Performance of Antenatal Diagnostic Criteria of Twin-Anemia-Polycythemia Sequence

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2020
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Abstract
This study aims to elicit the validation performance of different diagnostic criteria and to evaluate the disease course and perinatal outcomes of pregnancies complicated by twin anemia polycythemia sequence (TAPS). Monochorionic diamniotic (MCDA) twin pregnancies who received serial middle cerebral artery (MCA) peak systolic velocity (PSV) measurements without non-TAPS-related demise or major anomalies were included. Course of disease, antenatal intervention, additional ultrasound features, and perinatal outcomes were compared between each criteria and onset. Forty-nine cases of TAPS and 203 non-TAPS controls were identified. The incidence of TAPS was 19.2%, 15.7%, 7.8%, and 6.3% for ΔPSV MoM > 0.373, ΔPSV MoM > 0.5, traditional, and Delphi consensus criteria, respectively (p < 0.001). The incidence of antenatal intervention was 55.1, 62.5, 75.0, and 87.5%, respectively. Furthermore, cases detected according to the Delphi consensus criteria had a higher rate of progression or intervention compared to cases detected with ΔPSV MoM > 0.373 (87.0 vs. 59.0%, p = 0.037). TAPS had a significantly higher birth weight discordance than uncomplicated MCDA twins (25.3 vs. 7.3%, p < 0.001). Application of four different diagnostic criteria for TAPS leads to significant differences in the incidence, severity, and antenatal intervention. The Delphi criteria identified more severe cases likely to require intervention, and the delta PSV > 0.373 criteria identified milder cases, without a significant impact on neonatal outcomes.
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Authors Becky Liu;Erkan Kalafat;Amar Bhide;Basky Thilaganathan;Asma Khalil;Liu, Becky;Kalafat, Erkan;Bhide, Amar;Thilaganathan, Basky;Khalil, Asma;
Journal journal of clinical medicine
Year 2020
DOI
10.3390/jcm9092754
URL
https://www.mdpi.com/2077-0383/9/9/2754/htm
Keywords
disease progression diagnostic criteria perinatal outcomes twin anemia polycythemia sequence antenatal intervention disease progression diagnostic criteria perinatal outcomes twin anemia polycythemia sequence antenatal intervention National Center for Biotechnology Information NCBI NLM MEDLINE pubmed abstract nih national institutes of health national library of medicine pmid:32858863 pmc7563169 doi:10.3390/jcm9092754 becky liu erkan kalafat asma khalil

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