Treatment and outcome of 370 cases with spontaneous or post‐laser twin anemia–polycythemia sequence managed in 17 fetal therapy centers
ABSTRACT Objective To investigate the antenatal management and outcome in a large international cohort of monochorionic twin pregnancies with spontaneous or post‐laser twin anemia–polycythemia sequence (TAPS). Methods This study analyzed data of monochorionic twin pregnancies diagnosed antenatally w...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2020-09, Vol.56 (3), p.378-387 |
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| creator | Tollenaar, L. S. A. Slaghekke, F. Lewi, L. Ville, Y. Lanna, M. Weingertner, A. Ryan, G. Arévalo, S. Khalil, A. Brock, C. O. Klaritsch, P. Hecher, K. Gardener, G. Bevilacqua, E. Kostyukov, K. V. Bahtiyar, M. O. Kilby, M. D. Tiblad, E. Oepkes, D. Lopriore, E. Middeldorp, J. M. Haak, M. C. Klumper, F. J. C. M. Akkermans, J. Delagrange, H. Pandya, V. Faiola, S. Favre, R. Hobson, S. R. Rodo, C. Thilaganathan, B. Papanna, R. Greimel, P. Tavares de Sousa, M. Carlin, A. Gladkova, K. A. Copel, J. A. |
| description | ABSTRACT
Objective
To investigate the antenatal management and outcome in a large international cohort of monochorionic twin pregnancies with spontaneous or post‐laser twin anemia–polycythemia sequence (TAPS).
Methods
This study analyzed data of monochorionic twin pregnancies diagnosed antenatally with spontaneous or post‐laser TAPS in 17 fetal therapy centers, recorded in the TAPS Registry between 2014 and 2019. Antenatal diagnosis of TAPS was based on fetal middle cerebral artery peak systolic velocity > 1.5 multiples of the median (MoM) in the TAPS donor and |
| doi_str_mv | 10.1002/uog.22042 |
| format | Article |
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Objective
To investigate the antenatal management and outcome in a large international cohort of monochorionic twin pregnancies with spontaneous or post‐laser twin anemia–polycythemia sequence (TAPS).
Methods
This study analyzed data of monochorionic twin pregnancies diagnosed antenatally with spontaneous or post‐laser TAPS in 17 fetal therapy centers, recorded in the TAPS Registry between 2014 and 2019. Antenatal diagnosis of TAPS was based on fetal middle cerebral artery peak systolic velocity > 1.5 multiples of the median (MoM) in the TAPS donor and < 1.0 MoM in the TAPS recipient. The following antenatal management groups were defined: expectant management, delivery within 7 days after diagnosis, intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)), laser surgery and selective feticide. Cases were assigned to the management groups based on the first treatment that was received after diagnosis of TAPS. The primary outcomes were perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis‐to‐birth interval.
Results
In total, 370 monochorionic twin pregnancies were diagnosed antenatally with TAPS during the study period and included in the study. Of these, 31% (n = 113) were managed expectantly, 30% (n = 110) with laser surgery, 19% (n = 70) with IUT (± PET), 12% (n = 43) with delivery, 8% (n = 30) with selective feticide and 1% (n = 4) underwent termination of pregnancy. Perinatal mortality occurred in 17% (39/225) of pregnancies in the expectant‐management group, 18% (38/215) in the laser group, 18% (25/140) in the IUT (± PET) group, 10% (9/86) in the delivery group and in 7% (2/30) of the cotwins in the selective‐feticide group. The incidence of severe neonatal morbidity was 49% (41/84) in the delivery group, 46% (56/122) in the IUT (± PET) group, 31% (60/193) in the expectant‐management group, 31% (57/182) in the laser‐surgery group and 25% (7/28) in the selective‐feticide group. Median diagnosis‐to‐birth interval was longest after selective feticide (10.5 (interquartile range (IQR), 4.2–14.9) weeks), followed by laser surgery (9.7 (IQR, 6.6–12.7) weeks), expectant management (7.8 (IQR, 3.8–14.4) weeks), IUT (± PET) (4.0 (IQR, 2.0–6.9) weeks) and delivery (0.3 (IQR, 0.0–0.5) weeks). Treatment choice for TAPS varied greatly within and between the 17 fetal therapy centers.
