Improved prediction of twin anemia–polycythemia sequence by delta middle cerebral artery peak systolic velocity: new antenatal classification system

Tollenaar, Lisanne S.A.; Lopriore, Enrico; Middeldorp, Johanna M.; Haak, Monique C.; Klumper, Frans; Oepkes, Dick; Slaghekke, Femke

doi:10.1002/uog.20096

Cited by 66 publications

(79 citation statements)

References 15 publications

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“…The other fetus (twin B) had a low MCA‐PSV (20.7 cm/s; 0.81 MoM) with a normal amniotic volume (MVP, 6.4 cm). These findings met the diagnostic criteria of prenatal TAPS stage 2 …”

Section: Data Availability Statementsupporting

confidence: 54%

“…TAPS can be diagnosed both prenatally and postnatally . The prenatal diagnosis is based on Doppler ultrasound study, including discordant measurement of MCA‐PSV, and recently the classification system was updated by Tollenaar et al To diagnose TAPS, delta MCA‐PSV > 0.5 MoM rather than cutoff values of MCA‐PSV are used for diagnosis anemia (>1.5 MoM) and polycythemia (<1.0 MoM) …”

Section: Data Availability Statementmentioning

confidence: 99%

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Spontaneous twin anemia polycythemia sequence without amniotic fluid discordance followed by development of twin‐to‐twin transfusion syndrome and treated by fetoscopic laser photocoagulation

et al. 2019

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“…The other fetus (twin B) had a low MCA‐PSV (20.7 cm/s; 0.81 MoM) with a normal amniotic volume (MVP, 6.4 cm). These findings met the diagnostic criteria of prenatal TAPS stage 2 …”

Section: Data Availability Statementsupporting

confidence: 54%

Section: Data Availability Statementmentioning

confidence: 99%

Spontaneous twin anemia polycythemia sequence without amniotic fluid discordance followed by development of twin‐to‐twin transfusion syndrome and treated by fetoscopic laser photocoagulation

et al. 2019

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“…Monochorionic twin pregnancies identified as having TAPS antenatally and/or postnatally were eligible for inclusion. Antenatal diagnosis was based on the recently updated ultrasound Doppler criteria for TAPS 6 . In brief, TAPS was diagnosed in the presence of change in fetal middle cerebral artery (MCA) peak systolic velocity (PSV) > 0.5 multiples of the median (MoM), which is suggestive of the imbalanced chronic fetofetal transfusion leading to fetal anemia and polycythemia.…”

Section: Methodsmentioning

confidence: 99%

“…Postnatal diagnosis was based on a large (> 8 g/dL) intertwin difference in hemoglobin with at least one of the following criteria: reticulocyte count ratio > 1.7 and the presence of only minuscule (diameter < 1 mm) anastomoses at the placental surface, detected by color dye injection 7 . TAPS was classified antenatally and postnatally from stages 1 to 5, in accordance with the previously published staging systems for TAPS 6,8 .…”

Section: Methodsmentioning

confidence: 99%

High risk of long‐term neurodevelopmental impairment in donor twins with spontaneous twin anemia–polycythemia sequence

