Fetal intraperitoneal transfusion for iatrogenic twin anemia-polycythemia sequence after laser therapy.
Twin anemia-polycythemia sequence (TAPS) is a rare variant of twin-twin transfusion syndrome (TTTS) without the characteristic twin oligohydramnios-polyhydramnios sequence and cardiovascular milieu attributed to renin-angiotensin system mediators. It can occur spontaneously or iatrogenically after fetoscopic laser surgery. We report the case of a woman, gravida 2 para 1, with a monochorionic diamniotic pregnancy who developed Quintero Stage III TTTS. She underwent laser photocoagulation of identifiable anastomotic vessels and subsequently developed suspected TAPS 2 weeks later. The pregnancy was successfully treated with serial intrauterine intraperitoneal transfusions (IUT-PTs) of red blood cells. Although TAPS is a rare condition, serial middle cerebral artery peak systolic velocity measurements are warranted as follow-up in patients who have undergone fetoscopic laser surgery for TTTS. IUT-PTs may be superior to intravascular intrauterine transfusions in the treatment of this condition.
Herway
C
C
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and the Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX 77030, USA.
Johnson
A
A
Moise
K
K
Moise
K J
KJ
D000328:Adult; D000740:Anemia / Q000628:therapy*; D001783:Blood Flow Velocity / Q000502:physiology; D001805:Blood Transfusion, Intrauterine / Q000379:methods*; D017707:Erythrocyte Transfusion / Q000379:methods; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects*; D010920:Placenta / Q000503:physiopathology* / Q000601:surgery; D011086:Polycythemia / Q000628:therapy*; D011247:Pregnancy; D016216:Ultrasonography, Prenatal