Twin Anemia-Polycythemia Sequence (TAPS) is a serious complication that can occur in pregnancies involving monochorionic twins, that is, identical twins sharing a single placenta. It would have you looking for the best obstetrician in Mumbai. This article discusses the causes, symptoms, and treatment of TAPS.
What is the Twin Anemia-Polycythemia Sequence
This condition occurs when tiny blood vessel connections in the placenta cause blood to flow unevenly from one twin to the other. This then makes one twin (the donor) lose blood, leading to anemia, while the other twin (the recipient) ends up with too much blood and that makes their blood thicker than usual—a condition called polycythemia.
It is important to note that TAPS differs from another condition called Twin-to-Twin Transfusion Syndrome (TTTS). While TTTS is caused by larger blood vessel connections between the twins, which often leads to fluid imbalances in the amniotic sacs, smaller connections cause TAPS.
What Causes TAPS?
The primary cause of TAPS is the uneven flow between monochorionic twins. This is due to the tiny surface connections between the placenta’s arteries and veins, which cause blood to flow continuously from one twin to the other twin. Twin Anemia-Polycythemia Sequence can also be caused by a complication after a procedure called laser surgery, which is used to treat Twin-to-Twin Transfusion Syndrome.
The blood vessels are sealed using laser ablation to balance blood flow in the twins. However, the tiny blood connections may remain or develop and lead to TAPS. It is noteworthy that sometimes TAPS spontaneously develops, which shows how unpredictable monochorionic pregnancies are.
Symptoms of Twin Anemia-Polycythemia Sequence
TAPS develops gradually, so it may not show symptoms in the mother early on. However, the anemic twin(the donor) would have pale skin and low hemoglobin levels. The polycythemic twin (recipient) Wood would have a reddish or darker complexion because of thickened blood. In some cases, the placenta on the donor twin’s side may seem thickened, and the recipient twin’s liver may show bright white spots called starry sky.
The Treatment
The treatment depends on the stage of the pregnancy.
These treatments are done during the early stage of the pregnancy. The essence is to help keep both twins stable before delivery:
- Intrauterine Transfusion: For the twin with anemia, a direct blood Transfusion is given in the umbilical vein. This now helps restore hemoglobin levels to normal.
- Partial Exchange Transfusion: This is for the recipient twin who has thick blood. The procedure remixes a portion of the blood and replaces it with a fluid solution like saline or plasma. This would reduce blood viscosity and decrease clotting risk.
- Selective Fetoscopic Laser Surgery (SFL): For advanced cases of TAPS, this procedure is used to target the abnormal blood vessel connections in the shared placenta. A fetoscope (tiny camera) is inserted into the uterus, and a laser is used to seal the problematic vessels.
- Preterm Delivery: Where TAPS occurs towards the end of the pregnancy, the doctors may deliver the babies preterm. They would require intensive care if it comes to this.
Conclusion
The Twin Anemia-Polycythemia Sequence (TAPS) shows how complex monochorionic twin pregnancies can be. However, it shows that one must be vigilant and that timely care can do much good for the babies and the mother. Experienced professionals like Dr. Neelima Mantri have the knowledge and individualized care required for parents managing high-risk pregnancies.
