Abstract：
Antenatal management of monochorionic pregnancies complicated by twin anemia polycythemia sequence (TAPS) remains sub-optimally defined. Our objective was to evaluate the safety and efficacy of fetoscopic selective laser photocoagulation with respect to fetal and neonatal survival.
A case series is reported with patients referred to the Texas Children\'s Fetal Center for evaluation and management of suspected spontaneous TAPS without concomitant twin-to-twin syndrome from 2014 to 2023. All evaluations were performed by our team and patients with stage II-IV TAPS were offered expectant management, intrauterine transfusion, or laser therapy. Cases of post-laser TAPS were excluded from this study. Pregnancy and neonatal outcomes were obtained from electronic medical records.
During a 10-year time period, 18 patients presented to our center for the management of TAPS. Thirteen patients had stage II-IV TAPS (13/18, 72%) and elected to proceed with laser photocoagulation. All procedures were completed, and \"solomonization\" was performed for 12/13. Normalization of middle cerebral artery Dopplers in both fetuses was noted after all cases. There was one intrauterine fetal death of the 26 viable fetuses after laser treatment, which was complicated by selective growth restriction. Most patients (12/13) were delivered by Cesarean section at a mean gestational age of 29 ± 3 weeks. Subsequently, there was one ex-donor neonatal death in an infant who had prenatal hydrops. Overall, 30-day postnatal survival was 24/26 fetuses (92.3%).
In the setting of spontaneous TAPS, laser therapy is feasible and appears to be an effective approach with overall favorable perinatal outcomes.
A case series is reported with patients referred to the Texas Children\'s Fetal Center for evaluation and management of suspected spontaneous TAPS without concomitant twin-to-twin syndrome from 2014 to 2023. All evaluations were performed by our team and patients with stage II-IV TAPS were offered expectant management, intrauterine transfusion, or laser therapy. Cases of post-laser TAPS were excluded from this study. Pregnancy and neonatal outcomes were obtained from electronic medical records.
During a 10-year time period, 18 patients presented to our center for the management of TAPS. Thirteen patients had stage II-IV TAPS (13/18, 72%) and elected to proceed with laser photocoagulation. All procedures were completed, and \"solomonization\" was performed for 12/13. Normalization of middle cerebral artery Dopplers in both fetuses was noted after all cases. There was one intrauterine fetal death of the 26 viable fetuses after laser treatment, which was complicated by selective growth restriction. Most patients (12/13) were delivered by Cesarean section at a mean gestational age of 29 ± 3 weeks. Subsequently, there was one ex-donor neonatal death in an infant who had prenatal hydrops. Overall, 30-day postnatal survival was 24/26 fetuses (92.3%).
In the setting of spontaneous TAPS, laser therapy is feasible and appears to be an effective approach with overall favorable perinatal outcomes.
摘要：
目的：单绒毛膜妊娠并发双胎性贫血红细胞增多症（TAPS）的产前管理仍未达到最佳定义。我们的目的是评估胎儿镜选择性激光光凝术对胎儿和新生儿存活的安全性和有效性。
方法：报告了一个病例系列，患者转诊至德克萨斯州儿童胎儿中心，以评估和处理2014年至2023年疑似自发性TAPS，但没有合并双胎对双胎综合征。所有评估均由我们的团队进行，并为II-IV期TAPS患者提供预期管理，宫内输血,或激光治疗。本研究排除了激光后TAPS的病例。从电子病历中获得妊娠和新生儿结局。
结果：在10年的时间内，向我们的TAPS管理中心介绍了18例患者。13例患者患有II-IV期TAPS（13/18，72％），并选择进行激光光凝。所有的程序都完成了,12/13进行了“solomization”。在所有病例之后，注意到两个胎儿的大脑中动脉多普勒正常。激光治疗后26例存活胎儿有1例胎儿宫内死亡,由于选择性生长限制而变得复杂。大多数患者（12/13）通过剖宫产分娩，平均胎龄为29±3周。随后，有1名前供者新生儿死亡的婴儿有产前水肿.总的来说,产后30天生存率为24/26个胎儿（92.3％）。
结论：在自发TAPS的设置中，激光治疗是可行的,并且似乎是一种有效的方法,具有良好的围产期结局.
方法：报告了一个病例系列，患者转诊至德克萨斯州儿童胎儿中心，以评估和处理2014年至2023年疑似自发性TAPS，但没有合并双胎对双胎综合征。所有评估均由我们的团队进行，并为II-IV期TAPS患者提供预期管理，宫内输血,或激光治疗。本研究排除了激光后TAPS的病例。从电子病历中获得妊娠和新生儿结局。
结果：在10年的时间内，向我们的TAPS管理中心介绍了18例患者。13例患者患有II-IV期TAPS（13/18，72％），并选择进行激光光凝。所有的程序都完成了,12/13进行了“solomization”。在所有病例之后，注意到两个胎儿的大脑中动脉多普勒正常。激光治疗后26例存活胎儿有1例胎儿宫内死亡,由于选择性生长限制而变得复杂。大多数患者（12/13）通过剖宫产分娩，平均胎龄为29±3周。随后，有1名前供者新生儿死亡的婴儿有产前水肿.总的来说,产后30天生存率为24/26个胎儿（92.3％）。
结论：在自发TAPS的设置中，激光治疗是可行的,并且似乎是一种有效的方法,具有良好的围产期结局.
