title: 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.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.
authors.forename: Samer A
authors.initials: SA
authors.lastname: Assaf
authors.forename: Kurt
authors.initials: K
authors.lastname: Benirschke
authors.forename: Ramen H
authors.initials: RH
authors.lastname: Chmait
mesh_terms: D000025:Abortion, Eugenic; D000740:Anemia / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D005332:Fetoscopy; D006801:Humans; D015160:Hydrops Fetalis / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D007231:Infant, Newborn; D008875:Middle Aged; D010920:Placenta / Q000098:blood supply / Q000601:surgery; D010922:Placenta Diseases / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D011086:Polycythemia / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal; D011272:Pregnancy, Multiple; D014310:Triplets; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery