Yoshimura Yoshihiro, Ozawa Katsusuke, Goto HIroyuki, Yamazaki Yu, Isohata Hitoshi, Ochiai Daigo
Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, JPN.
Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, JPN.
Cureus. 2024 Nov 12;16(11):e73563. doi: 10.7759/cureus.73563. eCollection 2024 Nov.
Complications of twin pregnancy such as twin anemia-polycythemia sequence (TAPS), which involve placental anastomotic vessels, occur mostly in monochorionic diamniotic twins and they have rarely been reported in dichorionic diamniotic (DD) twins. Here, we report a case of DD twins diagnosed with TAPS with fetal hydrops caused by fetal anemia at 28 weeks, which resolved spontaneously during pregnancy. A 37-year-old pregnant woman was referred to our hospital because of a twin pregnancy at 13 weeks. The fetus showed the lambda sign, leading to the diagnosis of DD twin. At 28 weeks, fetal ascites and subcutaneous edema were observed in twin A. In blood flow assessment, elevated middle cerebral artery peak systolic velocity (MCA-PSV) 88.0 cm/s (2.3 MoM), pulsatile flow in the umbilical vein, and increased flow in the ductus venosus were also found, but no abnormal flow in the umbilical artery was found in twin A. In contrast, there were no signs of hydrops and MCA-PSV was 38.7 cm/s (1.0 MoM) in twin B. Both fetuses did not show any abnormality of amniotic fluid volume. Thus, the twin was diagnosed with TAPS in DD twins. Fetal hydrops could be resolved spontaneously, and MCA-PSV gradually decreased. Two female infants weighing 2,366 g and 2,048 g were delivered by cesarean section at 35 weeks. Blood tests demonstrated Hb 8.5 g/dl and reticulocyte 7.4% in twin A and Hb 13.3 g/dl and reticulocyte 6.1% in twin B, respectively. This case highlights that complications of twin pregnancy involving placental anastomotic vessels such as TAPS could occur even in DD twins.
双胎妊娠的并发症，如涉及胎盘吻合血管的双胎贫血-红细胞增多序列（TAPS），大多发生在单绒毛膜双羊膜囊双胎中，而在双绒毛膜双羊膜囊（DD）双胎中鲜有报道。在此，我们报告一例DD双胎被诊断为TAPS的病例，该双胎在孕28周时因胎儿贫血出现胎儿水肿，并在孕期自发消退。一名37岁孕妇因13周双胎妊娠转诊至我院。胎儿显示λ征，诊断为DD双胎。孕28周时，在双胎A中观察到胎儿腹水和皮下水肿。在血流评估中，还发现双胎A的大脑中动脉收缩期峰值流速（MCA-PSV）升高至88.0 cm/s（2.3倍中位数）、脐静脉有搏动血流以及静脉导管血流增加，但未发现脐动脉异常血流。相比之下，双胎B没有水肿迹象，MCA-PSV为38.7 cm/s（1.0倍中位数）。两个胎儿羊水体积均无异常。因此，该双胎被诊断为DD双胎中的TAPS。胎儿水肿可自发消退，MCA-PSV逐渐下降。孕35周时通过剖宫产分娩出两名女婴，体重分别为2366 g和2048 g。血液检查显示双胎A的血红蛋白为8.5 g/dl，网织红细胞为7.4%，双胎B的血红蛋白为13.3 g/dl，网织红细胞为6.1%。该病例突出表明，即使在DD双胎中，涉及胎盘吻合血管的双胎妊娠并发症如TAPS也可能发生。
