Journal of Clinical Medicine (Jun 2020)
Post-Laser Twin Anemia Polycythemia Sequence: Diagnosis, Management, and Outcome in an International Cohort of 164 Cases
- Lisanne S.A. Tollenaar,
- Enrico Lopriore,
- Stefano Faiola,
- Mariano Lanna,
- Julien Stirnemann,
- Yves Ville,
- Liesbeth Lewi,
- Roland Devlieger,
- Anne Sophie Weingertner,
- Romain Favre,
- Sebastian R. Hobson,
- Greg Ryan,
- Carlota Rodo,
- Silvia Arévalo,
- Philipp Klaritsch,
- Patrick Greimel,
- Kurt Hecher,
- Manuela Tavares de Sousa,
- Asma Khalil,
- Basky Thilaganathan,
- Eric P. Bergh,
- Ramesha Papanna,
- Glenn J. Gardener,
- Andrew Carlin,
- Elisa Bevilacqua,
- Victorya A. Sakalo,
- Kirill V. Kostyukov,
- Mert O. Bahtiyar,
- Abigail Wilpers,
- Mark D. Kilby,
- Eleonor Tiblad,
- Dick Oepkes,
- Johanna M. Middeldorp,
- Monique C. Haak,
- Frans J.C.M. Klumper,
- Joost Akkermans,
- Femke Slaghekke
Affiliations
- Lisanne S.A. Tollenaar
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Enrico Lopriore
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Stefano Faiola
- Fetal Therapy Unit “U. Nicolini”, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy
- Mariano Lanna
- Fetal Therapy Unit “U. Nicolini”, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy
- Julien Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, 75015 Paris, France
- Yves Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, 75015 Paris, France
- Liesbeth Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium
- Roland Devlieger
- Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium
- Anne Sophie Weingertner
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, CEDEX, 67000 Strasbourg, France
- Romain Favre
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, CEDEX, 67000 Strasbourg, France
- Sebastian R. Hobson
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada
- Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada
- Carlota Rodo
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
- Silvia Arévalo
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
- Philipp Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria
- Patrick Greimel
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria
- Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Manuela Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Asma Khalil
- Fetal Medicine Unit, St George University Hospital NHS Foundation Trust, London SW17 0RE, UK
- Basky Thilaganathan
- Fetal Medicine Unit, St George University Hospital NHS Foundation Trust, London SW17 0RE, UK
- Eric P. Bergh
- The Fetal Center, Department of Obstetrics, Children’s Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UT Health, McGovern Medical School, University of Texas, Houston, TX 77030, USA
- Ramesha Papanna
- The Fetal Center, Department of Obstetrics, Children’s Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UT Health, McGovern Medical School, University of Texas, Houston, TX 77030, USA
- Glenn J. Gardener
- Department of Maternal Fetal Medicine, Mater Mothers’ Hospital, South Brisbane, QLD 4101, Australia
- Andrew Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, 1020 Brussels, Belgium
- Elisa Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, 1020 Brussels, Belgium
- Victorya A. Sakalo
- Acad. V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, 495 Moscow, Russia
- Kirill V. Kostyukov
- Acad. V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, 495 Moscow, Russia
- Mert O. Bahtiyar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
- Abigail Wilpers
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
- Mark D. Kilby
- Fetal Medicine Centre, Birmingham Women’s and Children’s Foundation Trust, University of Birmingham, Birmingham B4 6NH, UK
- Eleonor Tiblad
- Center for Fetal Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Dick Oepkes
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Johanna M. Middeldorp
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Monique C. Haak
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Frans J.C.M. Klumper
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Joost Akkermans
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Femke Slaghekke
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- DOI
- https://doi.org/10.3390/jcm9061759
- Journal volume & issue
-
Vol. 9,
no. 6
p. 1759
Abstract
The aim of this study was to investigate the management and outcome in the post-laser twin anemia polycythemia sequence (TAPS). Data of the international TAPS Registry, collected between 2014 and 2019, were used for this study. The primary outcomes were perinatal mortality and severe neonatal morbidity. Secondary outcomes included a risk factor analysis for perinatal mortality and severe neonatal morbidity. A total of 164 post-laser TAPS pregnancies were included, of which 92% (151/164) were diagnosed antenatally and 8% (13/164) postnatally. The median number of days between laser for TTTS and detection of TAPS was 14 (IQR: 7–28, range: 1–119). Antenatal management included expectant management in 43% (62/151), intrauterine transfusion with or without partial exchange transfusion in 29% (44/151), repeated laser surgery in 15% (24/151), selective feticide in 7% (11/151), delivery in 6% (9/151), and termination of pregnancy in 1% (1/151). The median gestational age (GA) at birth was 31.7 weeks (IQR: 28.6–33.7; range: 19.0–41.3). The perinatal mortality rate was 25% (83/327) for the total group, 37% (61/164) for donors, and 14% (22/163) for recipients (p p = 0.568. Independent risk factors for spontaneous perinatal mortality were antenatal TAPS Stage 4 (OR = 3.4, 95%CI 1.4-26.0, p = 0.015), TAPS donor status (OR = 4.2, 95%CI 2.1–8.3, p p = 0.001). Severe neonatal morbidity was significantly associated with GA at birth (OR = 1.5, 95%CI 1.3–1.7, p < 0.001). In conclusion, post-laser TAPS most often occurs within one month after laser for TTTS, but may develop up to 17 weeks after initial surgery. Management is mostly expectant, but varies greatly, highlighting the lack of consensus on the optimal treatment and heterogeneity of the condition. Perinatal outcome is poor, particularly due to the high rate of perinatal mortality in donor twins.
Keywords
- monochorionic twins
- twin anemia polycythemia sequence
- TAPS
- twin-twin transfusion syndrome
- TTTS
- laser surgery