There are 2 forms of TAPS: Post-laser TAPS happens after incomplete laser surgery for TTTS. The placenta should also be flipped over to check for a color difference between the 2 sections – because this is not present in acute TTTS. TAPS is diagnosed after birth using detailed blood tests involving hemoglobin levels and looking at the placenta for those tiny connections (via dye injection). There are other signs on ultrasound, like a starry sky liver for recipients, and cardiomegaly (enlarged heart) or echogenic (bright) placenta for donors. TAPS is diagnosed via doppler readings on the Mid-Cerebral Artery (MCA) before birth. There are no physical signs for the parent for TAPS, unlike TTTS. This is a long, slow transfer of blood at the rate of around 5-15ml per day. Red blood cells flow from donor to recipient, causing chronic anemia in one twin, and polycythemia in the other twin. These connections are less than 1 millimeter thick. It’s caused by tiny, artery-to vein (AV) connections in the placenta. Twin Anemia Polycythemia Sequence, or TAPS, is a rare disease affecting monochorionic twins (twins who share a placenta). This might also help you understand how they’re separate diseases because if they were the same disease, we wouldn’t need different diagnostic criteria, and you wouldn’t have a few different diagnoses at the same time.
Important to note: All 3 diseases are not mutually exclusive, and can happen in any combination as well. The 3 diseases are twin twin transfusion syndrome (TTTS), twin anemia polycythemia sequence (TAPS), and selective fetal growth restriction (SFGR) (also sometimes called selective intrauterine growth restriction (SIUGR) ) Diagnostic Criteria for TTTS, TAPS, and SFGR Twin Twin Transfusion This is so important, as all 3 are completely different. In order to talk about the key differences, it’s probably best to break the 3 diseases that are most commonly called “forms of TTTS” into their own distinct diseases. This paper is upheld by the TAPS community as the paper that gave our disease a name, It’s also the reason why International TAPS Day is on March 3rd! What Is The Difference Between TAPS and TTTS? The second paper, by Lopriore et al, was published on March 3rd, and it described the same thing happening spontaneously in monochorionic twins. Robyrr et al described small connections in the placenta that were either missed by the laser or incompletely sealed in the process. The first described a complication of laser surgery for TTTS, where one twin was born pale and anemic, and the other polycythemic. On March 1st, 2006, 2 papers were published within days of each other. But in the early 2000s, a new diagnosis came along, shattering the umbrella diagnosis of twin-twin transfusion syndrome. There are papers going back to mid last century describing twins born with anemia and polycythemia. But with the advances in monitoring and laser surgery, this shouldn’t be happening, right? But in 2006, the mystery was solved. When babies were born different colors, it was just assumed that it was acute TTTS. But there were always puzzling cases where it didn’t fit TTTS criteria. Size discordance? Different colors? All TTTS. Everything that could go wrong with twins sharing a placenta was labeled twin-twin transfusion syndrome (TTTS). In 1999, the most widely accepted staging system for TTTS was introduced as well, meaning that diagnosis was easier. Illustration by Gautier Scientific Illustration and used with permission from the artist and the LUMC Fetal Therapy Team. The technology was developed further and, and in 1988 it helped guide the first fetoscopic laser surgery.įetoscopic laser surgery for TTTS. The arrival of ultrasound technology opened many doors, and in the mid-1980s pregnancy ultrasound was almost routine. We learned that the way cords were inserted into the placenta, how the placenta was shared, and even the types of blood vessels in the placenta had a big impact on the babies.
Of course with the evolution of technology, and more research we began to understand more about the concept of intertwin transfusion. Research into shared placentas and the transfer of blood between babies has been happening over many years. In the late 1800’s, a German obstetrician was beginning to describe connections in the placentas of monochorionic twins, and he is also recognized as one of the first to actively describe the concept of transfusions between the twins. There are even famous red and white twins, like the biblical story of Jacob and Esau, and the Wikkelkinderen of Muiderslot Castle. If you look into history, you’ll see depictions of twins everywhere. Diagnostic Criteria for TTTS, TAPS, and SFGR.What Is The Difference Between TAPS and TTTS?.
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