Can middle cerebral artery peak systolic velocity predict polycythemia in monochorionic–diamniotic twins? Evidence from a prospective cohort study

Fishel-Bartal, M.; Weisz, Boaz; Mazaki‐Tovi, Shali; Ashwal‏, Eran; Chayen, Benjamin; Lipitz, Shlomo; Yinon, Yoav

doi:10.1002/uog.15838

Cited by 31 publications

(44 citation statements)

References 26 publications

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“…Furthermore, MCA Doppler alone cannot detect polycythemia in the monochorionic twins in cases of twin anemia-polycythemia sequence. 24 However, by directly estimating the hematocrit, we have shown that MRI can detect the differences in hematocrit between the twins and thus could become a better tool to diagnose interfetal blood transfusion in monochorionic twins.…”

Section: Obstetrics Original Researchmentioning

confidence: 97%

The utility of MRI for measuring hematocrit in fetal anemia

Duan²,

Marini

et al. 2020

American Journal of Obstetrics and Gynecology

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Section: Obstetrics Original Researchmentioning

confidence: 97%

The utility of MRI for measuring hematocrit in fetal anemia

Duan²,

Marini

et al. 2020

American Journal of Obstetrics and Gynecology

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“…MCA-PSV measurement in polycythemic twins did not differ compared to normal twins. Fishel-Bartal et al (2015) did find a significant correlation between a large inter-twin difference in MCA-PSV (delta MCA-PSV) and large inter-twin hematocrit difference and proposed the alternative use of a delta MCA-PSV >0.5 MoM instead of the currently used fixed cut-off levels of <1.0 MoM and >1.5 MoM for the pre-natal diagnosis of TAPS.…”

Section: Antenatal Criteriamentioning

confidence: 99%

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

et al. 2016

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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.

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“…In this review, nine studies employed a MCA–PSV cutoff value of 0.8–1.0 MoM while five studies used a cutoff value of <1 MoM. The reviewers demonstrated that 0.8 MoM provided the best option with regard to sensitivity and specifity Other studies including infants and adults demonstrated that MCA–PSV measurements were low in polycythemic subjects and levels increased to near normal levels after exchange and or dilution . Nonetheless all efforts for establishing cut–off values for fetal polycythemia have been unsuccessful with unacceptable predictive values and overlapping measurements between normal and anemic fetuses.…”

Section: Discussionmentioning

confidence: 99%