April 5th, 2020

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Twin Anemia Polycythemia Sequence: A Report of Three Cases
Authors:  Joao Casanova, M.D., Catarina Paiva, M.D., Carmen Carvalho, M.D., and Ana C. Cunha, M.D.
BACKGROUND: Vascular anastomoses in monochorionic placentas are the key factor in the development of several complications, including twin anemiapolycythemia sequence (TAPS). TAPS is an uncommon form of chronic fetofetal transfusion, characterized by large intertwin hemoglobin (Hb) differences in the absence of amniotic fluid discordances.

CASE: We report 3 unusual cases of spontaneous TAPS. Looking to the intertwin Hb differences, each case fits in a different stage of postnatal twin anemia-polycythemia classification. Five of the 6 twins had a good outcome despite major hemodynamic changes.

CONCLUSION: Spontaneous TAPS is by far more infrequent than its postlaser counterpart. Our report is somewhat uncommon due to the fact that the 3 cases were spontaneous, consecutive, and each one fit as an example of the various degrees of severity according to the described classifications of this condition.
Keywords:  arteriovenous anastomoses, fetal transfusion syndrome, fetofetal transfusion, fetomaternal transfusion, polycythemia, spontaneous twin anemia-polycythemia sequence, twin pregnancy, twin transfusion, twin-to-twin transfusion syndrome, vascular anastomoses
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