How to treat TAPS

The optimal management in TAPS is not clear, and includes expectant management1, induction of labor, intrauterine blood transfusion (intravenous and/or intraperitoneal, with or without partial exchange transfusion)2-4, selective feticide or fetoscopic laser surgery5-7.

Fetoscopic laser surgery is the only causative treatment for this disease (in analogy with TTTS) but is technically challenging due to the absence of polyhydramnios and the presence of only minuscule anastomoses.

A recent study on TAPS management showed that fetoscopic laser surgery is more likely to prolong the pregnancy and may improve survival and neonatal outcome, compared to treatment with intrauterine transfusion or expectant management. Whether is is a true benefit from laser treatment cannot firmly be concluded from this study.7

More research, either through randomized multicenter trials (ideally) or international cooperation between fetal centers using a web-based TAPS registry is needed to increase awareness, gather information on the short- and long-term morbidity in TAPS cases and evaluate the best treatment for TAPS.

Reference List

(1) Lopriore E, Hecher K, Vandenbussche FP, van den Wijngaard JP, Klumper FJ, Oepkes D. Fetoscopic laser treatment of twin-to-twin transfusion syndrome followed by severe twin anemia-polycythemia sequence with spontaneous resolution. Am J Obstet Gynecol 2008; 198(2):e4-e7.

(2) Herway C, Johnson A, Moise K, Moise KJ, Jr. Fetal intraperitoneal transfusion for iatrogenic twin anemia-polycythemia sequence after laser therapy. Ultrasound Obstet Gynecol 2009; 33(5):592-594.

(3) Lopriore E, van den Wijngaard JP, Middeldorp JM, Oepkes D, Walther FJ, van Gemert MJ et al. Assessment of feto-fetal transfusion flow through placental arterio-venous anastomoses in a unique case of twin-to-twin transfusion syndrome. Placenta 2007; 28(2-3):209-211.

>(4) Genova L, Slaghekke F, Klumper FJ, Middeldorp JM, Steggerda SJ, Oepkes D et al. Management of twin anemia-polycythemia sequence using intrauterine blood transfusion for the donor and partial exchange transfusion for the recipient. Fetal Diagn Ther 2013; 34(2):121-126.

(5) Slaghekke F, Kist WJ, Oepkes D, Pasman SA, Middeldorp JM, Klumper FJ et al. Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome. Fetal Diagn Ther 2010; 27(4):181-190.

(6) Weingertner AS, Kohler A, Kohler M, Bouffet N, Hunsinger MC, Mager C et al. Clinical and placental characteristics in four new cases of twin anemia-polycythemia sequence. Ultrasound Obstet Gynecol 2010; 35(4):490-494.

(7) Slaghekke F, Favre R, Peeters SHP, Middeldorp JM, Weingertner AS, Van Zwet EW et al. Laser surgery as a management option for Twin Anemia Polycythemia Sequence. Ultrasound Obstet Gynecol 2014.