Advertisement
Research Article| Volume 279, P45-49, December 2022

Download started.

Ok

Perinatal outcomes of twin-to-twin transfusion syndrome associated with evidence of twin anemia polycythemia using different standardized definitions

Published:October 10, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.10.007
Perinatal outcomes of twin-to-twin transfusion syndrome associated with evidence of twin anemia polycythemia using different standardized definitions
Previous ArticleThe acceptability of emergency cervical cerclage within a randomised controlled trial for cervical dilatation with exposed membranes at 16–27 + 6 weeks gestation: Findings from a qualitative process evaluation of the C-STICH2 pilot trial
Next ArticleINFEXIT: Implementing vaginal disinfection prior to cesarean section

      Abstract

      Objectives

      To evaluate the survival of twin-to-twin transfusion syndrome (TTTS) and concomitant twin anemia polycythemia sequence (TAPS) compared to TTTS without TAPS at the time of fetoscopic laser photocoagulation (FLP).

      Methods

      TTTS pregnancies undergoing FLP were divided to three groups including (i) traditional TAPS definition of middle cerebral artery (MCA) peak systolic velocity (PSV) < 1 multiple of the median (MoM) in recipient and > 1.5 MoM in the donor fetus, (ii) delta MCA-PSV > 0.5 MoM and (iii) delta MCA-PSV > 1.0 MoM.

      Results

      A total of 353 monochorionic twins underwent FLP for TTTS. Based on the traditional definition, 335 (94.9 %) had TTTS only and 18 (5.1 %) had TTTS + TAPS. There were 245 (69.4 %) TTTS only and 108 (30.6 %) TTTS + TAPS considering delta MCA-PSV > 0.5 MoM and 339 (96 %) TTTS only and 14 (4 %) TTTS + TAPS considering delta MCA-PSV > 1.0 MoM. No significant differences in survival were noted at birth or 30-days after delivery between TTTS and TTTS with TAPS patients using the traditional definition, delta > 0.5 MoM or delta > 1.0 MoM.

      Conclusion

      The rate of neonatal survival at birth or at 30-days of life following FLP for TTTS only and TTTS with TAPS were not different based on any of the clinically used TAPS definitions.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Obstetrics and Gynecology and Reproductive Biology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Lopriore E.
        • Middeldorp J.
        • Oepkes D.
        • Kanhai H.
        • Walther F.
        • Vandenbussche F.
        Twin anemia–polycythemia sequence in two monochorionic twin pairs without oligo-polyhydramnios sequence.
        Placenta. 2007; 28: 47-51
        View in Article

      2. Lewi L, Jani J, Blickstein I, Huber A, Gucciardo L, Van Mieghem T, et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol 2008;199(5):514. e1-. e8.

        View in Article
        • Slaghekke F.
        • Lopriore E.
        • Lewi L.
        • Middeldorp J.M.
        • van Zwet E.W.
        • Weingertner A.-S.
        • et al.
        Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial.
        The Lancet. 2014; 383: 2144-2151
        View in Article
        • Slaghekke F.
        • Kist W.J.
        • Oepkes D.
        • Pasman S.A.
        • Middeldorp J.M.
        • Klumper F.J.
        • et al.
        Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome.
        Fetal Diagn Ther. 2010; 27: 181-190
        View in Article
        • Tollenaar L.S.A.
        • Lopriore E.
        • Middeldorp J.M.
        • Haak M.C.
        • Klumper F.J.
        • Oepkes D.
        • et al.
        Improved prediction of twin anemia-polycythemia sequence by delta middle cerebral artery peak systolic velocity: new antenatal classification system.
        Ultrasound in obstetrics & gynecology : off J Int Soc Ultrasoun Obstet Gynecol. 2019; 53: 788-793
        View in Article
        • Khalil A.
        • Gordijn S.
        • Ganzevoort W.
        • Thilaganathan B.
        • Johnson A.
        • Baschat A.A.
        • et al.
        Consensus diagnostic criteria and monitoring of twin anemia–polycythemia sequence: Delphi procedure.
        Ultrasound Obstet Gynecol. 2020; 56: 388-394
        View in Article
        • Donepudi R.
        • Papanna R.
        • Snowise S.
        • Johnson A.
        • Bebbington M.
        • Moise Jr, K.
        Does anemia–polycythemia complicating twin–twin transfusion syndrome affect outcome after fetoscopic laser surgery?.
        Ultrasound Obstet Gynecol. 2016; 47: 340-344
        View in Article
        • Tollenaar L.S.A.
        • Slaghekke F.
        • van Klink J.M.M.
        • Groene S.G.
        • Middeldorp J.M.
        • Haak M.C.
        • et al.
        Twin-twin transfusion syndrome with anemia-polycythemia: prevalence, characteristics, and outcome.
        J Clin Med. 2019; 8: 1129
        View in Article
        • Van Winden K.R.
        • Quintero R.A.
        • Kontopoulos E.V.
        • Korst L.M.
        • Llanes A.
        • Chmait R.H.
        Pre-operative twin anemia/polycythemia in the setting of twin-twin transfusion syndrome (TTTS).
        Fetal Diagn Ther. 2015; 37: 274-280
        View in Article
        • Hadlock F.P.
        • Harrist R.
        • Sharman R.S.
        • Deter R.L.
        • Park S.K.
        Estimation of fetal weight with the use of head, body, and femur measurements—a prospective study.
        Am J Obstet Gynecol. 1985; 151: 333-337
        View in Article
        • Khalil A.
        • Beune I.
        • Hecher K.
        • Wynia K.
        • Ganzevoort W.
        • Reed K.
        • et al.
        Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure.
        Ultrasound Obstet Gynecol. 2019; 53: 47-54
        View in Article
        • Quintero R.A.
        • Morales W.J.
        • Allen M.H.
        • Bornick P.W.
        • Johnson P.K.
        • Kruger M.
        Staging of twin-twin transfusion syndrome.
        J Perinatol. 1999; 19: 550-555
        View in Article
        • Moaddab A.
        • Nassr A.A.
        • Espinoza J.
        • Ruano R.
        • Bateni Z.H.
        • Shamshirsaz A.A.
        • et al.
        Twin anemia polycythemia sequence: a single center experience and literature review.
        Europ J Obstet Gynecol Reproduct Biol. 2016; 205: 158-164
        View in Article

      Article info

      Publication history

      Published online: October 10, 2022
      Accepted: October 6, 2022
      Received in revised form: October 4, 2022
      Received: August 23, 2022

      Identification

      DOI: https://doi.org/10.1016/j.ejogrb.2022.10.007

      Copyright

      © 2022 Elsevier B.V. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX