Treatment and outcome in 370 cases with spontaneous or post-laser twin anemia polycythemia sequence managed in 17 different fetal therapy centers: treatment and outcome in 370 TAPS twins

L Tollenaar; Femke Slaghekke; Liesbeth Lewi; Yves Ville; Mariano Lanna; A Weingertner; G Ryan; S Arevalo; A Khalil; C Brock; P Klaritsch; Kurt Hecher; G Gardener; E Bevilacqua; K Kostyukov; M Bahtiyar; Mark Kilby; E Tiblad; Dick Oepkes; Enrico Lopriore

doi:10.1002/uog.22042

Treatment and outcome in 370 cases with spontaneous or post-laser twin anemia polycythemia sequence managed in 17 different fetal therapy centers: treatment and outcome in 370 TAPS twins

L Tollenaar, Femke Slaghekke, Liesbeth Lewi, Yves Ville, Mariano Lanna, A Weingertner, G Ryan, S Arevalo, A Khalil, C Brock, P Klaritsch, Kurt Hecher, G Gardener, E Bevilacqua, K Kostyukov, M Bahtiyar, Mark Kilby, E Tiblad, Dick Oepkes, Enrico Lopriore

Metabolism and Systems Research

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Abstract

Objectiveto investigate antenatal management and outcome in a large international cohort of spontaneous and post‐laser twin anemia polycythemia sequence (TAPS).
MethodsData of monochorionic twins diagnosed antenatally with TAPS collected in the TAPS Registry between 2014‐2019 were included in this study. Antenatal diagnosis of TAPS was based on middle cerebral artery peak systolic velocity (MCA‐PSV) > 1.5 Multiples of the Median (MoM) in the TAPS donor and < 1.0 MoM in the TAPS recipient. Cases were assigned to the management groups based on the first treatment that was received. The primary outcome included perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis‐to‐birth interval.
ResultsIn total, 370 TAPS cases were antenatally diagnosed and managed either with expectant management in 31% (113/370), laser surgery in 30% (110/370), intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)) in 19% (70/370), delivery in 12% (43/370), selective feticide in 8% (30/370) or termination of pregnancy in 1% (4/370). Perinatal mortality occurred in 17% (37/225) of the expectant group, in 18% (38/215) of the laser group, in 18% (25/140) in the IUT (± PET) group, in 10% (9/86) in the delivery group and in 7% (2/30) of the co‐twins in the selective‐feticide group (p = 0.177). Severe neonatal morbidity was 49% (41/84) in delivery, 46% (56/122) in IUT (± PET), 31% (60/193) in expectant management, 31% (57/182) in laser surgery and 25% (7/28) in selective feticide (p = 0.027). Median diagnosis‐to‐birth interval was longest after selective feticide (10.5 weeks; IQR: 4.2‐14.9), followed by laser surgery (9.7 weeks, IQR: 6.6‐12.7), expectant management (7.8 weeks; IQR: 3.8‐14.4), IUT (± PET) (4.0 weeks, IQR: 2.0‐6.9 weeks) and delivery (0.3 weeks, IQR: 0.0‐0.5), p < 0.001. Treatment for TAPS varied greatly within and between the 17 fetal therapy centers.
ConclusionsAntenatal treatment for TAPS differs considerably amongst fetal therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolonging pregnancy was best achieved in expectant management, laser surgery and selective feticide.

Original language	English
Journal	Ultrasound in Obstetrics and Gynecology
Early online date	14 Apr 2020
DOIs	https://doi.org/10.1002/uog.22042
Publication status	E-pub ahead of print - 14 Apr 2020

Keywords

monochorionic twins
twin anemia polycythemia sequence
TAPS
treatment
intrauterine transfusion
laser surgery
selective feticide
expectant management

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10.1002/uog.22042Licence: None: All rights reserved

Tollenaar_et_al_Treatment_and_outcome_in_370_cases_Ultrasound_in_Obstetrics_and_Gynecology_2020
This is the peer reviewed version of the following article: Tollenaar, L.S.A., Slaghekke, F., Lewi, L., Ville, Y., Lanna, M., Weingertner, A., Ryan, G., Arévalo, S., Khalil, A., Brock, C.O., Klaritsch, P., Hecher, K., Gardener, G., Bevilacqua, E., Kostyukov, K.V., Bahtiyar, M.O., Kilby, M.D., Tiblad, E., Oepkes, D., Lopriore, E. and (2020), Treatment and outcome in 370 cases with spontaneous or post‐laser twin anemia polycythemia sequence managed in 17 different fetal therapy centers. Ultrasound Obstet Gynecol. Accepted Author Manuscript. doi:10.1002/uog.22042, which has been published in final form at https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.22042. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Accepted author manuscript, 501 KBLicence: Other (please specify with Rights Statement)

