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Post-laser twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 164 cases
- Source :
- Journal of Clinical Medicine, 9 (6, Journal of Clinical Medicine, Vol 9, Iss 1759, p 1759 (2020), Journal of Clinical Medicine, Volume 9, Issue 6, Journal of Clinical Medicine, 9(6). MDPI
- Publication Year :
- 2020
-
Abstract
- The aim of this study was to investigate the management and outcome in the post-laser twin anemia polycythemia sequence (TAPS). Data of the international TAPS Registry, collected between 2014 and 2019, were used for this study. The primary outcomes were perinatal mortality and severe neonatal morbidity. Secondary outcomes included a risk factor analysis for perinatal mortality and severe neonatal morbidity. A total of 164 post-laser TAPS pregnancies were included, of which 92% (151/164) were diagnosed antenatally and 8% (13/164) postnatally. The median number of days between laser for TTTS and detection of TAPS was 14 (IQR: 7&ndash<br />28, range: 1&ndash<br />119). Antenatal management included expectant management in 43% (62/151), intrauterine transfusion with or without partial exchange transfusion in 29% (44/151), repeated laser surgery in 15% (24/151), selective feticide in 7% (11/151), delivery in 6% (9/151), and termination of pregnancy in 1% (1/151). The median gestational age (GA) at birth was 31.7 weeks (IQR: 28.6&ndash<br />33.7<br />range: 19.0&ndash<br />41.3). The perinatal mortality rate was 25% (83/327) for the total group, 37% (61/164) for donors, and 14% (22/163) for recipients (p &lt<br />0.001). Severe neonatal morbidity was detected in 40% (105/263) of the cohort and was similar for donors (43%<br />51/118) and recipients (37%<br />54/145), p = 0.568. Independent risk factors for spontaneous perinatal mortality were antenatal TAPS Stage 4 (OR = 3.4, 95%CI 1.4-26.0, p = 0.015), TAPS donor status (OR = 4.2, 95%CI 2.1&ndash<br />8.3, p &lt<br />0.001), and GA at birth (OR = 0.8, 95%CI 0.7&ndash<br />0.9, p = 0.001). Severe neonatal morbidity was significantly associated with GA at birth (OR = 1.5, 95%CI 1.3&ndash<br />1.7, p &lt<br />0.001). In conclusion, post-laser TAPS most often occurs within one month after laser for TTTS, but may develop up to 17 weeks after initial surgery. Management is mostly expectant, but varies greatly, highlighting the lack of consensus on the optimal treatment and heterogeneity of the condition. Perinatal outcome is poor, particularly due to the high rate of perinatal mortality in donor twins.
- Subjects :
- Laser surgery
TAPS
medicine.medical_specialty
laser surgery
medicine.medical_treatment
Neonatal morbidity
Exchange transfusion
lcsh:Medicine
Twin-twin transfusion syndrome
twin anemia polycythemia sequence
Article
03 medical and health sciences
0302 clinical medicine
medicine
Twin Anemia-Polycythemia Sequence
030212 general & internal medicine
Monochorionic twins
Risk factor
Perinatal mortality
Pregnancy
030219 obstetrics & reproductive medicine
business.industry
Obstetrics
lcsh:R
Gestational age
Généralités
General Medicine
neonatal morbidity
medicine.disease
fetal demise
Management
TTTS
perinatal mortality
Twin anemia polycythemia sequence
Cohort
monochorionic twins
Fetal demise
business
management
twin-twin transfusion syndrome
Subjects
Details
- Language :
- English
- ISSN :
- 20770383
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Medicine, 9 (6, Journal of Clinical Medicine, Vol 9, Iss 1759, p 1759 (2020), Journal of Clinical Medicine, Volume 9, Issue 6, Journal of Clinical Medicine, 9(6). MDPI
- Accession number :
- edsair.doi.dedup.....54c1ef11ea668f4a7f2039a594546267