Performance of antenatal diagnostic criteria of twin-anemia-polycythemia sequence

Liu B., Kalafat E., Bhide A., Thilaganathan B., Khalil A.

Journal of Clinical Medicine, vol.9, no.9, pp.1-12, 2020 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 9 Issue: 9
  • Publication Date: 2020
  • Doi Number: 10.3390/jcm9092754
  • Journal Name: Journal of Clinical Medicine
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, EMBASE, Directory of Open Access Journals
  • Page Numbers: pp.1-12
  • Keywords: twin anemia polycythemia sequence, diagnostic criteria, perinatal outcomes, disease progression, antenatal intervention, PEAK SYSTOLIC VELOCITY, GROWTH RESTRICTION, LASER COAGULATION, CLASSIFICATION, MANAGEMENT
  • Middle East Technical University Affiliated: No


© 2020 by the authors. Licensee MDPI, Basel, Switzerland.This study aims to elicit the validation performance of different diagnostic criteria and to evaluate the disease course and perinatal outcomes of pregnancies complicated by twin anemia polycythemia sequence (TAPS). Monochorionic diamniotic (MCDA) twin pregnancies who received serial middle cerebral artery (MCA) peak systolic velocity (PSV) measurements without non-TAPS-related demise or major anomalies were included. Course of disease, antenatal intervention, additional ultrasound features, and perinatal outcomes were compared between each criteria and onset. Forty-nine cases of TAPS and 203 non-TAPS controls were identified. The incidence of TAPS was 19.2%, 15.7%, 7.8%, and 6.3% for ∆PSV MoM > 0.373, ∆PSV MoM > 0.5, traditional, and Delphi consensus criteria, respectively (p < 0.001). The incidence of antenatal intervention was 55.1, 62.5, 75.0, and 87.5%, respectively. Furthermore, cases detected according to the Delphi consensus criteria had a higher rate of progression or intervention compared to cases detected with ∆PSV MoM > 0.373 (87.0 vs. 59.0%, p = 0.037). TAPS had a significantly higher birth weight discordance than uncomplicated MCDA twins (25.3 vs. 7.3%, p < 0.001). Application of four different diagnostic criteria for TAPS leads to significant differences in the incidence, severity, and antenatal intervention. The Delphi criteria identified more severe cases likely to require intervention, and the delta PSV > 0.373 criteria identified milder cases, without a significant impact on neonatal outcomes.