Conclusions
Antenatal treatment for TAPS differs considerably amongst fetal therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolongation of pregnancy was best achieved by expectant management, treatment by laser surgery or selective feticide. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
A video of this article is available online here.</description><identifier>ISSN: 0960-7692</identifier><identifier>ISSN: 1469-0705</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.22042</identifier><identifier>PMID: 32291846</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Anemia ; Birth ; Diagnosis ; expectant management ; Fetuses ; Gynecology ; intrauterine transfusion ; Laser surgery ; Lasers ; Management ; Medicin och hälsovetenskap ; monochorionic twins ; Morbidity ; Mortality ; Neonates ; Obstetrics ; Original Paper ; Original Papers ; Polycythemia ; Pregnancy ; Prolongation ; selective feticide ; Surgery ; TAPS ; Therapy ; Transfusion ; treatment ; twin anemia–polycythemia sequence ; Ultrasonic imaging ; Ultrasound</subject><ispartof>Ultrasound in obstetrics & gynecology, 2020-09, Vol.56 (3), p.378-387</ispartof><rights>2020 The Authors. published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.</rights><rights>2020. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5082-d7b5482eb03c0e9b2a3ba062f665c9aee08cf22a4ce6aa00260b99504a2c92753</citedby><cites>FETCH-LOGICAL-c5082-d7b5482eb03c0e9b2a3ba062f665c9aee08cf22a4ce6aa00260b99504a2c92753</cites><orcidid>0000-0002-5813-8067 ; 0000-0002-5675-267X ; 0000-0002-7359-4853 ; 0000-0002-9884-5778 ; 0000-0002-8752-5920 ; 0000-0003-2802-7670 ; 0000-0002-2078-2295</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.22042$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.22042$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,552,780,784,885,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:144533977$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Tollenaar, L. S. A.</creatorcontrib><creatorcontrib>Slaghekke, F.</creatorcontrib><creatorcontrib>Lewi, L.</creatorcontrib><creatorcontrib>Ville, Y.</creatorcontrib><creatorcontrib>Lanna, M.</creatorcontrib><creatorcontrib>Weingertner, A.</creatorcontrib><creatorcontrib>Ryan, G.</creatorcontrib><creatorcontrib>Arévalo, S.</creatorcontrib><creatorcontrib>Khalil, A.</creatorcontrib><creatorcontrib>Brock, C. O.</creatorcontrib><creatorcontrib>Klaritsch, P.</creatorcontrib><creatorcontrib>Hecher, K.</creatorcontrib><creatorcontrib>Gardener, G.</creatorcontrib><creatorcontrib>Bevilacqua, E.</creatorcontrib><creatorcontrib>Kostyukov, K. V.</creatorcontrib><creatorcontrib>Bahtiyar, M. O.</creatorcontrib><creatorcontrib>Kilby, M. D.</creatorcontrib><creatorcontrib>Tiblad, E.</creatorcontrib><creatorcontrib>Oepkes, D.</creatorcontrib><creatorcontrib>Lopriore, E.</creatorcontrib><creatorcontrib>Middeldorp, J. M.</creatorcontrib><creatorcontrib>Haak, M. C.</creatorcontrib><creatorcontrib>Klumper, F. J. C. M.</creatorcontrib><creatorcontrib>Akkermans, J.</creatorcontrib><creatorcontrib>Delagrange, H.</creatorcontrib><creatorcontrib>Pandya, V.</creatorcontrib><creatorcontrib>Faiola, S.</creatorcontrib><creatorcontrib>Favre, R.</creatorcontrib><creatorcontrib>Hobson, S. R.</creatorcontrib><creatorcontrib>Rodo, C.</creatorcontrib><creatorcontrib>Thilaganathan, B.</creatorcontrib><creatorcontrib>Papanna, R.</creatorcontrib><creatorcontrib>Greimel, P.</creatorcontrib><creatorcontrib>Tavares de Sousa, M.</creatorcontrib><creatorcontrib>Carlin, A.</creatorcontrib><creatorcontrib>Gladkova, K. A.</creatorcontrib><creatorcontrib>Copel, J. A.</creatorcontrib><creatorcontrib>Collaborators</creatorcontrib><title>Treatment and outcome of 370 cases with spontaneous or post‐laser twin anemia–polycythemia sequence managed in 17 fetal therapy centers</title><title>Ultrasound in obstetrics & gynecology</title><description>ABSTRACT
Objective
To investigate the antenatal management and outcome in a large international cohort of monochorionic twin pregnancies with spontaneous or post‐laser twin anemia–polycythemia sequence (TAPS).
