Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.
University of Maryland School of Medicine, Baltimore, Maryland, USA.
Prenat Diagn. 2022 Jul;42(8):985-993. doi: 10.1002/pd.6195. Epub 2022 Jun 28.
To investigate whether the presence of twin-anemia polycythemia sequence (TAPS) with twin-to-twin transfusion syndrome (TTTS) or post-laser TAPS would change outcomes using different TAPS diagnostic criteria.
TTTS cases undergoing laser surgery between 2012 and 2020 were included. Groups included pre-laser TTTS-only compared to TTTS + TAPS, and no post-laser TAPS compared to post-laser TAPS. Three prenatal TAPS diagnostic criteria were used: group A: middle cerebral artery-peak systolic velocity (MCA-PSV) > 1.5 MoM in one twin and <1 MoM in the other twin, group B: inter-twin MCA-PSV difference >1 MoM, and group C: inter-twin MCA-PSV difference >0.5 MoM. Perinatal outcomes including survival and severe cerebral injury were investigated.
174 laser procedures were included. TTTS + TAPS cases were 16 in group A, 17 in group B, and 29 in group C. Post-laser TAPS cases were 11 in group A, 6 in group B, and 12 in group C. There were no differences in preoperative, operative variables and outcomes including survival and severe cerebral injury between groups using all three TAPS diagnostic criteria. The incidence of TTTS + TAPS was highest in group C (16.7%), then group B (9.8%), followed by group A (9.2%). The incidence of post-laser TAPS was highest in group C (9%), then group A (8.3%), followed by group B (4.5%).
Presence of TAPS complicating TTTS and presence of post-laser TAPS do not seem to be associated with worse perinatal outcomes including postnatal-ultrasound detected cerebral injury using three different TAPS criteria. Collaborative studies are needed to investigate the validity and the performance of different TAPS criteria.
探讨伴有双胎贫血-多血序列征（TAPS）的双胎输血综合征（TTTS）或激光治疗后 TAPS 是否会改变不同 TAPS 诊断标准下的结局。
纳入 2012 年至 2020 年间接受激光手术的 TTTS 病例。组 1 为仅 TTTS 与 TTTS+TAPS 比较，组 2 为无激光治疗后 TAPS 与激光治疗后 TAPS 比较。使用 3 种产前 TAPS 诊断标准：A 组：一胎大脑中动脉收缩期峰值流速（MCA-PSV）>1.5 中位数倍数（MoM），另一胎 <1 MoM；B 组：双胎 MCA-PSV 差值>1 MoM；C 组：双胎 MCA-PSV 差值>0.5 MoM。研究围产期结局，包括存活和严重脑损伤。
共纳入 174 例激光手术。A 组 TTTS+TAPS 病例 16 例，B 组 17 例，C 组 29 例。A 组激光治疗后 TAPS 病例 11 例，B 组 6 例，C 组 12 例。使用所有 3 种 TAPS 诊断标准，各组间术前、手术变量及结局（包括存活率和严重脑损伤）均无差异。A 组 TAPS 发生率最高（16.7%），其次是 B 组（9.8%），C 组（9.2%）。C 组激光治疗后 TAPS 发生率最高（9%），其次是 A 组（8.3%），B 组（4.5%）。
TTTS 合并 TAPS 及激光治疗后 TAPS 的存在似乎与围产期结局（包括新生儿超声检查发现的脑损伤）无关，采用 3 种不同 TAPS 标准。需要开展协作研究，以评估不同 TAPS 标准的有效性和性能。
