title: Evolution of middle cerebral artery peak systolic velocity after a successful laser procedure for iatrogenic twin anemia-polycythemia sequence.
abstract: We report a case of twin anemia-polycythemia sequence (TAPS) treated by laser at 24 + 5 weeks' gestation, 7 weeks after a first laser procedure for twin-to-twin transfusion syndrome at 16 + 6 weeks. This management led to the birth of two healthy neonates by Cesarean section at 36 weeks. In this case, weekly measurement of the middle cerebral artery peak systolic velocity allowed us to monitor the twins after both laser treatments and, more specifically, to detect TAPS. Following delivery, placental injection showed a minuscule coagulated arteriovenous anastomosis. Intrauterine transfusion is generally chosen to manage TAPS, but the choice of therapy must consider gestational age, technical difficulties and disease severity. The laser procedure cannot be used as a curative treatment for TAPS in all cases. We propose a decisional algorithm to help clinicians select the appropriate treatment.
authors.affiliation: Division of Prenatal Diagnosis, Department of Obstetrics and Gynecology, Hôpital Paule de Viguier, Toulouse, France. m.groussolles@free.fr
authors.forename: M
authors.initials: M
authors.lastname: Groussolles
authors.forename: A
authors.initials: A
authors.lastname: Sartor
authors.forename: L
authors.initials: L
authors.lastname: Connan
authors.forename: C
authors.initials: C
authors.lastname: Vayssière
mesh_terms: D000328:Adult; D000740:Anemia / Q000628:therapy*; D001783:Blood Flow Velocity; D002585:Cesarean Section; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D005332:Fetoscopy; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation / Q000379:methods; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011086:Polycythemia / Q000628:therapy*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy*; D011256:Pregnancy Outcome; D014427:Twins; D016216:Ultrasonography, Prenatal