Post-Laser Twin Anemia Polycythemia Sequence: Diagnosis, Management, and Outcome in an International Cohort of 164 Cases
Abstract
:1. Introduction
2. Experimental Section
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
Center | Country | Post-Laser TAPS Cases |
---|---|---|
Leiden University Medical Center | The Netherlands | 66 |
Children’s Hospital V. Buzzi Milan | Italy | 17 |
Necker-Enfants Malades Hospital Paris | France | 16 |
Leuven University Hospital | Belgium | 13 |
Center Medico-Chirurgical Obstetrical Strasbourg | France | 10 |
Mount Sinai Hospital Toronto | Canada | 10 |
Saint George’s Hospital London | United Kingdom | 5 |
Birmingham Women’s and Children’s NHS Foundation Trust | United Kingdom | 5 |
Medical University of Graz | Austria | 3 |
Mater Hospital Brisbane | Australia | 4 |
University of Texas McGovern Medical School at Houston | United States of America | 4 |
V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Moscow | Russia | 4 |
Karolinska University Hospital Stockholm | Sweden | 3 |
Hospital Universitari Vall d’Hebron Barcelona | Spain | 2 |
Brugmann University Hospital | Belgium | 1 |
University Medical Center Hamburg-Eppendorf | Germany | 1 |
Appendix B
Death † (n = 60/304) | Alive † (n = 244/304) | Univariate Analysis OR (95% CI) | SE | p | Multivariate Analysis OR (95% CI) | SE | p | |
---|---|---|---|---|---|---|---|---|
GA at diagnosis TAPS | 23.3 ± 3.3 | 23.7 ± 3.7 | 1.0 (0.9–1.1) | 0.1 | 0.623 | |||
GA at laser TTTS | 20.1 ± 2.4 | 20.8 ± 3.3 | 0.9 (0.8–1.0) | 0.1 | 0.233 | |||
Days between TTTS laser and TAPS | 20.9 ± 18.4 | 21.8 ± 23.1 | 1.0 (1.0–1.0) | 0.0 | 0.829 | |||
Quintero stage for TTTS ‡ | ||||||||
1 | 3/35 (9) | 32/35 (91) | - * | - * | ||||
2 | 27/140 (19) | 113/140 (81) | 2.5 (0.7–8.5) | 0.6 | 0.139 | 1.7 (0.4–6.9) | 0.7 | 0.439 |
3 | 27/111 (24) | 84/111(76) | 3.6 (1.1–12.0) | 0.6 | 0.039 | 3.5 (0.9–13.2) | 0.7 | 0.069 |
4 | 2/10 (20) | 8/10 (80) | 2.8 (0.2–32.4) | 1.3 | 0.418 | 3.4 (0.3–33.6) | 1.2 | 0.298 |
Antenatal TAPS stage | ||||||||
1 | 6/47 (13) | 41/47 (87) | - * | - * | ||||
2 | 12/122 (10) | 110/122 (90) | 0.9 (0.3–3.2) | 0.6 | 0.864 | 0.8 (0.2–3.2) | 0.7 | 0.790 |
3 | 14/56 (25) | 50/56 (75) | 2.6 (0.7–9.1) | 0.6 | 0.136 | 2.6 (0.6–10.3) | 0.7 | 0.182 |
4 | 20/46 (44) | 26/46 (55) | 6.1 (1.8–20.4) | 0.6 | 0.003 | 6.1 (1.4–26.0) | 0.7 | 0.015 |
TAPS recipient | 17/158 (11) | 146/158 (89) | - * | - * | ||||
TAPS donor | 43/146 (30) | 103/146 (70) | 3.7 (2.2–6.3) | 0.3 | <0.001 | 4.2 (2.1–8.3) | 0.3 | <0.001 |
Persistence of TTTS-TAPS donor-role, no § | 25/162 (15) | 137/162 (85) | - * | |||||
Persistence of TTTS-TAPS donor-role, yes § | 34/137 (25) | 103/137 (77) | 1.8 (1.0–3.5) | 0.3 | 0.061 | |||
Antenatal therapy | ||||||||
Expectant management | 27/124 (22) | 97/124 (78) | - * | |||||
Delivery | 4/18 (22) | 14/18 (78) | 1.4 (0.3–4.2) | 0.6 | 0.622 | |||
IUT (± PET) | 16/81 (20) | 72/81 (82) | 0.9 (0.4–1.9) | 0.4 | 0.893 | |||
Laser surgery | 9/44 (21) | 38/44 (79) | 1.0 (0.3–2.8) | 0.5 | 0.942 | |||
Selective feticide (co-twin) | 0/11 (0) | 11/11 (100) | 0.3 (0.0–2.9) | 1.1 | 0.330 | |||
GA at birth | 29.5 ± 5.0 | 31.6 ± 3.1 | 0.8 (0.7–1.0) | 0.1 | 0.006 | 0.8 (0.7–0.9) | 0.1 | 0.001 |
SNM † (139/429) | No SNM † (290/429) | Univariate Analysis OR (95% CI) | SE | p | Multivariate Analysis OR (95% CI) | SE | p | |
