TY - JOUR
T1 - Post-laser twin anemia polycythemia sequence
T2 - diagnosis, management, and outcome in an international cohort of 164 cases
AU - Tollenaar, Lisanne S.A.
AU - Lopriore, Enrico
AU - Faiola, Stefano
AU - Lanna, Mariano
AU - Stirnemann, Julien
AU - Ville, Yves
AU - Lewi, Liesbeth
AU - Devlieger, Roland
AU - Weingertner, Anne Sophie
AU - Favre, Romain
AU - Hobson, Sebastian R.
AU - Ryan, Greg
AU - Rodo, Carlota
AU - Arévalo, Silvia
AU - Klaritsch, Philipp
AU - Greimel, Patrick
AU - Hecher, Kurt
AU - de Sousa, Manuela Tavares
AU - Khalil, Asma
AU - Thilaganathan, Basky
AU - Bergh, Eric P.
AU - Papanna, Ramesha
AU - Gardener, Glenn J.
AU - Carlin, Andrew
AU - Bevilacqua, Elisa
AU - Sakalo, Victorya A.
AU - Kostyukov, Kirill V.
AU - Bahtiyar, Mert O.
AU - Wilpers, Abigail
AU - Kilby, Mark D.
AU - Tiblad, Eleonor
AU - Oepkes, Dick
AU - Middeldorp, Johanna M.
AU - Haak, Monique C.
AU - Klumper, Frans J.C.M.
AU - Akkermans, Joost
AU - Slaghekke, Femke
N1 - Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2020/6
Y1 - 2020/6
N2 - 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.
AB - 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.
KW - Fetal demise
KW - Laser surgery
KW - Management
KW - Monochorionic twins
KW - Neonatal morbidity
KW - Perinatal mortality
KW - TAPS
KW - TTTS
KW - Twin anemia polycythemia sequence
KW - Twin-twin transfusion syndrome
UR - http://www.scopus.com/inward/record.url?scp=85090846429&partnerID=8YFLogxK
U2 - 10.3390/jcm9061759
DO - 10.3390/jcm9061759
M3 - Article
AN - SCOPUS:85090846429
SN - 2077-0383
VL - 9
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 6
M1 - 1759
ER -