Pathophysiology, diagnosis, and management of twin anemia polycythemia sequence in monochorionic multiple gestations

Research output: Contribution to journalReview articlepeer-review


Twin anemia polycythemia sequence (TAPS) is a consequence of unequal sharing of red blood cells between monochorionic twins resulting in anemia in the donor and polycythemia in the recipient twin. Prenatally TAPS can occur spontaneously or complicate incomplete laser surgery for twin transfusion syndrome. While there may be clinical overlap with twin transfusion syndrome or selective fetal growth restriction, diagnosis relies on Doppler measurement of middle cerebral artery peak systolic velocities. Significantly discordant velocities are diagnostic, while severity staging is based on signs of cardiovascular compromise. Conservative management, fetoscopic laser coagulation, selective twin reduction, fetal blood and exchange transfusion, and delivery may be selected guided by the gestational age of diagnosis, the severity of the condition, the likelihood of success, and the patients’ priorities. Prenatal curative treatment that minimizes the risk for prematurity and residual morbidity at birth is most likely to offer the greatest short-term and long-term benefits.

Original languageEnglish (US)
Pages (from-to)115-126
Number of pages12
JournalBest Practice and Research: Clinical Obstetrics and Gynaecology
StatePublished - Nov 2022
Externally publishedYes


  • Management
  • Mononchorionic twins
  • Twin anemia polycythemia sequence
  • Twin-twin transfusion

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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