{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:38:26Z","timestamp":1791437906447,"version":"4.3.3"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T00:00:00Z","timestamp":1598918400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/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":[[2020,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the antenatal management and outcome in a large international cohort of monochorionic twin pregnancies with spontaneous or post\u2010laser twin anemia\u2013polycythemia sequence (TAPS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study analyzed data of monochorionic twin pregnancies diagnosed antenatally with spontaneous or post\u2010laser TAPS in 17 fetal therapy centers, recorded in the TAPS Registry between 2014 and 2019. Antenatal diagnosis of TAPS was based on fetal middle cerebral artery peak systolic velocity &gt;\u20091.5 multiples of the median (MoM) in the TAPS donor and &lt;\u20091.0\u2009MoM in the TAPS recipient. The following antenatal management groups were defined: expectant management, delivery within 7\u2009days after diagnosis, intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)), laser surgery and selective feticide. Cases were assigned to the management groups based on the first treatment that was received after diagnosis of TAPS. The primary outcomes were perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis\u2010to\u2010birth interval.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 370 monochorionic twin pregnancies were diagnosed antenatally with TAPS during the study period and included in the study. Of these, 31% (<jats:italic>n<\/jats:italic>\u2009=\u2009113) were managed expectantly, 30% (<jats:italic>n<\/jats:italic>\u2009=\u2009110) with laser surgery, 19% (<jats:italic>n<\/jats:italic>\u2009=\u200970) with IUT (\u00b1\u2009PET), 12% (<jats:italic>n<\/jats:italic>\u2009=\u200943) with delivery, 8% (<jats:italic>n<\/jats:italic>\u2009=\u200930) with selective feticide and 1% (<jats:italic>n<\/jats:italic>\u2009=\u20094) underwent termination of pregnancy. Perinatal mortality occurred in 17% (39\/225) of pregnancies in the expectant\u2010management group, 18% (38\/215) in the laser group, 18% (25\/140) in the IUT (\u00b1\u2009PET) group, 10% (9\/86) in the delivery group and in 7% (2\/30) of the cotwins in the selective\u2010feticide group. The incidence of severe neonatal morbidity was 49% (41\/84) in the delivery group, 46% (56\/122) in the IUT (\u00b1\u2009PET) group, 31% (60\/193) in the expectant\u2010management group, 31% (57\/182) in the laser\u2010surgery group and 25% (7\/28) in the selective\u2010feticide group. Median diagnosis\u2010to\u2010birth interval was longest after selective feticide (10.5\u2009(interquartile range (IQR), 4.2\u201314.9)\u2009weeks), followed by laser surgery (9.7 (IQR, 6.6\u201312.7)\u2009weeks), expectant management (7.8 (IQR, 3.8\u201314.4)\u2009weeks), IUT (\u00b1\u2009PET) (4.0 (IQR, 2.0\u20136.9)\u2009weeks) and delivery (0.3 (IQR, 0.0\u20130.5)\u2009weeks). Treatment choice for TAPS varied greatly within and between the 17 fetal therapy centers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Antenatal treatment for TAPS differs considerably amongst fetal therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolongation of pregnancy was best achieved by expectant management, treatment by laser surgery or selective feticide. \u00a9 2020 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.22042","type":"journal-article","created":{"date-parts":[[2020,4,15]],"date-time":"2020-04-15T05:56:17Z","timestamp":1586930177000},"page":"378-387","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Treatment and outcome of 370 cases with spontaneous or post\u2010laser twin anemia\u2013polycythemia sequence managed in 17 fetal therapy centers"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2078-2295","authenticated-orcid":false,"given":"L. S. A.","family":"Tollenaar","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Division of Fetal therapy Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Slaghekke","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal therapy Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9884-5778","authenticated-orcid":false,"given":"L.","family":"Lewi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5675-267X","authenticated-orcid":false,"given":"Y.","family":"Ville","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Maternal\u2010Fetal Medicine H\u00f4pital Necker\u2010Enfants Malades, AP\u2010HP  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Lanna","sequence":"additional","affiliation":[{"name":"Fetal Therapy Unit \u2018U. Nicolini\u2019, Vittore Buzzi Children's Hospital University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Weingertner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Strasbourg University Hospital  Strasbourg Cedex France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Ontario Fetal Centre, Mount Sinai Hospital University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Ar\u00e9valo","sequence":"additional","affiliation":[{"name":"Maternal Fetal Medicine Unit, Department of Obstetrics Vall d'Hebron University Hospital  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":false,"given":"A.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"},{"name":"Vascular Biology Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8752-5920","authenticated-orcid":false,"given":"C. O.","family":"Brock","sequence":"additional","affiliation":[{"name":"The Fetal Center, Department of Obstetrics, Children's Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UT Health, McGovern Medical School University of Texas  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7359-4853","authenticated-orcid":false,"given":"P.","family":"Klaritsch","sequence":"additional","affiliation":[{"name":"Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology Medical University of Graz, Graz  Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Hecher","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Gardener","sequence":"additional","affiliation":[{"name":"Department of Maternal Fetal Medicine Mater Mothers' Hospital  South Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Bevilacqua","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital Brugmann Universit\u00e9 Libre de Bruxelles  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. V.","family":"Kostyukov","sequence":"additional","affiliation":[{"name":"Acad. V. I. Kulakov Research Center of Obstetrics Gynecology, and Perinatology, Ministry of Health of the Russian Federation  Moscow Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5813-8067","authenticated-orcid":false,"given":"M.\u2009O.","family":"Bahtiyar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences Yale School of Medicine  New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.\u2009D.","family":"Kilby","sequence":"additional","affiliation":[{"name":"Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Tiblad","sequence":"additional","affiliation":[{"name":"Center for Fetal Medicine Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Oepkes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal therapy Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Lopriore","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2006.01.010"},{"issue":"514","key":"e_1_2_7_3_1","first-page":"e1","article-title":"The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study","volume":"199","author":"Lewi L","year":"2008","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62419-8"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.08.069"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1017\/thg.2016.18"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20846"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13387"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12337"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14925"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.07.041"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9061759"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000304512"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2453"},{"key":"e_1_2_7_15_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_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197801000-00001"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1984.01040030908011"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-5108(18)30638-9"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.56.12.900"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0166-4328(05)80189-5"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13382"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2018.04.005"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1159\/000380822"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032597"},{"key":"e_1_2_7_25_1","article-title":"Spontaneous twin anemia polycythemia sequence: management and outcome in a large international cohort of 249 cases","author":"LSA Tollenaar","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_7_26_1","unstructured":"The TAPSTrial: Fetoscopic laser surgery for twin anemia polycythemia sequence\u00a0\u2013\u00a0a multicenter open\u2010label randomized controlled trial.ClinicalTrials.gov NCT04432168."}],"container-title":["Ultrasound in Obstetrics &amp; 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