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Tollenaar, L., Slaghekke, F., Lewi, L., Ville, Y., Lanna, M., Weingertner, A., Ryan, G., Arevalo, S., Khalil, A., Brock, C., Klaritsch, P., Hecher, K., Gardener, G., Bevilacqua, E., Kostyukov, K., Bahtiyar, M., Kilby, M., Tiblad, E., Oepkes, D., & Lopriore, E. (2020). Treatment and outcome in 370 cases with spontaneous or post-laser twin anemia polycythemia sequence managed in 17 different fetal therapy centers: treatment and outcome in 370 TAPS twins. Ultrasound in Obstetrics and Gynecology. Advance online publication. https://doi.org/10.1002/uog.22042

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title = "Treatment and outcome in 370 cases with spontaneous or post-laser twin anemia polycythemia sequence managed in 17 different fetal therapy centers: treatment and outcome in 370 TAPS twins",

abstract = "Objectiveto investigate antenatal management and outcome in a large international cohort of spontaneous and post‐laser twin anemia polycythemia sequence (TAPS).MethodsData of monochorionic twins diagnosed antenatally with TAPS collected in the TAPS Registry between 2014‐2019 were included in this study. Antenatal diagnosis of TAPS was based on middle cerebral artery peak systolic velocity (MCA‐PSV) > 1.5 Multiples of the Median (MoM) in the TAPS donor and < 1.0 MoM in the TAPS recipient. Cases were assigned to the management groups based on the first treatment that was received. The primary outcome included perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis‐to‐birth interval.ResultsIn total, 370 TAPS cases were antenatally diagnosed and managed either with expectant management in 31% (113/370), laser surgery in 30% (110/370), intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)) in 19% (70/370), delivery in 12% (43/370), selective feticide in 8% (30/370) or termination of pregnancy in 1% (4/370). Perinatal mortality occurred in 17% (37/225) of the expectant group, in 18% (38/215) of the laser group, in 18% (25/140) in the IUT (± PET) group, in 10% (9/86) in the delivery group and in 7% (2/30) of the co‐twins in the selective‐feticide group (p = 0.177). Severe neonatal morbidity was 49% (41/84) in delivery, 46% (56/122) in IUT (± PET), 31% (60/193) in expectant management, 31% (57/182) in laser surgery and 25% (7/28) in selective feticide (p = 0.027). Median diagnosis‐to‐birth interval was longest after selective feticide (10.5 weeks; IQR: 4.2‐14.9), followed by laser surgery (9.7 weeks, IQR: 6.6‐12.7), expectant management (7.8 weeks; IQR: 3.8‐14.4), IUT (± PET) (4.0 weeks, IQR: 2.0‐6.9 weeks) and delivery (0.3 weeks, IQR: 0.0‐0.5), p < 0.001. Treatment for TAPS varied greatly within and between the 17 fetal therapy centers.ConclusionsAntenatal treatment for TAPS differs considerably amongst fetal therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolonging pregnancy was best achieved in expectant management, laser surgery and selective feticide.",

keywords = "monochorionic twins, twin anemia polycythemia sequence, TAPS, treatment, intrauterine transfusion, laser surgery, selective feticide, expectant management",

author = "L Tollenaar and Femke Slaghekke and Liesbeth Lewi and Yves Ville and Mariano Lanna and A Weingertner and G Ryan and S Arevalo and A Khalil and C Brock and P Klaritsch and Kurt Hecher and G Gardener and E Bevilacqua and K Kostyukov and M Bahtiyar and Mark Kilby and E Tiblad and Dick Oepkes and Enrico Lopriore",

year = "2020",

month = apr,

day = "14",

doi = "10.1002/uog.22042",

language = "English",

journal = "Ultrasound in Obstetrics and Gynecology",

issn = "0960-7692",

publisher = "Wiley",

}

Tollenaar, L, Slaghekke, F, Lewi, L, Ville, Y, Lanna, M, Weingertner, A, Ryan, G, Arevalo, S, Khalil, A, Brock, C, Klaritsch, P, Hecher, K, Gardener, G, Bevilacqua, E, Kostyukov, K, Bahtiyar, M, Kilby, M, Tiblad, E, Oepkes, D & Lopriore, E 2020, 'Treatment and outcome in 370 cases with spontaneous or post-laser twin anemia polycythemia sequence managed in 17 different fetal therapy centers: treatment and outcome in 370 TAPS twins', Ultrasound in Obstetrics and Gynecology. https://doi.org/10.1002/uog.22042

TY - JOUR

T1 - Treatment and outcome in 370 cases with spontaneous or post-laser twin anemia polycythemia sequence managed in 17 different fetal therapy centers

