Embolism in a neonate after TAPS and fetoscopic laser therapy of TOPS – Case Report

Case report: A MCDA female twin pregnancy complicated by TOPS/TTTS (Quintero 1) was referred to our centre for further diagnosis and management at 27+5 weeks GA by a DEGUM II outpatient clinic. A intrauterine fetoscopic guided laser therapy had been performed previously at 21+0 weeks GA. A Twin Anemia Polycythemia Sequence (TAPS) was diagnosed using MCA Doppler PSV in the anemic twin was > 1.5 MoM and < 0.2 MoM in the polycythemic twin respectively. Under daily surveillance in our inpatient clinic the TAPS situation remained stable until 28+4 weeks GA: The polycythemic twin showed signs of developing cardiomyopathy in addition to the pulsatile flow in the Ductus Venosus (PIV 3,389). A cesarean section was performed uneventfully (900 g, APGAR (5/7/7), NapH 7.35 in the anemic twin and 1040 g, APGAR 6/7/7, NapH 7.35 in the polycythemic twin). The polycythemic twin after delivery still showed signs of cardiomyopathy. A thrombolytic therapy was performed successfully due to rapidly developing embolisms in descending aorta, the region of the aortic bifurcation and lower limbs. However DI, DII and DV of the left foot showed aseptic necrosis with consecutive muscular contractile disorder in that region.

Conclusion: TAPS pregnancies show a high risk profile not just in the prenatal but also in the neonatal period especially in view of cardiac, hematologic and especially hemodynamic disorders.