TAPS and TOPS: Two Distinct Forms of Feto-fetal Transfusion in Monochorionic Twins

Abstract

Monochorionic twins share a single placenta with inter-twin vascular anastomoses, allowing the transfer of blood from one fetus to the other and vice versa. These anastomoses are the essential anatomical substrate for the development of severe complications, including twin-twin transfusion syndrome (TTTS) and twin-anemia-polycythemia sequence (TAPS). TTTS and TAPS are both chronic forms of feto-fetal transfusion. TTTS is characterized by the twin oligo-polyhydramnios sequence (TOPS), whereas TAPS is characterized by large inter-twin hemoglobin differences in the absence of amniotic fluid discordances. TAPS may occur spontaneously in a minority of monochorionic twins or in TTTS cases after laser treatment. This review focuses on the differences between TAPS and TTTS in terms of pathogenesis, incidence, diagnostic criteria, treatment modalities, perinatal outcome and long-term outcome.

Zusammenfassung

Monochoriale Zwillinge teilen sich eine Plazenta, auf deren Oberfläche Blutgefäße eine Verbindung herstellen zwischen beiden Kreißläufen. Diese Gefäßverbindungen erlauben die Transfusion von Blut vom einen Feten zum anderen. Somit ergibt sich die Möglichkeit ernsthafter Komplikationen, unter anderem das Fetofetale Transfusions Syndroom (FFTS) und die Twin-Anämie-Polyzythämie-Sequenz (TAPS). FFTS und TAPS sind beide chronische Formen der fetofetalen Tranfusion. FFTS wird gekennzeichnet durch eine Twin-Oligo-Polyhydramnion-Sequenz (TOPS), während TAPS sich manifestiert durch eine erhebliche Differenz zwischen den Hemoglobinkonzentrationen beider Kinder ohne daß die Fruchtwassermengen zich deutlich unterscheiden. TAPS kann spontan auftreten bei monochorialen Zwillingen, aber viel öfter tritt es auf nach einer Laserbehandlung wegen FFTS. Dieser Übersichtsartikel beschreibt den Unterschied zwischen FFTS und TAPS in Bezug auf Pathogenese, Inzidenz, diagnostische Kriterien, Möglichkeiten der Behandlung und unmittelbare sowie langfristige Folgen für die Kinder.

Key words

Twin to twin transfusion syndrome (TTTS) - Twin oligo-polyhydramnios sequence (TOPS) - Twin anemia-polycythemia sequence (TAPS)

Schlüsselwörter

fetofetales Transfusions Syndrom (FFTS) - Anämie-Polyzythämie-Sequenz (TAPS) - Twin-Oligo-Polyhydramnion-Sequenz (TOPS)

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