Review of the correlation between blood flow velocity and polycythemia in the fetus, neonate and adult: appropriate diagnostic levels need to be determined for twin anemia-polycythemia sequence

Introduction: Twin anaemia-polycythaemia sequence (TAPS) occurs when significant haemoglobin discordance exists between monochorionic fetuses. Most reported cases occur iatrogenically after twin-to-twin transfusion syndrome (TTTS) laser therapy; spontaneous TAPS is also reported. The purpose of this study was to investigate pregnancy management and immediate neonatal outcomes for monochorionic multiple pregnancies complicated by TAPS referred to the NSW Fetal Therapy Centre (FTC). Methods: Retrospective cohort study of multiple pregnancies referred to NSW FTC between April 2006 and April 2014. Fourteen TAPS cases [discordant middle cerebral artery peak systolic volume (MCA-PSV) or clinician diagnosis antenatally, or Hb >20 g/dL vs. <12 g/dL post-natally] were compared to an existing TTTS database (n = 142) and uncomplicated monochorionic diamniotic (MCDA) twin pregnancies (n = 45). Outcomes measured were maternal demographics; ultrasound findings at referral; management, including whether in utero fetal therapy was performed; and pregnancy outcome, including gestation at birth, mode of birth, birthweight, fetal/neonatal complications and neonatal survival to discharge. Results: The majority of TAPS cases were spontaneous (9/14) and occurred later in pregnancy than TTTS (median gestation at diagnosis 26.0 AE 4.9 vs. 20.4 AE 2.6 weeks, P < 0.001). However, TAPS perinatal outcome was similar to TTTS (survival of both twins 62% vs. 53%, survival of at least one twin 85% vs. 87%, overall survival 73% vs. 70%) and overall survival significantly lower than for uncomplicated MCDA pregnancies (73% vs. 98%, P < 0.001). Conclusion: Overall mortality for TAPS was similar to that of TTTS but significantly higher compared to uncomplicated MCDA pregnancies, underscoring the potential severity of TAPS despite its later gestational onset.

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“…This supports the conclusions of Fishel‐Bartal et al . and Lucewicz et al . reported in recent literature.…”

Section: Discussionsupporting

confidence: 93%

“…suggest that Delta MCA‐PSV measurements are more effective than specified cut‐offs. The controversy over antenatal diagnosis, and widespread lack of evidence for the use of specified cut‐offs, means that caution should be taken when defining TAPS purely on MCA‐PSV measurements . Post‐natally, Slaghekke et al .…”

Section: Introductionmentioning

confidence: 99%

Uncommon complications of monochorionic twin pregnancies: Twin anaemia-polycythaemia sequence

Fisher

Welsh

Wilson

et al. 2016

Australas J Ultrasound Med

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“…The correlation between MCA‐PSV and fetal anemia is well established. However, the use of MCA‐PSV for the diagnosis of fetal polycythemia has not yet been validated. The aim of this study was to determine whether fetal MCA‐PSV can predict polycythemia in MCDA twin pregnancies.…”

Section: Introductionmentioning

confidence: 99%

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

Fishel-Bartal

Weisz

Mazaki‐Tovi

et al. 2016

Ultrasound in Obstet & Gyne

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“…The primary search of the Pubmed, Embase, and SCOPUS databases produced 432 publications. Based on abstract review, 54 of these publications were selected to be reviewed in their entirety [ 1 , 2 , 4 , 5 , 7 , 9 , 10 , 11 , 12 , 16 , 19 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. The secondary search of bibliographies produced three additional publications which were also reviewed in their entirety for a total 57 publications [ 6 , 66 , 67 ].…”

Section: Resultsmentioning

confidence: 99%

Middle Cerebral Artery Doppler Velocimetry for the Diagnosis of Twin Anemia Polycythemia Sequence: A Systematic Review

Brock

Bergh

Moise

et al. 2020

JCM

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Twin anemia polycythemia sequence (TAPS) is a rare complication of monochorionic diamniotic (MCDA) twins. Middle cerebral artery peak systolic velocity (MCA-PSV) measurements are used to screen for TAPS while fetal or neonatal hemoglobin levels are required for definitive diagnosis. We sought to perform a systematic review of the efficacy of MCA-PSV in diagnosing TAPS. Search criteria were developed using relevant terms to query the Pubmed, Embase, and SCOPUS electronic databases. Publications reporting diagnostic characteristics of MCA-PSV measurements (i.e., sensitivity, specificity or receiver operator curves) were included. Each article was assessed for bias using the Quality Assessment of Diagnostic Accuracy Studies II (QUADAS II) tool. Results were assessed for uniformity to determine whether meta-analysis was feasible. Data were presented in tabular form. Among publications, five met the inclusion criteria. QUADAS II analysis revealed that four of the publications were highly likely to have bias in multiple areas. Meta-analysis was precluded by non-uniformity between definitions of TAPS by MCA-PSV and neonatal or fetal hemoglobin levels. High-quality prospective studies with consistent definitions and ultrasound surveillance protocols are still required to determine the efficacy of MCA-PSV in diagnosing TAPS. Other ultrasound findings (e.g., placenta echogenicity discordance) may augment Doppler studies.

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Review of the correlation between blood flow velocity and polycythemia in the fetus, neonate and adult: appropriate diagnostic levels need to be determined for twin anemia-polycythemia sequence

Abstract: Twin anemia-polycythemia sequence (TAPS) is recognized increasingly antenatally by the demonstration of an anemic twin and a polycythemic cotwin using the middle cerebral artery peak systolic velocity (MCA-PSV

Cited by 12 publications

References 54 publications

Uncommon complications of monochorionic twin pregnancies: Twin anaemia-polycythaemia sequence

Uncommon complications of monochorionic twin pregnancies: Twin anaemia-polycythaemia sequence

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

Middle Cerebral Artery Doppler Velocimetry for the Diagnosis of Twin Anemia Polycythemia Sequence: A Systematic Review

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