Spontaneous twin anemia‐polycythemia sequence from two donors to one recipient in a monochorionic triamniotic pregnancy: Case report and review of the literature

Burgos, Eva Manuela Pena; Zapata, Rita María Regojo; Miranda, Miriam Turiel; Alvarado, Eugenia Antolín; Calle, María de la

doi:10.1111/jog.15042

Cited by 2 publications

(1 citation statement)

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“…Most published cases on TAPS in triplets are anecdotal and involve mainly DCTA pregnancies [10][11][12] . We recorded two cases of spontaneous and three cases of post-laser TAPS.…”

Section: Interpretation Of Study Findings and Comparison With Publish...mentioning

confidence: 99%

Perinatal outcome of monochorionic triamniotic triplet pregnancy: multicenter cohort study

Sileo,

Accurti,

Baschat

et al. 2023

Ultrasound in Obstet & Gyne

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ObjectiveMonochorionic triplet pregnancies are extremely rare and information on these pregnancies and their complications are limited. We aimed to investigate the risk of early and late pregnancy complications, perinatal outcomes, and the timing and methods of fetal intervention in monochorionic triplet pregnancies.MethodsThis was a multicenter retrospective cohort study including monochorionic triamniotic (MCTA) triplet pregnancies. The exclusion criteria were twins, or multiple pregnancies with higher order than triplets (e.g. quadruplets, quintuplets), and dichorionic or trichorionic triplet pregnancies. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anomalies, twin to twin transfusion syndrome (TTTS), twin anemia polycythemia syndrome (TAPS), twin reversed arterial perfusion sequence (TRAP), or selective fetal growth restriction (sFGR) were ascertained from the patient records. Data on antenatal interventions were collected, including selective (fetal) reduction (3 to 2 or 3 to 1), laser surgery, or any active fetal intervention (including amniodrainage). Finally, perinatal outcomes included livebirth, intrauterine demise (IUD), neonatal death (NND), perinatal death (PND) and termination of pregnancy (TOP). Neonatal data such as GA at birth, birthweight, neonatal intensive care unit (NICU) admission, and neonatal morbidity were also collected.ResultsIn our cohort of MCTA triplet pregnancies (n=153 after excluding early miscarriages, TOP and loss to follow‐up), the majority (90%) were managed expectantly. The incidence of fetal abnormalities and TRAP was 13.7% and 5.2%, respectively. The most common antenatal complication related to chorionicity was TTTS, which complicated just over a quarter (27.6%) of the pregnancies, followed by sFGR (16.4%), while TAPS (both spontaneous and post‐laser) occurred in only 3.3%; no antenatal complication was recorded in 49.3% of pregnancies. Survival was largely associated with the development of these complications: 85.1%, 100% and 47.6% of pregnancies had at least one surviving newborn in those without antenatal complications, complicated by sFGR, or complicated by TTTS, respectively. The overall rates of preterm birth prior to 28 weeks and prior to 32 weeks’ gestation were 14.5% and 49.2%, respectively.ConclusionMCTA triplet pregnancies represent a challenge in counseling, surveillance and management as monochorionicity‐related complications occur in almost half of these pregnancies, which negatively impact their perinatal outcomes.This article is protected by copyright. All rights reserved.

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“…Most published cases on TAPS in triplets are anecdotal and involve mainly DCTA pregnancies [10][11][12] . We recorded two cases of spontaneous and three cases of post-laser TAPS.…”

Section: Interpretation Of Study Findings and Comparison With Publish...mentioning

confidence: 99%

Perinatal outcome of monochorionic triamniotic triplet pregnancy: multicenter cohort study

Sileo,

Accurti,

Baschat

et al. 2023

Ultrasound in Obstet & Gyne

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Multidisciplinary Approach in the Diagnosis and Treatment of Twin Anemia Polycythemia Sequence in Monochorionic Twin Pregnancies: Case Report

Fortún Agud,

Marfil González,

Monis Rodríguez

et al. 2024

Life

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Twin anemia–polycythemia sequence (TAPS) in monochorionic twin pregnancies is a potentially serious complication caused by unidirectional vascular anastomoses in the placenta, resulting in one anemic donor twin and one polycythemic recipient twin. Diagnosis of this condition is achieved through Doppler ultrasound assessment of the difference between the MoM of the peak systolic velocity of the middle cerebral artery between the twins, establishing the diagnosis with a delta value >0.5 MoM. Management of this situation is individualized and may include intrauterine transfusions, intrauterine laser treatment, and expectant management through ultrasound monitoring of both fetuses to prevent complications. In severe cases, pregnancy termination may be necessary. It is essential that these pregnancies are managed by a multidisciplinary team of professionals, including obstetricians specialized in fetal medicine and neonatologists, to ensure the best possible outcome for both the mother and the fetuses. Early detection and treatment are crucial in the management of pregnancies complicated by twin anemia–polycythemia sequence. The main objective of this article is to conduct a review of the existing literature on the anemia–polycythemia sequence in monochorionic pregnancies, emphasizing the exceptional nature of the presented case due to its spontaneous occurrence, which has a very low prevalence compared to post-laser TAPS cases. It also discusses the different treatment options, highlighting the importance of expectant management and individualization in each case.

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Spontaneous twin anemia‐polycythemia sequence from two donors to one recipient in a monochorionic triamniotic pregnancy: Case report and review of the literature

Cited by 2 publications

References 10 publications

Perinatal outcome of monochorionic triamniotic triplet pregnancy: multicenter cohort study

Perinatal outcome of monochorionic triamniotic triplet pregnancy: multicenter cohort study

Multidisciplinary Approach in the Diagnosis and Treatment of Twin Anemia Polycythemia Sequence in Monochorionic Twin Pregnancies: Case Report

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