Division of Fetal Medicine, Department of Obstetrics, Leiden, The Netherlands.
Fetal Diagn Ther. 2013;34(2):121-6. doi: 10.1159/000346413. Epub 2013 May 22.
Twin anemia-polycythemia sequence (TAPS) is a rare condition which may occur either spontaneously in uncomplicated monochorionic twin pregnancies or may develop after laser treatment in twin-twin transfusion syndrome. TAPS is characterized by a large intertwin discordance in hemoglobin levels without discordance in amniotic fluid levels, and may lead to severe complications including fetal hydrops, hematological morbidity and perinatal mortality. Several treatments have been proposed including intrauterine transfusion, laser surgery, elective delivery and expectant management. The optimal treatment remains unclear. In this case series we report 3 TAPS cases managed recently at our center with a combination of intrauterine blood transfusion for the anemic twin and intrauterine partial exchange transfusion for the polycythemic twin. In 1 case, the donor was found to have severe cerebral injury on neuroimaging examination. We propose etiologic mechanisms for cerebral injury in TAPS, discuss the rationale behind this treatment alternative, and evaluate the pros and cons of the various management options.
双胎贫血-多血症序列（TAPS）是一种罕见的疾病，可能在未经处理的单绒毛膜双胎妊娠中自发发生，也可能在双胞胎输血综合征的激光治疗后发生。TAPS 的特征是血红蛋白水平存在较大的双胞胎间差异，而羊水水平无差异，并可能导致严重并发症，包括胎儿水肿、血液学发病率和围产儿死亡率。已经提出了几种治疗方法，包括宫内输血、激光手术、选择性分娩和期待管理。最佳治疗方法仍不清楚。在本病例系列中，我们报告了最近在我们中心管理的 3 例 TAPS 病例，采用宫内输血治疗贫血双胞胎和宫内部分换血治疗多血症双胞胎相结合的方法。在 1 例中，供体在神经影像学检查中发现严重的脑损伤。我们提出了 TAPS 中脑损伤的病因机制，讨论了这种治疗替代方法的原理，并评估了各种管理选择的优缺点。
