{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T05:02:42Z","timestamp":1787374962191,"version":"build-2736575974"},"reference-count":14,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T00:00:00Z","timestamp":1557100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the diagnostic accuracy of delta middle cerebral artery peak systolic velocity (MCA\u2010PSV) &gt;\u20090.5 multiples of the median (MoM) and compare its predictive value with that of the current MCA\u2010PSV cut\u2010off values of &gt;\u20091.5 MoM in the donor and &lt;\u20091.0 MoM in the recipient, for the diagnosis of twin anemia\u2013polycythemia sequence (TAPS) in monochorionic twin pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective consecutive cohort study comprising all uncomplicated monochorionic twin pregnancies and twin pregnancies with a postnatal diagnosis of TAPS managed between 2003 and 2017 in the Dutch national referral center for fetal therapy. Cases with incomplete MCA\u2010PSV  Doppler measurements 1 week prior to delivery or with incomplete hemoglobin measurements within 1\u2009day after birth were excluded. The postnatal diagnosis of TAPS was based on an intertwin hemoglobin difference &gt;\u20098 g\/dL and at least one of the following: reticulocyte count ratio &gt;\u20091.7 or presence of minuscule anastomoses on the placental surface. We compared the predictive accuracy of the current diagnostic method using MCA\u2010PSV cut\u2010off values of &gt;\u20091.5 MoM in the donor and &lt;\u20091.0 MoM in the recipient with that of a new method based on intertwin difference in MCA\u2010PSV &gt;\u20090.5 MoM for prediction of TAPS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 45 uncomplicated and 35 TAPS monochorionic twin pregnancies were analyzed. The sensitivity and specificity of the cut\u2010off MCA\u2010PSV values (donor &gt;\u20091.5 MoM, recipient &lt;\u20091.0 MoM) to predict TAPS was 46% (95% CI, 30\u201362%) and 100% (95% CI, 92\u2013100%), respectively; positive predictive value was 100% (95% CI, 81\u2013100%) and negative predictive value 70% (95% CI, 58\u201380%). Delta MCA\u2010PSV showed a sensitivity of 83% (95% CI, 67\u201392%) and a specificity of 100% (95% CI, 92\u2013100%); the positive and negative predictive values were 100% (95% CI, 88\u2013100%) and 88% (95% CI, 77\u201394%), respectively. Of the 35 cases with TAPS diagnosed postnatally, 13 twin pairs showed a delta MCA\u2010PSV &gt;\u20090.5 MoM but did not fulfill the cut\u2010off MCA\u2010PSV criteria. Of these 13 TAPS twins, nine donors and four recipients had normal MCA\u2010PSV values. There was a high correlation between delta MCA\u2010PSV and intertwin difference in hemoglobin level (<jats:italic>R<\/jats:italic> = 0.725, <jats:italic>P<\/jats:italic> &lt;\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Delta MCA\u2010PSV &gt;\u20090.5 MoM has a greater diagnostic accuracy for predicting TAPS compared to the current MCA\u2010PSV cut\u2010off criteria. We therefore propose a new antenatal classification system for TAPS. In monochorionic twin pregnancies with delta MCA\u2010PSV &gt;\u20090.5 MoM on Doppler ultrasound, but normal MCA\u2010PSV values in the donor or recipient, obstetricians should be aware of the therapeutic implications and neonatal morbidities associated with TAPS. \u00a9 2018 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20096","type":"journal-article","created":{"date-parts":[[2018,8,20]],"date-time":"2018-08-20T10:27:45Z","timestamp":1534760865000},"page":"788-793","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":106,"title":["Improved prediction of twin anemia\u2013polycythemia sequence by delta middle cerebral artery peak systolic velocity: new antenatal classification system"],"prefix":"10.1002","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2078-2295","authenticated-orcid":false,"given":"L. S. A.","family":"Tollenaar","sequence":"first","affiliation":[{"name":"Division of Fetal Medicine, Department of Obstetrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Lopriore","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. M.","family":"Middeldorp","sequence":"additional","affiliation":[{"name":"Division of Fetal Medicine, Department of Obstetrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0443-1997","authenticated-orcid":false,"given":"M. C.","family":"Haak","sequence":"additional","affiliation":[{"name":"Division of Fetal Medicine, Department of Obstetrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. J.","family":"Klumper","sequence":"additional","affiliation":[{"name":"Division of Fetal Medicine, Department of Obstetrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Oepkes","sequence":"additional","affiliation":[{"name":"Division of Fetal Medicine, Department of Obstetrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Slaghekke","sequence":"additional","affiliation":[{"name":"Division of Fetal Medicine, Department of Obstetrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,5,6]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2006.01.010"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2491"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.07.046"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.08.069"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.05.012"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14925"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000304512"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15838"},{"key":"e_1_2_5_10_1","first-page":"e3208","article-title":"Accurate and simple evaluation of vascular anastomoses in monochorionic placentas using colored dye","volume":"55","author":"Lopriore E","year":"2011","journal-title":"J Vis Exp"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200001063420102"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.6436"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1927.10502953"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1017\/thg.2016.18"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2453"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.20096","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.20096","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.20096","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.20096","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T03:57:20Z","timestamp":1692503840000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.20096"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,6]]},"references-count":14,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.1002\/uog.20096"],"URL":"https:\/\/doi.org\/10.1002\/uog.20096","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,6]]},"assertion":[{"value":"2018-05-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}