Antenatal management of twin-twin transfusion syndrome and twin anemia-polycythemia sequence.
BACKGROUND
Twin-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS) are severe complications in monochorionic twin pregnancies associated with high mortality and morbidity risk if left untreated. Both diseases result from imbalanced inter-twin blood transfusion through placental vascular anastomoses.


METHODS
This review focuses on the differences in antenatal management between TTTS and TAPS. Expert commentary: The optimal management for TTTS is fetoscopic laser coagulation of the vascular anastomoses, preferably using the Solomon technique in which the whole vascular equator is coagulated. The Solomon technique is associated with a reduction of residual anastomosis and a reduction in post-operative complications. The optimal management for TAPS is not clear and includes expectant management, intra-uterine transfusion with or without partial exchange transfusion and fetoscopic laser surgery.
a Division of Fetal Medicine, Department of Obstetrics , Leiden University Medical Centre , Leiden , The Netherlands.
Femke
F
Slaghekke
b Division of Neonatology, Department of Pediatrics , Leiden University Medical Centre , Leiden , The Netherlands.
Depeng P
DP
Zhao
a Division of Fetal Medicine, Department of Obstetrics , Leiden University Medical Centre , Leiden , The Netherlands.
Johanna M
JM
Middeldorp
a Division of Fetal Medicine, Department of Obstetrics , Leiden University Medical Centre , Leiden , The Netherlands.
Frans J
FJ
Klumper
a Division of Fetal Medicine, Department of Obstetrics , Leiden University Medical Centre , Leiden , The Netherlands.
Monique C
MC
Haak
a Division of Fetal Medicine, Department of Obstetrics , Leiden University Medical Centre , Leiden , The Netherlands.
Dick
D
Oepkes
b Division of Neonatology, Department of Pediatrics , Leiden University Medical Centre , Leiden , The Netherlands.
Enrico
E
Lopriore
D000740:Anemia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D001803:Blood Transfusion; D019468:Disease Management; D005260:Female; D005330:Fetofetal Transfusion / Q000175:diagnosis* / Q000628:therapy*; D005332:Fetoscopy / Q000379:methods; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D011086:Polycythemia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D049268:Positron-Emission Tomography; D011247:Pregnancy; D059285:Pregnancy, Twin
Monochorionic twins; fetoscopic laser surgery; intrauterine transfusion; partial exchange transfusion; twin anemia-polycythemia sequence; twin-twin transfusion syndrome