The size of AA-anastomoses in TAPS appear to be significantly smaller (diameter <1 mm) compared to AA anastomoses in TTTS cases or in uncomplicated monochorionic twins (Zhao et al, 2013). Spontaneous TAPS placentas differ from post-laser TAPS placentas.…”

Section: Placental Characteristicsmentioning

confidence: 99%

Twin Anemia Polycythemia Sequence: Current Views on Pathogenesis, Diagnostic Criteria, Perinatal Management, and Outcome

et al. 2016

View full text Add to dashboard Cite

Monochorionic twins share a single placenta and are connected with each other through vascular anastomoses. Unbalanced inter-twin blood transfusion may lead to various complications, including twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS). TAPS was first described less than a decade ago, and the pathogenesis of TAPS results from slow blood transfusion from donor to recipient through a few minuscule vascular anastomoses. This gradually leads to anemia in the donor and polycythemia in the recipient, in the absence of twin oligo-polyhydramnios sequence (TOPS). TAPS may occur spontaneously in 3-5% of monochorionic twins or after laser surgery for TTTS. The prevalence of post-laser TAPS varies from 2% to 16% of TTTS cases, depending on the rate of residual anastomoses. Pre-natal diagnosis of TAPS is currently based on discordant measurements of the middle cerebral artery peak systolic velocity (MCA-PSV; >1.5 multiples of the median [MoM] in donors and <1.0 in recipients). Post-natal diagnosis is based on large inter-twin hemoglobin (Hb) difference (>8 g/dL), and at least one of the following: reticulocyte count ratio >1.7 or minuscule placental anastomoses. Management includes expectant management, and intra-uterine blood transfusion (IUT) with or without partial exchange transfusion (PET) or fetoscopic laser surgery. Post-laser TAPS can be prevented by using the Solomon laser surgery technique. Short-term neonatal outcome ranges from isolated inter-twin Hb differences to severe neonatal morbidity and neonatal death. Long-term neonatal outcome in post-laser TAPS is comparable with long-term outcome after treated TTTS. This review summarizes the current knowledge after 10 years of research on the pathogenesis, diagnosis, management, and outcome in TAPS.

show abstract

Arterio-Arterial Anastomoses do not Prevent the Development of Twin Anemia-Polycythemia Sequence

Cited by 28 publications

References 10 publications

Monochorionic Diamniotic Twin Pregnancies: Natural History and Risk Stratification

Monochorionic Diamniotic Twin Pregnancies: Natural History and Risk Stratification

Twin Anemia-Polycythemia Sequence: Diagnostic Criteria, Classification, Perinatal Management and Outcome

Twin Anemia Polycythemia Sequence: Current Views on Pathogenesis, Diagnostic Criteria, Perinatal Management, and Outcome

Contact Info

Product

Resources

About