---|---|---|---|---|---|---|---|---|
GA at diagnosis TAPS | 24.5 ± 3.1 | 23.4 ± 4.0 | 0.9 (0.8–1.0) | 0.1 | 0.090 | |||
GA at laser TTTS | 21.1 ± 2.6 | 20.6 ± 3.6 | 0.9 (0.8–1.0) | 0.1 | 0.261 | |||
Days between TTTS laser and TAPS | 22.3 ± 21.9 | 22.1 ± 23.9 | 1.0 (1.0–1.0) | 0.0 | 0.987 | |||
Quintero stage for TTTS | ||||||||
1 | 8/34 (24) | 26/34 (76) | - * | - * | ||||
2 | 64/123 (52) | 59/123 (48) | 3.2 (1.1–9.7) | 0.6 | 0.038 | 2.8 (0.9–9.0) | 0.6 | 0.066 |
3 | 28/89 (32) | 61/89 (68) | 1.3 (0.4–4.2) | 0.6 | 0.617 | 1.3 (0.4–3.9) | 0.6 | 0.690 |
4 | 3/10 (30) | 3/10 (70) | 1.3 (0.2–9.3) | 1.0 | 0.782 | 1.1 (0.1–10.0) | 1.1 | 0.959 |
Antenatal TAPS stage | ||||||||
1 | 18/45 (40) | 30/45 (60) | - * | |||||
2 | 41/112 (37) | 71/112 (63) | 1.0 (0.4–2.5) | 0.5 | 0.970 | |||
3 | 16/45 (36) | 29/45 (64) | 0.7 (0.2–2.2) | 0.6 | 0.570 | |||
4 | 17/32 (53) | 15/32 (47) | 1.6 (0.5–5.0) | 0.6 | 0.381 | |||
TAPS recipient | 54/145(37) | 91/145 (63) | - * | |||||
TAPS donor | 51/118 (43) | 67/118 (57) | 1.1 (0.8–1.5) | 0.2 | 0.568 | |||
Persistence of TTTS-TAPS donor-role, no | 47/139 (34) | 92/139 (66) | - * | |||||
Persistence of TTTS-TAPS donor-role, yes | 58/120 (48) | 62/120 (52) | 1.6 (0.9–3.0) | 0.3 | 0.116 | |||
Antenatal therapy | ||||||||
Expectant management | 34/100 (34) | 66/100 (66) | - * | |||||
Delivery | 9/17 (53) | 8/17 (47) | 2.1 (0.6–8.1) | 0.7 | 0.270 | |||
IUT (± PET) | 34/72 (47) | 38/72 (53) | 1.7 (0.8–3.7) | 0.4 | 0.158 | |||
Laser surgery | 12/37 (32) | 25/37 (68) | 1.1 (0.4–2.9) | 0.5 | 0.851 | |||
Selective feticide | 3/11 (27) | 8/11 (73) | 0.7 (0.2–3.2) | 0.7 | 0.720 | |||
GA at birth | 29.4 ± 2.6 | 32.9 ± 2.8 | 1.5 (1.3–1.7) | 0.1 | <0.001 | 1.5 (1.3–1.7) | 0.1 | <0.001 |
Severe growth restriction, no | 81/200 (41) | 119/200 (60) | - * | |||||
Severe growth restriction, yes | 24/62 (39) | 38/62 (61) | 1.3 (0.8–2.2) | 0.3 | 0.351 | |||
Postnatal TAPS, no | 23/58 (40) | 35/58 (60) | - * | |||||
Postnatal TAPS, yes | 64/151 (42) | 87/151(58) | 1.1 (0.5–2.5) | 0.4 | 0.800 |
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Post-Laser TAPS (N = 164 Pregnancies, 328 Fetuses) | |
---|---|
Gravidity | 2 (1–3) |
Parity | 0 (0–1) |
Antenatal diagnosis of TAPS | 151/164 (92) |
Location of placenta | |
Anterior | 72/164 (44) |
Posterior | 86/164 (52) |
Other † | 6/164 (4) |
TTTS stage ‡ | |
Q1 | 20/159 (13) |
Q2 | 75/159 (47) |
Q3 | 59/159 (37) |
Q4 | 5/159 (3) |
Solomon technique for TTTS laser | 60/164 (37) |
GA at laser for TTTS | 20.6 (18.0–23.0) |
Time between laser and post-laser TAPS (days) | 14 (7–28) |
Persistence of TTTS-TAPS donor-recipient role § | 73/161 (45) |
Laser for TTTS complete (surgeon’s opinion) ¶ | 126/156 (81) |
Post-Laser TAPS (N = 164 Pregnancies, 328 Fetuses) | |
---|---|
GA at diagnosis | 23.1 (20.4–25.9) |
TAPS stage at diagnosis | |
1 | 43/151 (28) |
2 | 69/151 (48) |
3 | 27/151 (17) |
4 | 12/151 (8) |
Highest TAPS stage | |
1 | 22/151 (15) |
2 | 62/151(40) |
3 | 26/151 (16) |
4 | 22/151 (14) |
5 | 19/151 (15) |
Presence of additional ultrasound markers † | |
Starry-sky liver (recipient) | 56/141 (40) |
Difference in placental echogenicity | 35/151 (23) |
Antenatal management | |
Expectant management | 62/151 (43) |
Delivery | 9/151 (6) |
IUT (± PET) | 44/151 (29) |
Laser surgery | 24/151 (15) |
Selective feticide | 11/151 (7) |
