Spontaneous twin anemia-polycythemia sequence complicated by recipient placental vascular thrombosis and hydrops fetalis.

Abstract

Twin anemia-polycythemia sequence (TAPS) is an atypical form of twin-twin transfusion syndrome (TTTS) that presents as a large intertwin hemoglobin difference with one twin developing anemia and the other developing polycythemia, without oligohydramnios-polyhydramnios sequence (Lopriore et al., Placenta 2007;28:47-51). The prenatal diagnostic criteria for TAPS require that the middle cerebral artery-peak systolic velocity (MCA-PSV) measure greater than 1.5 multiples of median (MoM) in the donor twin and less than 0.8 MoM in the recipient twin (Robyr et al., Am J Obstet Gynecol 2006;194:796-803; Klaritsch et al., Ultrasound Obstet Gynecol 2009;34:149-154; Mari et al., N Engl Med 2000;342:9-14). The presumed etiology of TAPS involves the presence of small caliber arteriovenous anastomoses, which generate a slow transfusional process allowing for hemodynamic compensation (Lopriore et al., Placenta 2007;28:47-51; Lopriore et al., Placenta 2009;30:223-225; Lewi et al., Am J Obstet Gynecol 2006;194:790-795; Lopriore et al., Am J Obstet Gynecol 2008;112:753-758; Van den Wijngaard et al., Placenta 2007;28:611-615). The resulting polycythemia in the recipient twin is a risk factor for fetal and placental thrombosis (Van den Wijngaard et al., Am J Physiol 2005;288:R799-R814). We present a case of spontaneous TAPS complicated by a large placental vessel thrombosis and hydrops fetalis. Treatment via selective laser photocoagulation of communicating vessels (SLPCV) resulted in normalization of the MCA-PSV discordance.

• Authors: Samer A Assaf, Kurt Benirschke, Ramen H Chmait
• Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (J Matern Fetal Neonatal Med) Vol. 24 Issue 3 Pg. 549-52 (Mar 2011) ISSN: 1476-4954 [Electronic] England
• PMID: 20593976 (Publication Type: Case Reports, Journal Article)

Topics

• Abortion, Eugenic
• Anemia (complications, diagnosis, surgery)
• Female
• Fetofetal Transfusion (complications, diagnosis, surgery)
• Fetoscopy
• Humans
• Hydrops Fetalis (diagnosis, pathology, surgery)
• Infant, Newborn
• Middle Aged
• Placenta (blood supply, surgery)
• Placenta Diseases (diagnosis, pathology, surgery)
• Polycythemia (complications, diagnosis, surgery)
• Pregnancy
• Pregnancy Reduction, Multifetal
• Pregnancy, Multiple
• Triplets
• Venous Thrombosis (complications, diagnosis, surgery)