Abstract：
BACKGROUND: Twin anemia polycythemia sequence is a rare complication in monochorionic twin pregnancy.
METHODS: We describe a case of dichorionic twin pregnancy presenting with suspected twin anemia polycythemia sequence. A 31-year-old White female, on her third pregnancy, had a routine ultrasound scan at 12 weeks gestation, which demonstrated a dichorionic twin pregnancy with one placenta located in the anterior wall and the other in the posterior wall of the uterus. At 21 weeks, a scan demonstrated a 24% growth discordance between the two fetuses with normal Doppler studies and amniotic fluid. At 27 weeks, one twin showed signs of anemia and the other polycythemia; the fetal middle cerebral artery peak systolic velocity was high in the anemic fetus and low in the polycythemic twin (1.8 and 0.5 multiples of the median). An intrauterine blood transfusion was carried out and this increased the fetal hemoglobin concentration in the anemic twin from 3.5 to 12.5 g/dL. At 29 weeks, delivery by cesarean section was carried out because of evidence from middle cerebral artery peak systolic velocity of recurrence of anemia in one twin and worsening polycythemia in the co-twin; at birth the hemoglobin concentrations were 5.6 and 24.9 g/dL, respectively. Histopathological examination confirmed dichorionicity with no communicating vessels between the two placentas.
CONCLUSIONS: This is the first case of twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy where intrauterine blood transfusion was used to prolong the pregnancy by almost 2 weeks in a \"twin anemia polycythemia sequence-like\" setting.
METHODS: We describe a case of dichorionic twin pregnancy presenting with suspected twin anemia polycythemia sequence. A 31-year-old White female, on her third pregnancy, had a routine ultrasound scan at 12 weeks gestation, which demonstrated a dichorionic twin pregnancy with one placenta located in the anterior wall and the other in the posterior wall of the uterus. At 21 weeks, a scan demonstrated a 24% growth discordance between the two fetuses with normal Doppler studies and amniotic fluid. At 27 weeks, one twin showed signs of anemia and the other polycythemia; the fetal middle cerebral artery peak systolic velocity was high in the anemic fetus and low in the polycythemic twin (1.8 and 0.5 multiples of the median). An intrauterine blood transfusion was carried out and this increased the fetal hemoglobin concentration in the anemic twin from 3.5 to 12.5 g/dL. At 29 weeks, delivery by cesarean section was carried out because of evidence from middle cerebral artery peak systolic velocity of recurrence of anemia in one twin and worsening polycythemia in the co-twin; at birth the hemoglobin concentrations were 5.6 and 24.9 g/dL, respectively. Histopathological examination confirmed dichorionicity with no communicating vessels between the two placentas.
CONCLUSIONS: This is the first case of twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy where intrauterine blood transfusion was used to prolong the pregnancy by almost 2 weeks in a \"twin anemia polycythemia sequence-like\" setting.
摘要：
背景：双胎贫血红细胞增多症是单绒毛膜双胎妊娠的一种罕见并发症。
方法：我们描述了一例双胎双胎妊娠，怀疑双胎贫血性红细胞增多症。一名31岁的白人女性,在她第三次怀孕的时候,在妊娠12周时进行了常规超声扫描，这表明双胎双胎妊娠，一个胎盘位于子宫前壁，另一个位于子宫后壁。在21周，扫描显示，两个正常多普勒研究的胎儿与羊水之间的生长不一致率为24％。在27周，一对双胞胎出现贫血和其他红细胞增多症;贫血胎儿的胎儿大脑中动脉峰值收缩期速度较高,而红细胞增多症双胞胎的胎儿则较低(中位数的1.8倍和0.5倍).进行了宫内输血，这将贫血双胞胎中的胎儿血红蛋白浓度从3.5g/dL增加到12.5g/dL。29周时,剖宫产分娩是由于大脑中动脉峰值收缩期速度的证据表明，一对双胞胎中贫血复发和双胞胎中红细胞增多症恶化；出生时血红蛋白浓度为5.6和24.9g/dL，分别。组织病理学检查证实，两个胎盘之间没有连通血管。
结论：这是第一例双胎贫血红细胞增多症，双胎双胎妊娠，在“双胎贫血红细胞增多症序列样”的情况下，宫内输血被用来延长妊娠近2周。
方法：我们描述了一例双胎双胎妊娠，怀疑双胎贫血性红细胞增多症。一名31岁的白人女性,在她第三次怀孕的时候,在妊娠12周时进行了常规超声扫描，这表明双胎双胎妊娠，一个胎盘位于子宫前壁，另一个位于子宫后壁。在21周，扫描显示，两个正常多普勒研究的胎儿与羊水之间的生长不一致率为24％。在27周，一对双胞胎出现贫血和其他红细胞增多症;贫血胎儿的胎儿大脑中动脉峰值收缩期速度较高,而红细胞增多症双胞胎的胎儿则较低(中位数的1.8倍和0.5倍).进行了宫内输血，这将贫血双胞胎中的胎儿血红蛋白浓度从3.5g/dL增加到12.5g/dL。29周时,剖宫产分娩是由于大脑中动脉峰值收缩期速度的证据表明，一对双胞胎中贫血复发和双胞胎中红细胞增多症恶化；出生时血红蛋白浓度为5.6和24.9g/dL，分别。组织病理学检查证实，两个胎盘之间没有连通血管。
结论：这是第一例双胎贫血红细胞增多症，双胎双胎妊娠，在“双胎贫血红细胞增多症序列样”的情况下，宫内输血被用来延长妊娠近2周。
