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
Placenta
Personal Characteristics
29-year-old woman
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 a reversed a-wave in the ductus venosus. Twin b presented a starry-sky appearance of its liver suggestive of polycythemia. 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 diagnosis of early twin anemia-polycythemia sequence (taps) was made the mca-psv of the donor (twin a) started to improve from 19 weeks’ gestation, normalizing completely by 21 weeks’ gestation. Magnetic resonance imaging of the fetal brain at 30 weeks’ gestation was normal in both twins. The ex-donor (twin-a) had a birth weight of 2275 g and a hemoglobin level of 28 g/dl, and received partial exchange transfusion on the first day after birth. The ex-recipient (twin b) had a birth weight of 2880 g and did not present any postnatal complications. X-ray angiography showed equal placental sharing between the twins
Remission Characteristics
Because of the early presentation of taps and subsequent placental growth, these minuscule anastomoses closed spontaneously between 15 and 19 weeks’ gestation.
Treatment & Mechanisms
Proposed Remission Mechanisms
Twin a: blood transfusion
Clinical Treatment
None reported
Non-Clinical Treatment
None reported