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Pre-Operative Twin Anemia/Polycythemia in the Setting of Twin-Twin Transfusion Syndrome (TTTS).

AbstractINTRODUCTION:
Twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS) are classified as distinct clinical disorders associated with unbalanced blood flow through placental vascular communications. Typically, TAPS placentas demonstrate few <1 mm arteriovenous (AV) communications, and at fetoscopy the twins are visibly pale and plethoric.
MATERIALS AND METHODS:
In a cohort of TTTS patients who underwent laser surgery, those with preoperative findings suggestive of anemia/polycythemia (AP) were compared to those with TTTS alone. AP was defined as middle cerebral artery peak systolic velocity in one twin >1.5 multiples of the median (MoM), and <1.0 MoM in the other.
RESULTS:
Of 369 TTTS patients, 9 (2.4%) met criteria for preoperative AP. The mean number (±SD) of AV communications in the TTTS + AP group was 5.6 ± 5.7, compared with 8.8 ± 4.8 in the TTTS-alone group (p = 0.013). Five TTTS + AP patients (56%) had a few thin AV communications (mean 2.8 ± 1.6); all 5 had visibly pale and plethoric twins. The remaining 4 (44%) had large or numerous anastomoses (mean 10.5 ± 6.8); none had fetal skin color discordance.
DISCUSSION:
Preoperative AP affected 2% of TTTS patients. Of these, approximately half had placental and skin color findings typically reported with isolated TAPS.
AuthorsKristi R Van Winden, Ruben A Quintero, Eftichia V Kontopoulos, Lisa M Korst, Arlyn Llanes, Ramen H Chmait
JournalFetal diagnosis and therapy (Fetal Diagn Ther) Vol. 37 Issue 4 Pg. 274-80 ( 2015) ISSN: 1421-9964 [Electronic] Switzerland
PMID25721425 (Publication Type: Journal Article)
Copyright© 2015 S. Karger AG, Basel.
Topics
  • Anemia (complications, surgery)
  • Female
  • Fetofetal Transfusion (complications, surgery)
  • Fetoscopy
  • Humans
  • Laser Therapy
  • Placenta (blood supply)
  • Polycythemia (complications, surgery)
  • Pregnancy
  • Pregnancy, Twin
  • Preoperative Period
  • Treatment Outcome

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