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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Article info
Publication history
Published online: October 26, 2018
Received:
January 1,
2018
Footnotes
Competing interests: The authors declare that they have no competing interests.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
