Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto 4050-313, Portugal.
Centro Hospitalar Universitário do Porto EPE, Centro Materno Infantil do Norte, Centro de Medicina Fetal, Serviço de Obstetrícia, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, Porto 4099-001, Portugal.
Curr Vasc Pharmacol. 2023;21(2):91-105. doi: 10.2174/1570161121666230131112930.
Twin pregnancy is associated with an increased risk of perinatal and maternal complications, and early establishment of the chorionicity type defines this risk. In monochorionic (MC) pregnancies, the fetuses share the same placental mass and exhibit vascular anastomoses crossing the intertwin membrane, and the combination and pattern of anastomoses determine the primary clinical picture and occurrence of future complications. Twin Anemia-Polycythemia Sequence (TAPS) was first described in 2006 after fetoscopic laser surgery in twin-to-twin transfusion syndrome (TTTS) twins, and in 2007, the first spontaneous cases were reported, recognizing TAPS as an individualized vascular identity in fetofetal transfusion syndromes. There are two types of TAPS: spontaneous (3-5%) and iatrogenic or postlaser (2-16%). TAPS consists of small diameter arteriovenous anastomoses (<1 mm) and low-rate, small-caliber AA anastomoses in the absence of amniotic fluid discordances. There are certain antenatal and postnatal diagnostic criteria, which have progressively evolved over time. New, additional secondary markers have been proposed, and their reliability is being studied. The best screening protocol for TAPS in MC twins is still a matter of debate. This review provides a survey of the relevant literature on the epidemiology, vascular pathophysiology, underlying hemodynamic factors that regulate mismatched vascular connections, and diagnostic criteria of this condition. The aim is to increase awareness and knowledge about this recently identified and frequently unrecognized and misdiagnosed pathology.
双胎妊娠与围产期和母体并发症的风险增加有关，而绒毛膜性的早期确定定义了这种风险。在单绒毛膜（MC）妊娠中，胎儿共享相同的胎盘，并表现出跨越双胎膜的血管吻合，吻合的组合和模式决定了主要的临床特征和未来并发症的发生。双胎贫血-多血症序列（TAPS）于 2006 年在双胎输血综合征（TTTS）双胞胎的胎儿镜激光手术后首次描述，2007 年首次报道了自发性病例，将 TAPS 视为胎儿输血综合征中个体血管特征。TAPS 有两种类型：自发性（3-5%）和医源性或激光后（2-16%）。TAPS 由小直径动静脉吻合（<1mm）和缺乏羊水不匹配的低速率、小口径 AA 吻合组成。存在某些产前和产后诊断标准，这些标准随着时间的推移而不断发展。已经提出了某些新的、额外的次要标志物，并且正在研究它们的可靠性。MC 双胞胎 TAPS 的最佳筛查方案仍存在争议。这篇综述提供了对 TAPS 的相关文献的调查，包括其流行病学、血管病理生理学、调节不匹配血管连接的潜在血液动力学因素以及该病症的诊断标准。目的是提高对这种最近确定的、经常未被识别和误诊的病理学的认识和了解。
