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Ultrasound/Imaging

Poster Session 4

(1060) Postnatal Incidence and Prenatal Detection of Twin Anemia Polycythemia Sequence (TAPS) among Monochorionic Twin Gestations

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Felicia V. LeMoine, MD

The MetroHealth System/ Case Western University Program
Cleveland, OH, United States

Coauthor(s)

AD

Alana Diedrick, N/A

Purdue University
Lafayette, IN, United States
AR

Angela Ranzini, MD

MetroHealth Medical Center, Case Western Reserve University
Cleveland, OH, United States

Objective: International screening recommendations for TAPS varyand are infrequently assessed by postnatal diagnostic criteria. Our study aims investigate the accuracy of prenatal sonography in the prediction of postnatal TAPS (pnTAPS) and serious neonatal morbidity in uncomplicated monochorionic, diamniotic (MCDA) twin gestations.

Study Design: A retrospective cohort study was performed via EMR query of single, tertiary center. PnTAPS was defined as neonatal intertwin hemoglobin discordance ≥8g/dL within 24 hours of delivery and placental vascular anastomoses (≤1mm). Serious neonatal morbidity included respiratory distress, culture-proven sepsis, intraventricular hemorrhage (grade III/IV), necrotizing enterocolitis (Stage II/III), periventricular leukomalacia (III/IV) or neonatal death. Outcomes were compared using Student’s t-test and Fisher’s exact/Chi-square test where appropriate. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were used to compared diagnostic accuracy of prenatal sonographic criteria.

Results: 73 MCDA pregnancies were identified; 65 met eligibility criteria. Postnatal diagnostic criteria were available in 39/65 (60%). Two (5.1%) were diagnosed with postnatal TAPS; neither were diagnosed prenatally. Those with postnatal diagnostic criteria available delivered at an earlier gestational age (33.9 [30,25] weeks versus 36.3 [36,37] weeks, p< 0.05) and experienced higher rates of serious neonatal morbidity (49.4% versus 1.9%, p< 0.05). There were no differences in maternal, obstetric, or neonatal variables. There was no difference in serious neonatal morbidity between those with and without pnTAPS. Table 1 demonstrates sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of prenatal diagnostic criteria.

Conclusion: Of those with postnatal testing, the prevalence of pnTAPS is 5.1% of MCDA twin gestations. However, both the prevalence of pnTAPS and assessment of prenatal diagnostic accuracy are limited by inconsistent neonatal blood sampling. Prenatal screening criteria were poor predictors of pnTAPS.