Fetal intraperitoneal transfusion for iatrogenic twin anemia-polycythemia sequence after laser therapy

Ultrasound Obstet Gynecol. 2009 May;33(5):592-4. doi: 10.1002/uog.6334.

Abstract

Twin anemia-polycythemia sequence (TAPS) is a rare variant of twin-twin transfusion syndrome (TTTS) without the characteristic twin oligohydramnios-polyhydramnios sequence and cardiovascular milieu attributed to renin-angiotensin system mediators. It can occur spontaneously or iatrogenically after fetoscopic laser surgery. We report the case of a woman, gravida 2 para 1, with a monochorionic diamniotic pregnancy who developed Quintero Stage III TTTS. She underwent laser photocoagulation of identifiable anastomotic vessels and subsequently developed suspected TAPS 2 weeks later. The pregnancy was successfully treated with serial intrauterine intraperitoneal transfusions (IUT-PTs) of red blood cells. Although TAPS is a rare condition, serial middle cerebral artery peak systolic velocity measurements are warranted as follow-up in patients who have undergone fetoscopic laser surgery for TTTS. IUT-PTs may be superior to intravascular intrauterine transfusions in the treatment of this condition.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anemia / therapy*
  • Blood Flow Velocity / physiology
  • Blood Transfusion, Intrauterine / methods*
  • Erythrocyte Transfusion / methods
  • Female
  • Fetofetal Transfusion / diagnostic imaging
  • Fetofetal Transfusion / surgery*
  • Fetoscopy / methods
  • Gestational Age
  • Humans
  • Laser Coagulation / adverse effects*
  • Placenta / physiopathology*
  • Placenta / surgery
  • Polycythemia / therapy*
  • Pregnancy
  • Ultrasonography, Prenatal