Twin anemia–polycythemia sequence in a case of monoamniotic twins
Article first published online: 6 JUN 2013
Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd.
Ultrasound in Obstetrics & Gynecology
Volume 42, Issue 1, pages 108–111, July 2013
How to Cite
Diehl, W., Glosemeyer, P., Tavares De Sousa, M., Hollwitz, B., Ortmeyer, G. and Hecher, K. (2013), Twin anemia–polycythemia sequence in a case of monoamniotic twins. Ultrasound Obstet Gynecol, 42: 108–111. doi: 10.1002/uog.12418
- Issue published online: 24 JUN 2013
- Article first published online: 6 JUN 2013
- Accepted manuscript online: 29 JAN 2013 03:20PM EST
- Manuscript Accepted: 7 JAN 2013
- fetoscopic laser coagulation;
- monoamniotic twins;
- twin anemia polycythemia sequence
Twin anemia–polycythemia sequence (TAPS) complicates up to 6% of monochorionic diamniotic twin pregnancies, typically in the late second or third trimester. The presence of only a few and very small arteriovenous vascular anastomoses characterizes the underlying angioarchitecture at the chorionic plate in cases of TAPS. In monoamniotic twins, large vascular anastomoses can usually be seen at the placental vascular equator, and therefore one would not expect the development of TAPS in monoamniotic twins. We report a case of TAPS in a monoamniotic pregnancy at 26 + 5 weeks' gestation which responded favorably to fetoscopic laser coagulation of the small placental anastomoses, resolving severe anemia in one twin and polycythemia in the other. The pregnancy continued until 32 + 5 weeks, when worsening cord entanglement with increased resistance and the development of postsystolic notches in the umbilical artery of one twin prompted delivery by Cesarean section. There was only a moderate difference in neonatal hemoglobin concentrations, with the former polycythemic twin needing a single partial volume exchange transfusion. The postnatal course of the neonates was uneventful, according to their gestational age at birth. To our knowledge this is the first case report describing successful laser therapy for TAPS in monoamniotic twins. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.