Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases

Transfusió intrauterina; Cirurgia làser; Seqüència anemia-policitemia bessona

Detalles Bibliográficos
Autores: Tollenaar, Lisanne S. A., Slaghekke, Femke, Lewi, Liesbeth, Colmant, Claire, Lanna, Mariano, Weingertner, Anne Sophie, Arévalo Martínez, Silvia
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Departament de Salut de la Generalitat de Catalunya (DS)
Repositorio:Scientia. Dipòsit d'Informació Digital del Departament de Salut
OAI Identifier:oai:scientiasalut.gencat.cat:11351/7090
Acceso en línea:https://hdl.handle.net/11351/7090
Access Level:acceso abierto
Palabra clave:Anèmia - Diagnòstic
Làsers en cirurgia
Fetus - Malalties
DISEASES::Hemic and Lymphatic Diseases::Hematologic Diseases::Anemia
DISEASES::Hemic and Lymphatic Diseases::Hematologic Diseases::Anemia::Anemia, Neonatal::Fetofetal Transfusion
Other subheadings::Other subheadings::/diagnosis
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Laser Therapy
ENFERMEDADES::enfermedades hematológicas y linfáticas::enfermedades hematológicas::anemia
ENFERMEDADES::enfermedades hematológicas y linfáticas::enfermedades hematológicas::anemia::anemia neonatal::transfusión fetofetal
Otros calificadores::Otros calificadores::/diagnóstico
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::tratamiento con láser
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network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases
title Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases
spellingShingle Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases
Tollenaar, Lisanne S. A.
Anèmia - Diagnòstic
Làsers en cirurgia
Fetus - Malalties
DISEASES::Hemic and Lymphatic Diseases::Hematologic Diseases::Anemia
DISEASES::Hemic and Lymphatic Diseases::Hematologic Diseases::Anemia::Anemia, Neonatal::Fetofetal Transfusion
Other subheadings::Other subheadings::/diagnosis
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Laser Therapy
ENFERMEDADES::enfermedades hematológicas y linfáticas::enfermedades hematológicas::anemia
ENFERMEDADES::enfermedades hematológicas y linfáticas::enfermedades hematológicas::anemia::anemia neonatal::transfusión fetofetal
Otros calificadores::Otros calificadores::/diagnóstico
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::tratamiento con láser
title_short Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases
title_full Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases
title_fullStr Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases
title_full_unstemmed Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases
title_sort Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases
dc.creator.none.fl_str_mv Tollenaar, Lisanne S. A.
Slaghekke, Femke
Lewi, Liesbeth
Colmant, Claire
Lanna, Mariano
Weingertner, Anne Sophie
Arévalo Martínez, Silvia
author Tollenaar, Lisanne S. A.
author_facet Tollenaar, Lisanne S. A.
Slaghekke, Femke
Lewi, Liesbeth
Colmant, Claire
Lanna, Mariano
Weingertner, Anne Sophie
Arévalo Martínez, Silvia
author_role author
author2 Slaghekke, Femke
Lewi, Liesbeth
Colmant, Claire
Lanna, Mariano
Weingertner, Anne Sophie
Arévalo Martínez, Silvia
author2_role author
author
author
author
author
author
dc.contributor.none.fl_str_mv Institut Català de la Salut
[Tollenaar LSA, Slaghekke F] Division of Fetal Therapy, Department of Obstetrics. [Lewi L] Leiden University Medical Center, Leiden, the Netherlands. Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium. [Colmant C] Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP, Paris, France. [Lanna M] Fetal Therapy Unit “U. Nicolini,” Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy. [Weingertner AS] Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg Cedex, France. [Arévalo S] Unitat de Medicina Maternal-Fetal, Servei d’Obstetrícia, Vall d’Hebron Hospital Universitari, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
dc.subject.none.fl_str_mv Anèmia - Diagnòstic
Làsers en cirurgia
Fetus - Malalties
DISEASES::Hemic and Lymphatic Diseases::Hematologic Diseases::Anemia
DISEASES::Hemic and Lymphatic Diseases::Hematologic Diseases::Anemia::Anemia, Neonatal::Fetofetal Transfusion
Other subheadings::Other subheadings::/diagnosis
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Laser Therapy
ENFERMEDADES::enfermedades hematológicas y linfáticas::enfermedades hematológicas::anemia
ENFERMEDADES::enfermedades hematológicas y linfáticas::enfermedades hematológicas::anemia::anemia neonatal::transfusión fetofetal
Otros calificadores::Otros calificadores::/diagnóstico
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::tratamiento con láser
topic Anèmia - Diagnòstic
Làsers en cirurgia
Fetus - Malalties
DISEASES::Hemic and Lymphatic Diseases::Hematologic Diseases::Anemia
DISEASES::Hemic and Lymphatic Diseases::Hematologic Diseases::Anemia::Anemia, Neonatal::Fetofetal Transfusion
Other subheadings::Other subheadings::/diagnosis
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Laser Therapy
ENFERMEDADES::enfermedades hematológicas y linfáticas::enfermedades hematológicas::anemia
ENFERMEDADES::enfermedades hematológicas y linfáticas::enfermedades hematológicas::anemia::anemia neonatal::transfusión fetofetal
Otros calificadores::Otros calificadores::/diagnóstico
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::tratamiento con láser
description Transfusió intrauterina; Cirurgia làser; Seqüència anemia-policitemia bessona
publishDate 2021
dc.date.none.fl_str_mv 2021
2022
2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11351/7090
url https://hdl.handle.net/11351/7090
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv American Journal of Obstetrics and Gynecology;224(2)
https://doi.org/10.1016/j.ajog.2020.07.041
dc.rights.none.fl_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv Scientia
