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JOGC

Intrauterine Interventions for the Treatment of Twin Anemia-Polycythemia Sequence: A Systematic Review

Published:October 26, 2018DOI:https://doi.org/10.1016/j.jogc.2018.04.005

      Abstract

      Background

      Twin anemia-polycythemia sequence (TAPS) is a complication of monochorionic, multiple gestation pregnancies in which blood shunting through placental anastomoses results in chronic anemia in one fetus and chronic polycythemia in another. The outcomes of different treatment modalities for TAPS are not well known.

      Objective

      To determine the outcomes of the intrauterine interventions used to treat TAPS.

      Study Design

      A systematic literature search of MEDLINE, EMBASE, and CENTRAL was performed in June 2016. Primary outcomes were mortality, morbidity, and adverse perinatal outcomes. Data were summarized in the form of weighted means, and statistical difference was determined.

      Results

      Twenty-one articles were identified for inclusion in this review and were composed of 105 cases of TAPS. In the cases presented in the literature, there was no statistically significant difference in mortality, morbidity, or emergent Caesarean section rates between expectant management, intrauterine transfusion (IUT), and laser ablation therapy. Laser ablation therapy and IUT were found to have a significantly lower rate of adverse perinatal outcomes when compared to expectantly managed cases.

      Conclusions

      The literature looking into the treatment of TAPS is very limited, with no randomized controlled trials and only one includable comparative study. Based on the data in the case report and case study literature, there is no mortality difference between any of the treatment modalities. Expectant management may be associated with an increase in adverse perinatal outcomes when compared to laser therapy and IUT. More comparative studies are needed to assist clinicians in adopting an evidence-based approach to the treatment of TAPS.

      Résumé

      Contexte

      La séquence anémie-polyglobulie gémellaire (TAPS) est une complication des grossesses multiples monochoriales dans laquelle la dérivation du sang par les anastomoses placentaires entraîne une anémie chronique chez un fœtus et une polyglobulie chronique chez un autre. Les issues des diverses formes de traitement de la TAPS ne sont pas bien connues.

      Objectif

      Déterminer les issues des interventions intra-utérines utilisées pour traiter la TAPS.

      Type d'étude

      Nous avons mené une revue systématique de la littérature en interrogeant les bases de données MEDLINE, Embase et CENTRAL en juin 2016. Les issues primaires étaient la mortalité, la morbidité et les issues périnatales indésirables. Nous avons résumé les données sous forme de moyennes pondérées, et déterminé les différences statistiques.

      Résultats

      Nous avons inclus 21 articles dans cette revue, pour un total de 105 cas de TAPS. Nous n'avons pas relevé de différences statistiquement significatives en ce qui concerne la mortalité, la morbidité ou les taux de césarienne d'urgence entre la prise en charge non interventionniste, la transfusion intra-utérine et la coagulation laser. Ces deux dernières techniques avaient un taux d'issues périnatales indésirables significativement plus faible que la prise en charge non interventionniste.

      Conclusions

      La littérature sur le traitement de la TAPS est très limitée : il n'existe pas d'ECR, et une seule étude comparative a pu être incluse. D'après les données des études de cas, il n'y a pas de différence dans la mortalité entre les formes de traitement. La prise en charge non interventionniste pourrait être associée à une augmentation des issues périnatales indésirables par rapport à la coagulation laser et à la transfusion intra-utérine. Il faudra davantage d'études comparatives pour aider les cliniciens à adopter une approche fondée sur des données probantes pour traiter la TAPS.

      Key Words

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