Perinatal Outcomes of Pregnancies Complicated by Twin Anaemi
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Spontaneous twin anaemiapolycythaemia sequence (TAPS) may have a better prognosis than post?Laser TAPS, results from a systematic review suggest.

No differences in terms of mortality and morbidity were observed comparing different management options for TAPS, the researchers commented.

To report the perinatal outcome in monochorionicdiamniotic (MCDA) twin pregnancies complicated by TAPS, they performed a search in Medline, Embase and Cochrane Library databases with following inclusion criteria: non?anomalous MCDA twin pregnancies with a diagnosis of TAPS.

Outcomes like mortality, morbidity and preterm birth (PTB) were stratified according to the type of TAPS (spontaneous or following laser treatment) and management option adopted (expectant, laser, intra?uterine transfusion [IUT] and selective reduction [SR]).

Assessment of spontaneous and post?laser TAPS (506 pregnancies) revealed occurrence of IUD in 5.32% of spontaneous and in 10.2% of post?laser TAPS, while for neonatal death, the corresponding figures were 4.0% and 9.2%. In total, 29.3% of twins after spontaneous and 33.3% after post?laser TAPS had occurrence of severe neonatal morbidity, while the corresponding figures for severe neurological morbidity were 4.0% and 11.1% respectively. All cases with post?laser TAPS and 86.3% of pregnancies with spontaneous TAPS were complicated by PTB. Both groups more frequently had iatrogenic PTB than the spontaneous PTB.

Outcome according to different management options (418 pregnancies) revealed IUD occurred in 9.8% of pregnancies managed expectantly and in 13.1%, 12.1% and 7.6% of those treated with laser, IUT and SR, respectively. Severe neonatal morbidity affected 27.3% twins in the expectant management group, 28.7% in the laser surgery group, 38.2% in the IUT group and 23.3% in the SR group. PTB complicated 80.4%, 73.4%, 100% and 100% of pregnancies after expectant management, laser, IUT and SR, respectively.

“Although a direct comparison could not be performed, the results indicate a better prognosis for spontaneous TAPS relative to post Laser TAPS,” researchers said.“ Comparison of different management options for TAPS (expectant, laser, intra?uterine transfusion and selective reduction) revealed no differences in terms of mortality and morbidity.”

They suggest undertaking an individualized prenatal management, taking into account the severity of TAPS and gestational age.

Source:
https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.23585
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