reponame:Scientia. Dipòsit d'Informació Digital del Departament de Salut
instname:Departament de Salut de la Generalitat de Catalunya (DS)
instname_str Departament de Salut de la Generalitat de Catalunya (DS)
reponame_str Scientia. Dipòsit d'Informació Digital del Departament de Salut
collection Scientia. Dipòsit d'Informació Digital del Departament de Salut
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869407993714442240
spelling Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 casesTollenaar, Lisanne S. A.Slaghekke, FemkeLewi, LiesbethColmant, ClaireLanna, MarianoWeingertner, Anne SophieArévalo Martínez, SilviaAnèmia - DiagnòsticLàsers en cirurgiaFetus - MalaltiesDISEASES::Hemic and Lymphatic Diseases::Hematologic Diseases::AnemiaDISEASES::Hemic and Lymphatic Diseases::Hematologic Diseases::Anemia::Anemia, Neonatal::Fetofetal TransfusionOther subheadings::Other subheadings::/diagnosisANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Laser TherapyENFERMEDADES::enfermedades hematológicas y linfáticas::enfermedades hematológicas::anemiaENFERMEDADES::enfermedades hematológicas y linfáticas::enfermedades hematológicas::anemia::anemia neonatal::transfusión fetofetalOtros calificadores::Otros calificadores::/diagnósticoTÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::tratamiento con láserTransfusió intrauterina; Cirurgia làser; Seqüència anemia-policitemia bessonaIntrauterine transfusion; Laser surgery; Twin anemia polycythemia sequenceTransfusión intrauterina; Cirugía láser; Secuencia anemia-policitemia gemelarBackground Twin anemia polycythemia sequence is a chronic form of unbalanced fetofetal transfusion through minuscule placental anastomoses in monochorionic twins, leading to anemia in the donor and polycythemia in the recipient. Owing to the low incidence of twin anemia polycythemia sequence, data on diagnosis, management, and outcome are limited. Objective This study aimed to investigate the diagnosis, management, and outcome in a large international cohort of spontaneous twin anemia polycythemia sequence. Study Design Data from the international twin anemia polycythemia sequence registry, retrospectively collected between 2014 and 2019, were used for this study. A total of 17 fetal therapy centers contributed to the data collection. The primary outcomes were perinatal mortality and severe neonatal morbidity. Secondary outcomes included a risk factor analysis for perinatal mortality and severe neonatal morbidity. Results A total of 249 cases of spontaneous twin anemia polycythemia sequence were included in this study, 219 (88%) of which were diagnosed antenatally and 30 (12%) postnatally. Twin anemia polycythemia sequence was diagnosed antenatally at a median gestational age of 23.7 weeks (interquartile range, 9.7–28.8; range, 15.1–35.3). Antenatal management included laser surgery in 39% (86 of 219), expectant management in 23% (51 of 219), delivery in 16% (34 of 219), intrauterine transfusion (with partial exchange transfusion) in 12% (26 of 219), selective feticide in 8% (18 of 219), and termination of pregnancy in 1% (3 of 219) of cases. Perinatal mortality rate was 15% (72 of 493) for the total group, 22% (54 of 243) for donors, and 7% (18 of 242) for recipients ( P <.001). Severe neonatal morbidity occurred in 33% (141 of 432) of twins with twin anemia polycythemia sequence and was similar for donors (32%; 63 of 196) and recipients (33%; 75 of 228) ( P =.628). Independent risk factors for spontaneous perinatal mortality were donor status (odds ratio, 3.8; 95% confidence interval, 1.9–7.5; P <.001), antenatal twin anemia polycythemia sequence stage (odds ratio, 6.3; 95% confidence interval, 1.4–27.8; P =.016 [stage 2]; odds ratio, 9.6; 95% confidence interval, 2.1–45.5; P =.005 [stage 3]; odds ratio, 20.9; 95% confidence interval, 3.0–146.4; P =.002 [stage 4]), and gestational age at birth (odds ratio, 0.8; 95% confidence interval, 0.7–0.9; P =.001). Independent risk factors for severe neonatal morbidity were antenatal twin anemia polycythemia sequence stage 4 (odds ratio, 7.9; 95% confidence interval, 1.4–43.3; P =.018) and gestational age at birth (odds ratio, 1.7; 95% confidence interval, 1.5–2.1, P <.001). Conclusion Spontaneous twin anemia polycythemia sequence can develop at any time in pregnancy from the beginning of the second trimester to the end of the third trimester. Management for twin anemia polycythemia sequence varies considerably, with laser surgery being the most frequent intervention. Perinatal mortality and severe neonatal morbidity were high, the former especially so in the donor twins.ElsevierInstitut Català de la Salut[Tollenaar LSA, Slaghekke F] Division of Fetal Therapy, Department of Obstetrics. [Lewi L] Leiden University Medical Center, Leiden, the Netherlands. Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium. [Colmant C] Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP, Paris, France. [Lanna M] Fetal Therapy Unit “U. Nicolini,” Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy. [Weingertner AS] Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg Cedex, France. [Arévalo S] Unitat de Medicina Maternal-Fetal, Servei d’Obstetrícia, Vall d’Hebron Hospital Universitari, Barcelona, SpainVall d'Hebron Barcelona Hospital Campus202220222021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/11351/7090Scientiareponame:Scientia. Dipòsit d'Informació Digital del Departament de Salutinstname:Departament de Salut de la Generalitat de Catalunya (DS)InglésAmerican Journal of Obstetrics and Gynecology;224(2)https://doi.org/10.1016/j.ajog.2020.07.041Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:scientiasalut.gencat.cat:11351/70902026-06-12T09:38:37Z
score 15,811543

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