Methods
This study analyzed data of monochorionic twin pregnancies diagnosed antenatally with spontaneous or post‐laser TAPS in 17 fetal therapy centers, recorded in the TAPS Registry between 2014 and 2019. Antenatal diagnosis of TAPS was based on fetal middle cerebral artery peak systolic velocity > 1.5 multiples of the median (MoM) in the TAPS donor and < 1.0 MoM in the TAPS recipient. The following antenatal management groups were defined: expectant management, delivery within 7 days after diagnosis, intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)), laser surgery and selective feticide. Cases were assigned to the management groups based on the first treatment that was received after diagnosis of TAPS. The primary outcomes were perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis‐to‐birth interval.
Results
In total, 370 monochorionic twin pregnancies were diagnosed antenatally with TAPS during the study period and included in the study. Of these, 31% (n = 113) were managed expectantly, 30% (n = 110) with laser surgery, 19% (n = 70) with IUT (± PET), 12% (n = 43) with delivery, 8% (n = 30) with selective feticide and 1% (n = 4) underwent termination of pregnancy. Perinatal mortality occurred in 17% (39/225) of pregnancies in the expectant‐management group, 18% (38/215) in the laser group, 18% (25/140) in the IUT (± PET) group, 10% (9/86) in the delivery group and in 7% (2/30) of the cotwins in the selective‐feticide group. The incidence of severe neonatal morbidity was 49% (41/84) in the delivery group, 46% (56/122) in the IUT (± PET) group, 31% (60/193) in the expectant‐management group, 31% (57/182) in the laser‐surgery group and 25% (7/28) in the selective‐feticide group. Median diagnosis‐to‐birth interval was longest after selective feticide (10.5 (interquartile range (IQR), 4.2–14.9) weeks), followed by laser surgery (9.7 (IQR, 6.6–12.7) weeks), expectant management (7.8 (IQR, 3.8–14.4) weeks), IUT (± PET) (4.0 (IQR, 2.0–6.9) weeks) and delivery (0.3 (IQR, 0.0–0.5) weeks). Treatment choice for TAPS varied greatly within and between the 17 fetal therapy centers.
Conclusions
Antenatal treatment for TAPS differs considerably amongst fetal therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolongation of pregnancy was best achieved by expectant management, treatment by laser surgery or selective feticide. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
A video of this article is available online here.</description><subject>Anemia</subject><subject>Birth</subject><subject>Diagnosis</subject><subject>expectant management</subject><subject>Fetuses</subject><subject>Gynecology</subject><subject>intrauterine transfusion</subject><subject>Laser surgery</subject><subject>Lasers</subject><subject>Management</subject><subject>Medicin och hälsovetenskap</subject><subject>monochorionic twins</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Neonates</subject><subject>Obstetrics</subject><subject>Original Paper</subject><subject>Original Papers</subject><subject>Polycythemia</subject><subject>Pregnancy</subject><subject>Prolongation</subject><subject>selective feticide</subject><subject>Surgery</subject><subject>TAPS</subject><subject>Therapy</subject><subject>Transfusion</subject><subject>treatment</subject><subject>twin anemia–polycythemia sequence</subject><subject>Ultrasonic