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Post-Laser Twin Anemia Polycythemia Sequence: Diagnosis, Management, and Outcome in an International Cohort of 164 Cases

1
Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
2
Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
3
Fetal Therapy Unit “U. Nicolini”, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy
4
Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, 75015 Paris, France
5
Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium
6
Department of Obstetrics and Gynecology, Strasbourg University Hospital, CEDEX, 67000 Strasbourg, France
7
Fetal Medicine Unit, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada
8
Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
9
Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria
10
Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
11
Fetal Medicine Unit, St George University Hospital NHS Foundation Trust, London SW17 0RE, UK
12
The Fetal Center, Department of Obstetrics, Children’s Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UT Health, McGovern Medical School, University of Texas, Houston, TX 77030, USA
13
Department of Maternal Fetal Medicine, Mater Mothers’ Hospital, South Brisbane, QLD 4101, Australia
14
Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, 1020 Brussels, Belgium
15
Acad. V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, 495 Moscow, Russia
16
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
17
Fetal Medicine Centre, Birmingham Women’s and Children’s Foundation Trust, University of Birmingham, Birmingham B4 6NH, UK
18
Center for Fetal Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 1759; https://doi.org/10.3390/jcm9061759
Received: 21 April 2020 / Revised: 19 May 2020 / Accepted: 25 May 2020 / Published: 5 June 2020
(This article belongs to the Special Issue Improving Perinatal Outcomes in Twin and Multiple Pregnancy)
The aim of this study was to investigate the management and outcome in the post-laser twin anemia polycythemia sequence (TAPS). Data of the international TAPS Registry, collected between 2014 and 2019, were used for this study. The primary outcomes were perinatal mortality and severe neonatal morbidity. Secondary outcomes included a risk factor analysis for perinatal mortality and severe neonatal morbidity. A total of 164 post-laser TAPS pregnancies were included, of which 92% (151/164) were diagnosed antenatally and 8% (13/164) postnatally. The median number of days between laser for TTTS and detection of TAPS was 14 (IQR: 7–28, range: 1–119). Antenatal management included expectant management in 43% (62/151), intrauterine transfusion with or without partial exchange transfusion in 29% (44/151), repeated laser surgery in 15% (24/151), selective feticide in 7% (11/151), delivery in 6% (9/151), and termination of pregnancy in 1% (1/151). The median gestational age (GA) at birth was 31.7 weeks (IQR: 28.6–33.7; range: 19.0–41.3). The perinatal mortality rate was 25% (83/327) for the total group, 37% (61/164) for donors, and 14% (22/163) for recipients (p < 0.001). Severe neonatal morbidity was detected in 40% (105/263) of the cohort and was similar for donors (43%; 51/118) and recipients (37%; 54/145), p = 0.568. Independent risk factors for spontaneous perinatal mortality were antenatal TAPS Stage 4 (OR = 3.4, 95%CI 1.4-26.0, p = 0.015), TAPS donor status (OR = 4.2, 95%CI 2.1–8.3, p < 0.001), and GA at birth (OR = 0.8, 95%CI 0.7–0.9, p = 0.001). Severe neonatal morbidity was significantly associated with GA at birth (OR = 1.5, 95%CI 1.3–1.7, p < 0.001). In conclusion, post-laser TAPS most often occurs within one month after laser for TTTS, but may develop up to 17 weeks after initial surgery. Management is mostly expectant, but varies greatly, highlighting the lack of consensus on the optimal treatment and heterogeneity of the condition. Perinatal outcome is poor, particularly due to the high rate of perinatal mortality in donor twins. View Full-Text
Keywords: monochorionic twins; twin anemia polycythemia sequence; TAPS; twin-twin transfusion syndrome; TTTS; laser surgery; management; perinatal mortality; fetal demise; neonatal morbidity monochorionic twins; twin anemia polycythemia sequence; TAPS; twin-twin transfusion syndrome; TTTS; laser surgery; management; perinatal mortality; fetal demise; neonatal morbidity
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MDPI and ACS Style

Tollenaar, L.S.A.; Lopriore, E.; Faiola, S.; Lanna, M.; Stirnemann, J.; Ville, Y.; Lewi, L.; Devlieger, R.; Weingertner, A.S.; Favre, R.; Hobson, S.R.; Ryan, G.; Rodo, C.; Arévalo, S.; Klaritsch, P.; Greimel, P.; Hecher, K.; de Sousa, M.T.; Khalil, A.; Thilaganathan, B.; Bergh, E.P.; Papanna, R.; Gardener, G.J.; Carlin, A.; Bevilacqua, E.; Sakalo, V.A.; Kostyukov, K.V.; Bahtiyar, M.O.; Wilpers, A.; Kilby, M.D.; Tiblad, E.; Oepkes, D.; Middeldorp, J.M.; Haak, M.C.; Klumper, F.J.C.M.; Akkermans, J.; Slaghekke, F. 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

AMA Style

Tollenaar LSA, Lopriore E, Faiola S, Lanna M, Stirnemann J, Ville Y, Lewi L, Devlieger R, Weingertner AS, Favre R, Hobson SR, Ryan G, Rodo C, Arévalo S, Klaritsch P, Greimel P, Hecher K, de Sousa MT, Khalil A, Thilaganathan B, Bergh EP, Papanna R, Gardener GJ, Carlin A, Bevilacqua E, Sakalo VA, Kostyukov KV, Bahtiyar MO, Wilpers A, Kilby MD, Tiblad E, Oepkes D, Middeldorp JM, Haak MC, Klumper FJCM, Akkermans J, Slaghekke F. 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 Style

Tollenaar, Lisanne S.A.; Lopriore, Enrico; Faiola, Stefano; Lanna, Mariano; Stirnemann, Julien; Ville, Yves; Lewi, Liesbeth; Devlieger, Roland; Weingertner, Anne S.; Favre, Romain; Hobson, Sebastian R.; Ryan, Greg; Rodo, Carlota; Arévalo, Silvia; Klaritsch, Philipp; Greimel, Patrick; Hecher, Kurt; de Sousa, Manuela T.; Khalil, Asma; Thilaganathan, Basky; Bergh, Eric P.; Papanna, Ramesha; Gardener, Glenn J.; Carlin, Andrew; Bevilacqua, Elisa; Sakalo, Victorya A.; Kostyukov, Kirill V.; Bahtiyar, Mert O.; Wilpers, Abigail; Kilby, Mark D.; Tiblad, Eleonor; Oepkes, Dick; Middeldorp, Johanna M.; Haak, Monique C.; Klumper, Frans J.C.M.; Akkermans, Joost; Slaghekke, Femke. 2020. "Post-Laser Twin Anemia Polycythemia Sequence: Diagnosis, Management, and Outcome in an International Cohort of 164 Cases" J. Clin. Med. 9, no. 6: 1759. https://doi.org/10.3390/jcm9061759

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