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

Abstract

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.

Perinatal outcomes of fetoscopic selective laser photocoagulation for spontaneous twin‐anemia polycythemia sequence

“…The use of one definition or another does not change outcomes when there is concomitant TTTS. 15,23 It remains uncertain whether outcomes of spontaneous TAPS (without TTTS) are improved using one definition or the other.…”

“…In our series, we utilized the traditional definition of TAPS in which the MCA‐PSV of the anemic twin was >1.5 MoM and <1.0 MoM in the polycythemic twin. The use of one definition or another does not change outcomes when there is concomitant TTTS 15,23 . It remains uncertain whether outcomes of spontaneous TAPS (without TTTS) are improved using one definition or the other.…”

Latrogenic twin anemia: polycythemia sequence post-amnioreduction in twin-twin transfusion syndrome

“…Compared with using MCA-PSV in donor > 1.5 MoM and in recipient < 1.0 MoM, the sensitivity has largely improved from 46% to 84%, with a comparable specificity, positive predictive value and negative predictive value. [5] Hiba et al [6] showed higher incidence of TAPS with delta MCA-PSV > 0.5, HTTPS://WWW.HKSMP.COM/JOURNALS/PRM but they thought that does not mean more intervention as intervention were necessarily. Recently, inconsistencies of the diagnostic criteria incurred Delphi experts consensus survey, reaching an agreement of the combination of MCA-PSV ≥ 1.5 MoM in the anemic twin and ≤ 0.8 MoM in the polycythemic or ∆MCA-PSV ≥ 1.0 MoM as diagnostic criteria of TAPS.…”