title: Fetal Intra-Peritoneal Transfusion for the Management of Very Early Spontaneous Twin Anemia-Polycythemia Sequence in an Obese Patient With a Whole Anterior Placenta.
abstract: Twin anemia-polycythemia sequence (TAPS) is a rare condition in monochorionic twin pregnancies. Small intertwin placental vascular communications allow transfusion, which results in a hemoglobin difference in the twins in the absence of oligohydramnios or polyhydramnios. We report here a case of TAPS diagnosed at 17 weeks' gestation in an obese patient (BMI 42) with a whole anterior placenta. The only possible treatment at this stage of pregnancy was intra-uterine transfusion (IUT), which was repeated weekly until photocoagulation of placental anastomoses was feasible. Fetoscopic laser surgery is the only curative treatment, but is challenging in TAPS because of the absence of polyhydramnios and the presence of minuscule anastomoses. An anterior placenta and high BMI can make the procedure even more challenging. This case report demonstrates that very early and rapidly progressing TAPS with technically complicated conditions (elevated BMI and anterior placenta) can be successfully managed with IUT until laser procedure is achievable.
authors.affiliation: Materno-fetal and Obstetrics Research Unit,Departments of Gynaecology and Obstetrics,University Hospital of Lausanne CHUV,Lausanne,Switzerland.From the Swiss Fetal Laser Group,Switzerland.
authors.forename: Cécile
authors.initials: C
authors.lastname: Guenot
authors.affiliation: Hôpital de la Tour,Meyrin,Switzerland.From the Swiss Fetal Laser Group,Switzerland.
authors.forename: Romaine
authors.initials: R
authors.lastname: Robyr
authors.affiliation: Department of Obstetrics and Gynaecology,University Hospital of Geneva HUG,Geneva,Switzerland.From the Swiss Fetal Laser Group,Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Jastrow
authors.affiliation: Materno-fetal and Obstetrics Research Unit,Departments of Gynaecology and Obstetrics,University Hospital of Lausanne CHUV,Lausanne,Switzerland.From the Swiss Fetal Laser Group,Switzerland.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Vial
authors.affiliation: Departments of Obstetrics and Gynaecology,Inselspital,Bern,Switzerland.From the Swiss Fetal Laser Group,Switzerland.
authors.forename: Luigi
authors.initials: L
authors.lastname: Raio
authors.affiliation: Materno-fetal and Obstetrics Research Unit,Departments of Gynaecology and Obstetrics,University Hospital of Lausanne CHUV,Lausanne,Switzerland.From the Swiss Fetal Laser Group,Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Baud
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D001805:Blood Transfusion, Intrauterine / Q000379:methods*; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications / Q000473:pathology* / Q000628:therapy; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation; D009765:Obesity / Q000150:complications / Q000473:pathology*; D010920:Placenta / Q000473:pathology; D011086:Polycythemia / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D011247:Pregnancy; D059285:Pregnancy, Twin; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal
keywords: TAPS; intraperitoneal fetal transfusion; intrauterine transfusion; laser photocoagulation of placental anastomoses; monochorionic twin pregnancy; twin anemia-polycythemia sequence