Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UT Health School of Medicine, Houston, TX, USA.
The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA.
Ultrasound Obstet Gynecol. 2016 Mar;47(3):340-4. doi: 10.1002/uog.14913.
Twin anemia-polycythemia sequence (TAPS) can occur as a unique disease or as a complication of twin-twin transfusion syndrome (TTTS). Middle cerebral artery (MCA) Doppler studies are not currently part of the routine evaluation of monochorionic twins since they are not used in the Quintero staging system. As such, the true incidence of TAPS is unknown. We aimed to compare the characteristics and outcomes of twin pregnancies with TTTS complicated by spontaneous anemia-polycythemia vs those with TTTS alone.
This was a secondary analysis of data collected prospectively from a cohort of 156 consecutive patients undergoing fetoscopic laser surgery for TTTS, between October 2011 and August 2014. TAPS was defined as discordance in the preoperative MCA peak systolic velocity (PSV), with one twin fetus having MCA-PSV ≤ 1.0 multiples of the median (MoM) and the other having MCA-PSV ≥ 1.5 MoM. Maternal demographics as well as preoperative, operative and postoperative variables were analyzed.
Included in the final analysis were 133 patients with complete records: 11 cases with TTTS with anemia-polycythemia and 122 cases with TTTS alone. There was no difference in maternal body mass index, gestational age (GA) at procedure, rate of preterm prelabor rupture of membranes or GA at delivery between the two groups. Patients with TTTS and anemia-polycythemia were more likely to be older (P = 0.03) and parous (P = 0.04) and had a significantly lower number of placental anastomoses (P = 0.01). The dual live-birth rate was similar for both groups (P = 0.76).
Cases of TTTS with anemia-polycythemia were more likely to be found in parous and older women and were characterized by fewer vascular anastomoses. TTTS with anemia-polycythemia was not associated with worse perinatal outcome after laser therapy. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
双胎贫血-红细胞增多序列（TAPS）可作为一种独特的疾病发生，也可作为双胎-双胎输血综合征（TTTS）的并发症。由于大脑中动脉（MCA）多普勒研究未被纳入 Quintero 分期系统，因此目前并非单绒毛膜双胎常规评估的一部分。因此，TAPS 的真实发病率尚不清楚。我们旨在比较 TTTS 并发自发性贫血-红细胞增多与 TTTS 单纯性的双胎妊娠的特征和结局。
这是对 2011 年 10 月至 2014 年 8 月期间连续 156 例接受胎儿镜激光手术治疗 TTTS 的患者前瞻性收集的数据进行的二次分析。TAPS 的定义为术前 MCA 收缩期峰值速度（PSV）的不一致，其中一个胎儿的 MCA-PSV≤1.0 个中位数倍数（MoM），而另一个胎儿的 MCA-PSV≥1.5 MoM。分析了产妇人口统计学特征以及术前、手术中和术后变量。
最终分析纳入了 133 例记录完整的患者：11 例 TTTS 伴贫血-红细胞增多，122 例 TTTS 单纯性。两组间产妇体重指数、手术时的孕龄（GA）、早产未足月胎膜早破的发生率或分娩时的 GA 无差异。TTTS 伴贫血-红细胞增多的患者年龄较大（P=0.03）、经产妇（P=0.04）且胎盘吻合支数量明显减少（P=0.01）。两组的双活产率相似（P=0.76）。
TTTS 伴贫血-红细胞增多病例更可能发生在经产妇和年龄较大的妇女中，其特征是血管吻合支较少。激光治疗后，TTTS 伴贫血-红细胞增多与围产儿结局恶化无关。版权所有 © 2015 ISUOG。由 John Wiley & Sons Ltd 出版。
