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In this thesis we describe that Twin Anemia Polycythemia Sequence (TAPS) is a form of chronic feto-fetal transfusion in monochorionic (identical) twins based on a small amount of blood transfusion through very small anastomoses. For the antenatal diagnosis of TAPS, Middle Cerebral Artery – Peak Systolic Velocity (MCA-PSV) Doppler measurements appear to be an accurate predictor for anemia and polycythemia. If antenatally detected, fetoscopic laser therapy might improve pregnancy outcome by treating the cause, and thereby prolonging the pregnancy. Another very important finding for the prevention of post-laser TAPS is that by using the Solomon technique for the treatment of Twin-Twin Transfusion Syndrome (TTTS) the incidence of post-laser TAPS is reduced. If laser is not feasible and intra uterine transfusion (IUT) is the preferred treatment option, we suggest adding partial exchange transfusion (PET) to prevent severe polycythemia and possible complications as limb necrosis and severe cerebral injury. Long-term neurodevelopmental outcome in post-laser TAPS is 9% and seems comparable with long-term outcome after treated TTTS. In conclusion, with this thesis we increased our knowledge on the pathophysiology, the diagnostic tools, management options, short and long-term outcome of TAPS.

Twin Anemia Polycythemia Sequence: Knowledge and Insights After 15 Years of Research