T2 - treatment and outcome in 370 TAPS twins

AU - Tollenaar, L

AU - Slaghekke, Femke

AU - Lewi, Liesbeth

AU - Ville, Yves

AU - Lanna, Mariano

AU - Weingertner, A

AU - Ryan, G

AU - Arevalo, S

AU - Khalil, A

AU - Brock, C

AU - Klaritsch, P

AU - Hecher, Kurt

AU - Gardener, G

AU - Bevilacqua, E

AU - Kostyukov, K

AU - Bahtiyar, M

AU - Kilby, Mark

AU - Tiblad, E

AU - Oepkes, Dick

AU - Lopriore, Enrico

PY - 2020/4/14

Y1 - 2020/4/14

N2 - Objectiveto investigate antenatal management and outcome in a large international cohort of spontaneous and post‐laser twin anemia polycythemia sequence (TAPS).MethodsData of monochorionic twins diagnosed antenatally with TAPS collected in the TAPS Registry between 2014‐2019 were included in this study. Antenatal diagnosis of TAPS was based on middle cerebral artery peak systolic velocity (MCA‐PSV) > 1.5 Multiples of the Median (MoM) in the TAPS donor and < 1.0 MoM in the TAPS recipient. Cases were assigned to the management groups based on the first treatment that was received. The primary outcome included perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis‐to‐birth interval.ResultsIn total, 370 TAPS cases were antenatally diagnosed and managed either with expectant management in 31% (113/370), laser surgery in 30% (110/370), intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)) in 19% (70/370), delivery in 12% (43/370), selective feticide in 8% (30/370) or termination of pregnancy in 1% (4/370). Perinatal mortality occurred in 17% (37/225) of the expectant group, in 18% (38/215) of the laser group, in 18% (25/140) in the IUT (± PET) group, in 10% (9/86) in the delivery group and in 7% (2/30) of the co‐twins in the selective‐feticide group (p = 0.177). Severe neonatal morbidity was 49% (41/84) in delivery, 46% (56/122) in IUT (± PET), 31% (60/193) in expectant management, 31% (57/182) in laser surgery and 25% (7/28) in selective feticide (p = 0.027). Median diagnosis‐to‐birth interval was longest after selective feticide (10.5 weeks; IQR: 4.2‐14.9), followed by laser surgery (9.7 weeks, IQR: 6.6‐12.7), expectant management (7.8 weeks; IQR: 3.8‐14.4), IUT (± PET) (4.0 weeks, IQR: 2.0‐6.9 weeks) and delivery (0.3 weeks, IQR: 0.0‐0.5), p < 0.001. Treatment for TAPS varied greatly within and between the 17 fetal therapy centers.ConclusionsAntenatal treatment for TAPS differs considerably amongst fetal therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolonging pregnancy was best achieved in expectant management, laser surgery and selective feticide.

AB - Objectiveto investigate antenatal management and outcome in a large international cohort of spontaneous and post‐laser twin anemia polycythemia sequence (TAPS).MethodsData of monochorionic twins diagnosed antenatally with TAPS collected in the TAPS Registry between 2014‐2019 were included in this study. Antenatal diagnosis of TAPS was based on middle cerebral artery peak systolic velocity (MCA‐PSV) > 1.5 Multiples of the Median (MoM) in the TAPS donor and < 1.0 MoM in the TAPS recipient. Cases were assigned to the management groups based on the first treatment that was received. The primary outcome included perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis‐to‐birth interval.ResultsIn total, 370 TAPS cases were antenatally diagnosed and managed either with expectant management in 31% (113/370), laser surgery in 30% (110/370), intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)) in 19% (70/370), delivery in 12% (43/370), selective feticide in 8% (30/370) or termination of pregnancy in 1% (4/370). Perinatal mortality occurred in 17% (37/225) of the expectant group, in 18% (38/215) of the laser group, in 18% (25/140) in the IUT (± PET) group, in 10% (9/86) in the delivery group and in 7% (2/30) of the co‐twins in the selective‐feticide group (p = 0.177). Severe neonatal morbidity was 49% (41/84) in delivery, 46% (56/122) in IUT (± PET), 31% (60/193) in expectant management, 31% (57/182) in laser surgery and 25% (7/28) in selective feticide (p = 0.027). Median diagnosis‐to‐birth interval was longest after selective feticide (10.5 weeks; IQR: 4.2‐14.9), followed by laser surgery (9.7 weeks, IQR: 6.6‐12.7), expectant management (7.8 weeks; IQR: 3.8‐14.4), IUT (± PET) (4.0 weeks, IQR: 2.0‐6.9 weeks) and delivery (0.3 weeks, IQR: 0.0‐0.5), p < 0.001. Treatment for TAPS varied greatly within and between the 17 fetal therapy centers.ConclusionsAntenatal treatment for TAPS differs considerably amongst fetal therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolonging pregnancy was best achieved in expectant management, laser surgery and selective feticide.

KW - monochorionic twins

KW - twin anemia polycythemia sequence

KW - TAPS

KW - treatment

KW - intrauterine transfusion

KW - laser surgery

KW - selective feticide

KW - expectant management

U2 - 10.1002/uog.22042

DO - 10.1002/uog.22042

M3 - Article

SN - 0960-7692

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

ER -

Treatment and outcome in 370 cases with spontaneous or post-laser twin anemia polycythemia sequence managed in 17 different fetal therapy centers: treatment and outcome in 370 TAPS twins

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