Antenatal management of twin-twin transfusion syndrome and twin anemia-polycythemia sequence

ABSTRACT

Introduction: Twin-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS) are severe complications in monochorionic twin pregnancies associated with high mortality and morbidity risk if left untreated. Both diseases result from imbalanced inter-twin blood transfusion through placental vascular anastomoses.

Areas covered: This review focuses on the differences in antenatal management between TTTS and TAPS.

Expert commentary: The optimal management for TTTS is fetoscopic laser coagulation of the vascular anastomoses, preferably using the Solomon technique in which the whole vascular equator is coagulated. The Solomon technique is associated with a reduction of residual anastomosis and a reduction in post-operative complications. The optimal management for TAPS is not clear and includes expectant management, intra-uterine transfusion with or without partial exchange transfusion and fetoscopic laser surgery.

KEYWORDS:

• Monochorionic twins
• twin-twin transfusion syndrome
• twin anemia-polycythemia sequence
• fetoscopic laser surgery
• intrauterine transfusion
• partial exchange transfusion

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.