imaging</subject><subject>Ultrasound</subject><issn>0960-7692</issn><issn>1469-0705</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>D8T</sourceid><recordid>eNp1ks9u1DAQxiMEokvhwBtY4gKHtOM_seMLEqqgIFXqpT1bjneym5LEwU66yq13Lki8YZ8EL1lARerJ9vj3feMZT5a9pnBCAdjp5DcnjIFgT7IVFVLnoKB4mq1AS8iV1OwoexHjDQBIweXz7Igzpmkp5Cr7fhXQjh32I7H9mvhpdL5D4mvCFRBnI0aya8YtiYPvR9ujnyLxgQw-jvd3P9oEBDLumj7JsWvs_d3Pwbezm8ft_kgifpuwd0g629sNrkkiqSI1jrYliQl2mIlL6THEl9mz2rYRXx3W4-z608ers8_5xeX5l7MPF7kroGT5WlWFKBlWwB2grpjllQXJaikLpy0ilK5mzAqH0trUHwmV1gUIy5xmquDHWb74xh0OU2WG0HQ2zMbbxhxCX9MOjVAMKE28fpQfgl__E_0RUiEKzrVSSft-0Sagw_W-0mDbhxYPbvpmazb-1iihFVBIBm8PBsGnVsbRdE102LbLXxjGNdCCS7HP9eY_9MZPoU-tNEzwUhelYvvq3y2UCz7GgPXfx1Aw-3EyaZzM73FK7OnC7poW58dBc315vih-Ae_X0D8</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Tollenaar, L. 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S. A. ; Slaghekke, F. ; Lewi, L. ; Ville, Y. ; Lanna, M. ; Weingertner, A. ; Ryan, G. ; Arévalo, S. ; Khalil, A. ; Brock, C. O. ; Klaritsch, P. ; Hecher, K. ; Gardener, G. ; Bevilacqua, E. ; Kostyukov, K. V. ; Bahtiyar, M. O. ; Kilby, M. D. ; Tiblad, E. ; Oepkes, D. ; Lopriore, E. ; Middeldorp, J. M. ; Haak, M. C. ; Klumper, F. J. C. M. ; Akkermans, J. ; Delagrange, H. ; Pandya, V. ; Faiola, S. ; Favre, R. ; Hobson, S. R. ; Rodo, C. ; Thilaganathan, B. ; Papanna, R. ; Greimel, P. ; Tavares de Sousa, M. ; Carlin, A. ; Gladkova, K. A. ; Copel, J. 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M.</creatorcontrib><creatorcontrib>Akkermans, J.</creatorcontrib><creatorcontrib>Delagrange, H.</creatorcontrib><creatorcontrib>Pandya, V.</creatorcontrib><creatorcontrib>Faiola, S.</creatorcontrib><creatorcontrib>Favre, R.</creatorcontrib><creatorcontrib>Hobson, S. R.</creatorcontrib><creatorcontrib>Rodo, C.</creatorcontrib><creatorcontrib>Thilaganathan, B.</creatorcontrib><creatorcontrib>Papanna, R.</creatorcontrib><creatorcontrib>Greimel, P.</creatorcontrib><creatorcontrib>Tavares de Sousa, M.</creatorcontrib><creatorcontrib>Carlin, A.</creatorcontrib><creatorcontrib>Gladkova, K. A.</creatorcontrib><creatorcontrib>Copel, J. A.</creatorcontrib><creatorcontrib>Collaborators</creatorcontrib><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Online Library Free Content</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tollenaar, L. S. A.</au><au>Slaghekke, F.</au><au>Lewi, L.</au><au>Ville, Y.</au><au>Lanna, M.</au><au>Weingertner, A.</au><au>Ryan, G.</au><au>Arévalo, S.</au><au>Khalil, A.</au><au>Brock, C. O.</au><au>Klaritsch, P.</au><au>Hecher, K.</au><au>Gardener, G.</au><au>Bevilacqua, E.</au><au>Kostyukov, K. V.</au><au>Bahtiyar, M. O.</au><au>Kilby, M. D.</au><au>Tiblad, E.</au><au>Oepkes, D.</au><au>Lopriore, E.</au><au>Middeldorp, J. M.</au><au>Haak, M. C.</au><au>Klumper, F. J. C. M.</au><au>Akkermans, J.</au><au>Delagrange, H.</au><au>Pandya, V.</au><au>Faiola, S.</au><au>Favre, R.</au><au>Hobson, S. R.</au><au>Rodo, C.</au><au>Thilaganathan, B.</au><au>Papanna, R.</au><au>Greimel, P.</au><au>Tavares de Sousa, M.</au><au>Carlin, A.</au><au>Gladkova, K. A.</au><au>Copel, J. A.</au><aucorp>Collaborators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment and outcome of 370 cases with spontaneous or post‐laser twin anemia–polycythemia sequence managed in 17 fetal therapy centers</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><date>2020-09</date><risdate>2020</risdate><volume>56</volume><issue>3</issue><spage>378</spage><epage>387</epage><pages>378-387</pages><issn>0960-7692</issn><issn>1469-0705</issn><eissn>1469-0705</eissn><abstract>ABSTRACT
Objective
To investigate the antenatal management and outcome in a large international cohort of monochorionic twin pregnancies with spontaneous or post‐laser twin anemia–polycythemia sequence (TAPS).
