Prevalence, size, number and localization of vascular anastomoses in monochorionic placentas

Zhao, Depeng; Villiers, S.F. de; Slaghekke, Femke; Walther, Frans J.; Middeldorp, Johanna M.; Oepkes, Dick; Lopriore, Enrico

doi:10.1016/j.placenta.2013.04.005

Cited by 92 publications

(75 citation statements)

References 18 publications

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“…There also was birth weight discordance in more than half of the nontreated TAPS cases, whereas this affected only 29% of the treated TAPS cases. Zhao et al [28], too, found a more marked tendency towards discrepant birth weights in the event of TAPS versus uncomplicated monochorionic diamniotic twin pregnancies. Correction of anemia therefore appears to be associated with improved growth of the anemic fetus.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study by Slaghekke et al [26] on the effect of laser photocoagulation on TAPS (n = 8) as compared to no treatment (n = 27) or IUT (n = 17), the survival rate after laser was 94% (vs. 83 and 84% with expectant management and IUT, respectively; p = 0.30), with a prolonged diagnosis-delivery interval (11 vs. 5 and 8 WG; p < 0.01) and no severe hematological complications (vs. 72 and 52%; p < 0.01). It should be noted that placental photocoagulation for TAPS is more complicated than for TTTS due to the absence of polyhydramnios, a less tense uterine wall, more opaque amniotic fluid as well as slender and often marginal anastomoses [6,28]. In the particular case of iatrogenic TAPS after laser treatment, the rationale for repeating the laser procedure should be carefully considered; if the anastomoses were not visualized during the first laser treatment for TTTS, it is unlikely that they will be identified any better during a second procedure.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Utility of in utero Treatment of Twin Anemia-Polycythemia Sequence

Sananès¹,

Veujoz²,

Séverac

et al. 2015

Fetal Diagn Ther

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Objective: The aim of this study is to evaluate the interest in the in utero treatment of twin anemia-polycythemia sequence (TAPS). Methods: The obstetrical and neonatal data on all cases of TAPS followed up in our institution between 2006 and 2013 were reviewed. Statistical analyses were conducted using Bayesian methods. Results: Twenty cases of TAPS were included. Laser therapy or intrauterine transfusion (IUT) was performed on the donor twin in 9 cases. Eleven cases were included in the ‘nontreated' group (managed expectantly or diagnosed at birth). The gestational age at diagnosis was lower in the group with treated TAPS [difference (diff) = -22.20 days (-57.13, 14.28), probability (Pr) (diff >0) = 10.6%]. The rate of preterm premature rupture of membranes was higher in the group with treated TAPS [diff = 22.5% (-14, 57), Pr (diff >0) = 89%], but overall mortality was similar. The interval between diagnosis and delivery was longer [diff = 44.37 days (9.41, 77.90), Pr (diff >0) = 99.2%], the TAPS resolution rate was higher [diff = 49.9% (12, 81), Pr (diff >0) = 99.4%], and the neonatal transfusion rate was lower [diff = -30.5% (-60, 0), Pr (diff >0) = 2.6%] in the treated group. Conclusion: In utero treatment for TAPS is associated with a higher resolution rate of TAPS and a longer time between diagnosis and birth, but overall mortality is the same as with expectant management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of the Utility of in utero Treatment of Twin Anemia-Polycythemia Sequence

Sananès¹,

Veujoz²,

Séverac

et al. 2015

Fetal Diagn Ther

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“…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

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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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“…The total number of anastomoses in TAPS placentas is lower compared to normal monochorionic placentas and TTTS cases (Zhao et al, 2013).…”

Section: Anastomoses In Taps Placentasmentioning

confidence: 73%

The Placenta in Twin-to-Twin Transfusion Syndrome and Twin Anemia Polycythemia Sequence

Couck

Lewi

2016

Twin Res Hum Genet

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Twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS) are complications unique to monochorionic twin pregnancies and their shared circulation. Both are the result of the transfusion imbalance in the intertwin circulation. TTTS is characterized by an amniotic fluid discordance, whereas in TAPS, there is a severe discordance in hemoglobin levels. The article gives an overview of the typical features of TTTS and TAPS placentas.

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Prevalence, size, number and localization of vascular anastomoses in monochorionic placentas

Cited by 92 publications

References 18 publications

Evaluation of the Utility of in utero Treatment of Twin Anemia-Polycythemia Sequence

Evaluation of the Utility of in utero Treatment of Twin Anemia-Polycythemia Sequence

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

The Placenta in Twin-to-Twin Transfusion Syndrome and Twin Anemia Polycythemia Sequence

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