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Prenatal diagnosis of spontaneous twin anemia-polycythemia sequence and postnatal examination of placental vascular anastomoses

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ABSTRACT

Twin anemia-polycythemia sequence (TAPS) is characterized by a wide discrepancy of hemoglobin between two monochorionic fetuses without sign of twin oligo-polyhydramnios sequence. A primiparous woman with monochorionic diamniotic twin transferred for preterm labor. Ultrasonographic evaluation at 32+3 weeks of gestation revealed increased middle cerebral artery-peak systolic velocity (77.4 cm/sec, 1.69 multiples of median) in donor and decreased in recipient twin (36.4 cm/sec, 0.79 multiples of median), the twin was diagnosed with TAPS. Repeated cesarean section was performed at 32+5 weeks of gestation following preeclampsia and preterm labor. After delivery, TAPS was confirmed through neonatal hematologic examination. There were no signs of acute hemorrhagic shock or brain injury. Placental evaluation via dye infusion and barium angiogram revealed one arterioarterial anastomoses with six arteriovenous anastomoses of placenta. We report a prenatally diagnosed case of spontaneous TAPS with arterioarterial and arteriovenous anastomoses and suggest careful monitoring of monochorionic twin and opinion on placenta vascular architecture.

No MeSH data available.


The placenta of the donor twin seemed hyperechoic and thicker as compared to the placenta of the recipient twin. R, recipient; D, donor.
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Figure 1: The placenta of the donor twin seemed hyperechoic and thicker as compared to the placenta of the recipient twin. R, recipient; D, donor.

Mentions: Ultrasonographic examination revealed monochorionic diamniotic twin and the placenta was located anterolaterally. The estimated body weight of twin A was 1,778 g (vertex presentation), the twin B was 2131 g (breech presentation). Single deepest pocket (SDP) of twin A was 5 cm, SDP of twin B was 8 cm. There were no structural anomalies in both fetuses on ultrasonographic examination. Due to intertwin weight discrepancy and increased SDP in larger twin, a detailed Doppler examination was done. Doppler examination of the MCA-PSV showed a mild increase (51.3 cm/sec, 1.17 multiples of median [MoM]) in twin A (the donor) and decrease (28.3 cm/sec, 0.64 MoM) in twin B (the recipient). At 32+3 weeks of gestation MCA-PSV Doppler showed further increase in donor (77.4 cm/sec, 1.69 MoM) and still remains low in recipient (36.4 cm/sec, 0.79 MoM), indicative of TAPS. The echogenecity of each placenta territory was clearly divided. Placenta of donor seemed hyperechoic and thicker compared to recipient (Fig. 1). SDP of donor was 4 cm, recipient was 8 cm. Estimated body weight of donor was 1,862 g, recipient was 2,183 g. Tei index of donor was 0.50, recipient was 0.34. There were no signs of hydrops and tricuspid regurgitation in both fetuses.


Prenatal diagnosis of spontaneous twin anemia-polycythemia sequence and postnatal examination of placental vascular anastomoses
The placenta of the donor twin seemed hyperechoic and thicker as compared to the placenta of the recipient twin. R, recipient; D, donor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120076&req=5

Figure 1: The placenta of the donor twin seemed hyperechoic and thicker as compared to the placenta of the recipient twin. R, recipient; D, donor.
Mentions: Ultrasonographic examination revealed monochorionic diamniotic twin and the placenta was located anterolaterally. The estimated body weight of twin A was 1,778 g (vertex presentation), the twin B was 2131 g (breech presentation). Single deepest pocket (SDP) of twin A was 5 cm, SDP of twin B was 8 cm. There were no structural anomalies in both fetuses on ultrasonographic examination. Due to intertwin weight discrepancy and increased SDP in larger twin, a detailed Doppler examination was done. Doppler examination of the MCA-PSV showed a mild increase (51.3 cm/sec, 1.17 multiples of median [MoM]) in twin A (the donor) and decrease (28.3 cm/sec, 0.64 MoM) in twin B (the recipient). At 32+3 weeks of gestation MCA-PSV Doppler showed further increase in donor (77.4 cm/sec, 1.69 MoM) and still remains low in recipient (36.4 cm/sec, 0.79 MoM), indicative of TAPS. The echogenecity of each placenta territory was clearly divided. Placenta of donor seemed hyperechoic and thicker compared to recipient (Fig. 1). SDP of donor was 4 cm, recipient was 8 cm. Estimated body weight of donor was 1,862 g, recipient was 2,183 g. Tei index of donor was 0.50, recipient was 0.34. There were no signs of hydrops and tricuspid regurgitation in both fetuses.

View Article: PubMed Central - PubMed

ABSTRACT

Twin anemia-polycythemia sequence (TAPS) is characterized by a wide discrepancy of hemoglobin between two monochorionic fetuses without sign of twin oligo-polyhydramnios sequence. A primiparous woman with monochorionic diamniotic twin transferred for preterm labor. Ultrasonographic evaluation at 32+3 weeks of gestation revealed increased middle cerebral artery-peak systolic velocity (77.4 cm/sec, 1.69 multiples of median) in donor and decreased in recipient twin (36.4 cm/sec, 0.79 multiples of median), the twin was diagnosed with TAPS. Repeated cesarean section was performed at 32+5 weeks of gestation following preeclampsia and preterm labor. After delivery, TAPS was confirmed through neonatal hematologic examination. There were no signs of acute hemorrhagic shock or brain injury. Placental evaluation via dye infusion and barium angiogram revealed one arterioarterial anastomoses with six arteriovenous anastomoses of placenta. We report a prenatally diagnosed case of spontaneous TAPS with arterioarterial and arteriovenous anastomoses and suggest careful monitoring of monochorionic twin and opinion on placenta vascular architecture.

No MeSH data available.