Spontaneous Regression Of Twin Anemia-polycythemia Sequence Presenting In First Trimester
Couck, I., Valenzuela, I., Russo, F., & Lewi, L. (2020). Spontaneous regression of twin anemia-polycythemia sequence presenting in first trimester. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 55(6), 839–840. https://doi.org/10.1002/uog.21897
View Original Source →Abstract
A 29-year old para 2 presented with a spontaneous monochorionic diamniotic twin pregnancy for the 12-week scan. Twin 1 had a fetal tachycardia of 192 beats per minute with a reversed a-wave in the ductus venosus. This article is protected by copyright. All rights reserved.
Case Details
Disease Location
Fetal vasculature (twins)
Personal Characteristics
29-year-old woman, para 2
Clinical Characteristics
Presented with a spontaneous monochorionic diamniotic twin pregnancy at 12 weeks gestation for ultrasound assessment. Twin a had fetal tachycardia of 192 bpm and reversed a-wave in the ductus venosus. Twin b showed a starry-sky appearance of its liver suggestive of polycythemia middle cerebral artery (mca) peak systolic velocity (psv) was 21 cm/s in twin a and 13 cm/s in twin b. At 15 weeks’ gestation, twin a had a mca-psv of 47 cm/s (> 1.5 multiples of the median (mom)) whilst twin b had a mca-psv of 18 cm/s (< 0.8 mom). The placental part of twin a was thickened and bright whereas that of twin b was thinner and dark 2 . Twin a had lower estimated fetal weight (123 g) and lower amniotic fluid volume (deepest vertical pocket (dvp) of 1.9 cm) than twin b (145 g and dvp of 3.9 cm) the diagnosis of early twin anemia–polycythemia sequence (taps) was made and expectant management was proposed. The mca-psv of the donor (twin a) started to improve from 19 weeks’ gestation normalizing completely by 21 weeks’ gestation. At 26 weeks’ gestation, assessment of the four-chamber view suggested possible coarctation of the aorta in the ex-donor (twin a). The ex-donor had a birth weight of 2275 g and hemoglobin level of 28 g/dl, and received partial exchange transfusion on the first day after birth. He was discharged at day 10 postpartum. The ex-recipient had a birth weight of 2880 g and did not present any postnatal complications.
Remission Characteristics
Magnetic resonance imaging of the fetal brain at 30 weeks’ gestation was normal in both twins. Both twins were born with adequate weight. Placental examination did not show a color difference on the maternal side, and color injection did not demonstrate any anastomoses. X-ray angiography showed equal placental sharing between the twins.
Treatment & Mechanisms
Proposed Remission Mechanisms
Because of the early presentation of taps and subsequent placental growth, these minuscule anastomoses closed spontaneously between 15 and 19 weeks’ gestation
Clinical Treatment
None reported (during pregnancy)