Termination of pregnancy | 1/151 (1) |
Female ‡ | 162/308 (53) |
Cesarean § | 206/326 (63) |
Injected Post-Laser TAPS Placentas (N = 74) | |
---|---|
Total number of anastomoses | 1 (1–2) |
Number of AV anastomoses | 1 (0–1) |
Number of VA anastomoses | 0 (0–1) |
Number of AA anastomoses | 0 (0–0) |
Number of VV anastomoses | 0 (0–0) |
Presence of anastomoses | |
Presence of AV/VA anastomoses | 58/74 (80) |
Presence of AA anastomoses | 6/74 (8) |
Presence of VV anastomoses | 5/74 (7) |
Type of anastomoses per placenta | |
No anastomoses | 10/74 (14) |
AV (one direction) | 40/74 (54) |
AVs (both directions) | 14/74 (19) |
AV/VA and AA | 3/74 (4) |
AV/VA and VV | 2/74 (3) |
Only AA | 2/74 (3) |
Only VV | 2/74 (3) |
AV/VA, AA and VV | 1/74 (1) |
All anastomoses diameter < 1 mm | 62/64 (97) |
Post-Laser TAPS (N = 164 Pregnancies; 328 Fetuses) | TAPS Donors (N = 164 Fetuses) | TAPS Recipients (N = 164 Fetuses) † | p-Value | |
---|---|---|---|---|
GA at birth | 31.7 (28.6–33.7; 19.0–41.3) | |||
Fetal demise † | 56/327 (17) | 43/164 (26) | 13/163 (8) | <0.001 |
Spontaneous | 33/327 (10) | 25/164 (15) | 8/163 (5) | <0.001 |
Intended | 23/327 (7) | 18/164 (11) | 5/163 (3) | 0.007 |
Neonatal mortality | 27/271 (10) | 18/121 (15) | 9/150 (6) | 0.008 |
Perinatal mortality (overall) † | 83/327 (25) | 61/164 (37) | 22/163 (14) | <0.001 |
Perinatal mortality (spontaneous) † | 60/327 (18) | 43/164 (26) | 17/163 (10) | <0.001 |
Severe neonatal morbidity ‡ | 105/263 (40) | 51/118 (43) | 54/145 (37) | 0.568 |
Respiratory distress syndrome | 88/263(34) | 42/118 (36) | 46/145 (32) | 0.945 |
Patent ductus arteriosus | 20/263 (8) | 11/118 (9) | 9/145 (6) | 0.278 |
Necrotizing enterocolitis | 6/263 (2) | 4/118 (3) | 2/145 (1) | 0.275 |
Retinopathy of prematurity | 9/263 (3) | 6/118 (5) | 3/145 (2) | 0.165 |
Amniotic band syndrome | 3/263 (1) | 2/118 (2) | 1/145 (1) | 0.451 |
Severe cerebral injury | 28/263 (11) | 13/118 (11) | 15/145 (10) | 0.916 |
Birth weight (g) § | 1390 ± 567 | 1346 ± 525 | 1533 ± 588 | <0.001 |
Severe growth restriction (bw < p3) § | 62/270 (23) | 31/121 (26) | 31/149 (21) | 0.267 |
Mild growth restriction (bw < p10) § | 122/270 (45) | 60/121 (50) | 61/149 (41) | 0.061 |
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Share and Cite
Tollenaar, L.S.A.; Lopriore, E.; Faiola, S.; Lanna, M.; Stirnemann, J.; Ville, Y.; Lewi, L.; Devlieger, R.; Weingertner, A.S.; Favre, R.; et al. Post-Laser Twin Anemia Polycythemia Sequence: Diagnosis, Management, and Outcome in an International Cohort of 164 Cases. J. Clin. Med. 2020, 9, 1759. https://doi.org/10.3390/jcm9061759
Tollenaar LSA, Lopriore E, Faiola S, Lanna M, Stirnemann J, Ville Y, Lewi L, Devlieger R, Weingertner AS, Favre R, et al. Post-Laser Twin Anemia Polycythemia Sequence: Diagnosis, Management, and Outcome in an International Cohort of 164 Cases. Journal of Clinical Medicine. 2020; 9(6):1759. https://doi.org/10.3390/jcm9061759
Chicago/Turabian StyleTollenaar, Lisanne S.A., Enrico Lopriore, Stefano Faiola, Mariano Lanna, Julien Stirnemann, Yves Ville, Liesbeth Lewi, Roland Devlieger, Anne Sophie Weingertner, Romain Favre, and et al. 2020. "Post-Laser Twin Anemia Polycythemia Sequence: Diagnosis, Management, and Outcome in an International Cohort of 164 Cases" Journal of Clinical Medicine 9, no. 6: 1759. https://doi.org/10.3390/jcm9061759