Tollenaar

Lopriore

Slaghekke

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? Donor twins of pregnancies complicated by spontaneous twin anemia-polycythemia sequence (TAPS) have four-fold higher odds of neurodevelopmental impairment compared with their recipient cotwins, are at increased risk of cognitive delay and have a high rate of deafness. What are the clinical implications of this work?Based on our findings, we strongly advise that routine long-term follow-up, including testing for hearing loss, should be an essential part of care of twins diagnosed with spontaneous TAPS. ABSTRACTObjectives To evaluate the long-term neurodevelopmental and behavioral outcomes in surviving infants of pregnancies with spontaneous twin anemia-polycythemia sequence (TAPS), to compare outcome between donors and recipients, and to investigate potential risk factors for neurodevelopmental impairment (NDI).Methods This was a retrospective study of a consecutive cohort of spontaneous-TAPS survivors delivered between 2005 and 2017 at the . Neurological, motor, cognitive and behavioral development were assessed at a median age of 4 years. The primary outcome was NDI, which was a composite outcome of cerebral palsy, deafness, blindness and motor and/or cognitive delay. NDI was subdivided into two grades of severity: mild-to-moderate and severe Correspondence to: Ms L. NDI. Outcome was compared between surviving donor and recipient twins. Logistic regression analysis was used to assess risk factors for NDI.Results Forty-nine twin pregnancies complicated by spontaneous TAPS were eligible for inclusion. The perinatal survival rate was 83% (81/98) of twins. Neurodevelopmental assessment was performed in 91% (74/81) of surviving twins. NDI occurred in 30% (22/74) of TAPS survivors, and was found more often in donors (44%; 15/34) than in recipients (18%; 7/40) (odds ratio (OR), 4.1; 95% CI, 1.8-9.1; P = 0.001). Severe NDI was detected in 9% (7/74) of survivors and was higher in donors compared with recipients (18% (6/34) vs 3% (1/40)), although the difference did not reach statistical significance; P = 0.056). Donors demonstrated lower cognitive scores compared with recipients (P = 0.011). Bilateral deafness was identified in 15% (5/34) of donors compared with 0% (0/40) of recipients (P = 0.056). Parental concern regarding development was reported more often for donor than for recipient twins (P = 0.001). On multivariate analysis, independent risk factors for NDI were gestational age at delivery (OR, 0.7; 95% CI, 0.5-0.9; P = 0.003) and severe anemia (OR, 6.4; 95% CI,; P < 0.001).Conclusion Surviving donor twins of pregnancies complicated by spontaneous TAPS have four-fold higher odds of NDI compared with recipient cotwins, are at increased risk of cognitive delay and have a high rate of deafness.

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“…Ultrasound screening for TAPS can be performed by measuring middle cerebral artery peak systolic velocity (MCA‐PSV). The severity of TAPS can be classified based on the degree of elevation of the MCA‐PSV above 1.5 multiples of the median in the anemic fetus, severity of intertwin MCA‐PSV discordance, the presence of any signs of cardiovascular compromise (by abnormal umbilical artery or ductus venosus Doppler waveforms) and/or hydrops . Intrauterine transfusion or fetoscopic laser are potential invasive therapies but there is no evidence guiding the most efficacious management .…”

mentioning

confidence: 99%

Updated guidance for the management of twin and triplet pregnancies from the National Institute for Health and Care Excellence guidance, UK: What's new that may improve perinatal outcomes?

Gibson

Castleman

Meher

et al. 2019

Acta Obstet Gynecol Scand

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In September 2019, NICE published updated guidance on the management of multiple pregnancy (NG 137). Many of the previous recommendations for care are upheld but there have been important changes: increased frequency of combined ultrasound/specialist antenatal care appointments for pregnancies containing a monochorionic placenta (twins and triplets), increased frequency of ultrasound monitoring in all triplet pregnancies, changes in the definition of selective growth restriction and its subsequent referral pathways, the introduction of some monitoring for twin (or triplet) anemia polycythemia sequence in monochorionic pregnancies (albeit in complex pregnancies or at an advanced stage), and a recommended timing of birth for any pregnancy with monoamniotic fetuses. New recommendations have been made for mode of delivery, fetal monitoring in labor, maternal analgesia, and the prevention of postpartum hemorrhage. The absence of any recommendation relating to the prevention of preterm birth is notable. The basis and implications of the updates that may improve perinatal outcomes are discussed.

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Improved prediction of twin anemia–polycythemia sequence by delta middle cerebral artery peak systolic velocity: new antenatal classification system

Cited by 66 publications

References 15 publications

Spontaneous twin anemia polycythemia sequence without amniotic fluid discordance followed by development of twin‐to‐twin transfusion syndrome and treated by fetoscopic laser photocoagulation

Spontaneous twin anemia polycythemia sequence without amniotic fluid discordance followed by development of twin‐to‐twin transfusion syndrome and treated by fetoscopic laser photocoagulation

High risk of long‐term neurodevelopmental impairment in donor twins with spontaneous twin anemia–polycythemia sequence

Updated guidance for the management of twin and triplet pregnancies from the National Institute for Health and Care Excellence guidance, UK: What's new that may improve perinatal outcomes?

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