Methods
This study analyzed data of monochorionic twin pregnancies diagnosed antenatally with spontaneous or post‐laser TAPS in 17 fetal therapy centers, recorded in the TAPS Registry between 2014 and 2019. Antenatal diagnosis of TAPS was based on fetal middle cerebral artery peak systolic velocity > 1.5 multiples of the median (MoM) in the TAPS donor and < 1.0 MoM in the TAPS recipient. The following antenatal management groups were defined: expectant management, delivery within 7 days after diagnosis, intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)), laser surgery and selective feticide. Cases were assigned to the management groups based on the first treatment that was received after diagnosis of TAPS. The primary outcomes were perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis‐to‐birth interval.
Results
In total, 370 monochorionic twin pregnancies were diagnosed antenatally with TAPS during the study period and included in the study. Of these, 31% (n = 113) were managed expectantly, 30% (n = 110) with laser surgery, 19% (n = 70) with IUT (± PET), 12% (n = 43) with delivery, 8% (n = 30) with selective feticide and 1% (n = 4) underwent termination of pregnancy. Perinatal mortality occurred in 17% (39/225) of pregnancies in the expectant‐management group, 18% (38/215) in the laser group, 18% (25/140) in the IUT (± PET) group, 10% (9/86) in the delivery group and in 7% (2/30) of the cotwins in the selective‐feticide group. The incidence of severe neonatal morbidity was 49% (41/84) in the delivery group, 46% (56/122) in the IUT (± PET) group, 31% (60/193) in the expectant‐management group, 31% (57/182) in the laser‐surgery group and 25% (7/28) in the selective‐feticide group. Median diagnosis‐to‐birth interval was longest after selective feticide (10.5 (interquartile range (IQR), 4.2–14.9) weeks), followed by laser surgery (9.7 (IQR, 6.6–12.7) weeks), expectant management (7.8 (IQR, 3.8–14.4) weeks), IUT (± PET) (4.0 (IQR, 2.0–6.9) weeks) and delivery (0.3 (IQR, 0.0–0.5) weeks). Treatment choice for TAPS varied greatly within and between the 17 fetal therapy centers.
Conclusions
Antenatal treatment for TAPS differs considerably amongst fetal therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolongation of pregnancy was best achieved by expectant management, treatment by laser surgery or selective feticide. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
A video of this article is available online here.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>32291846</pmid><doi>10.1002/uog.22042</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-5813-8067</orcidid><orcidid>https://orcid.org/0000-0002-5675-267X</orcidid><orcidid>https://orcid.org/0000-0002-7359-4853</orcidid><orcidid>https://orcid.org/0000-0002-9884-5778</orcidid><orcidid>https://orcid.org/0000-0002-8752-5920</orcidid><orcidid>https://orcid.org/0000-0003-2802-7670</orcidid><orcidid>https://orcid.org/0000-0002-2078-2295</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0960-7692 |
| ispartof | Ultrasound in obstetrics & gynecology, 2020-09, Vol.56 (3), p.378-387 |
| issn | 0960-7692 1469-0705 1469-0705 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_472011 |
| source | Wiley Online Library Free Content; SWEPUB Freely available online; Access via Wiley Online Library; EZB-FREE-00999 freely available EZB journals |
| subjects | Anemia Birth Diagnosis expectant management Fetuses Gynecology intrauterine transfusion Laser surgery Lasers Management Medicin och hälsovetenskap monochorionic twins Morbidity Mortality Neonates Obstetrics Original Paper Original Papers Polycythemia Pregnancy Prolongation selective feticide Surgery TAPS Therapy Transfusion treatment twin anemia–polycythemia sequence Ultrasonic imaging Ultrasound |
| title | Treatment and outcome of 370 cases with spontaneous or post‐laser twin anemia–polycythemia sequence managed in 17 fetal therapy centers |
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