A rare dichorionic triamniotic triplet pregnancy with spontaneous twin anemia-polycythemia sequence between two dichorionic fetuses

Fetal Diagnosis and Therapy

Jørgensen D.S. · Nørgaard L.N. · Ekelund C.K. · Jensen L.N. · Sundberg K.M.

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Article / Publication Details Abstract

Introduction This report presents a rare case of spontaneous twin anemia-polycythemia sequence (TAPS) between two dichorionic fetuses in a spontaneous, homozygotic, dichorionic, triamniotic, triplet pregnancy treated with multiple intrauterine blood transfusions and partial exchange transfusions. Case presentation The pregnancy was diagnosed with stage IV TAPS at gestational week 25+1. The patient was treated with laser surgery combined with multiple intrauterine blood transfusions and partial exchange transfusions. The triplets were delivered at a planned caesarean section at gestational week 28+1 with postnatal hemoglobin values of 18.21, 26.43 and 11.92 g/dl in triplet 1, 2 and 3, respectively. At four years of age triplet 1 is considered healthy, triplet 2 is diagnosed with mild mental retardation, and triplet 3 with profound mental retardation and dystonic cerebral palsy. Discussion/conclusion This is an extremely rare case of TAPS between dichorionic fetuses in a triplet pregnancy and routine surveillance with measurement of MCA-PSV in dichorionic pregnancies may contribute to the detection of similar cases in the future. Furthermore, this case contributes with rare long-term follow-up data of children treated for high stage TAPS with multiple IUTs and PETs.

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