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Antenatal twin anemia-polycythemia sequence classification. [6] Antenatal stage Results of a Doppler ultrasound scan Stage 1 MCA-PSV donor >1.5 MoM and MCA-PSV recipient <1.0 MoM, without other signs of fetal compromise Stage 2 MCA-PSV donor >1.7 MoM and MCA-PSV recipient <0.8 MoM, without other signs of fetal compromise Stage 3
Twin anemia–polycythemia sequence: Treatment: Fetoscopy and laser ablation; serial amniocentesis: Prognosis: 0–20% survival of one or all fetuses without treatment; [1] 66–85% survival of at least one fetus with treatment, with 6–15% risk of cerebral palsy: Frequency: Around 5–15% of identical twin pregnancies [2]
Polycythemia is defined as serum hematocrit (Hct) or hemoglobin (HgB) exceeding normal ranges expected for age and sex, typically Hct >49% in healthy adult men and >48% in women, or HgB >16.5 g/dL in men or >16.0 g/dL in women. [8] The definition is different for neonates and varies by age in children. [9] [10]
The other twin is usually normal in appearance. The normal twin, called the pump twin, drives blood through both fetuses. It is called "reversed arterial perfusion" because in the acardiac twin the blood flows in a reversed direction. [4] [5] TRAP sequence occurs in 1% of monochorionic twin pregnancies and 1 in 35,000 pregnancies overall. [6]
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The twin reversed arterial perfusion, or T.R.A.P. sequence, results in an 'acardiac twin', a parasitic twin that fails to develop a head, arms and a heart.The parasitic twin, little more than a torso with or without legs, receives its blood supply from the host twin by means of an umbilical cord-like structure, much like a fetus in fetu, except the acardiac twin is outside the autosite's body.
These patients may be monitored every 2–3 months for symptoms and disease progression. Otherwise, treatment is divided based on the local versus systemic spread of its clonal plasma cells. Patients with one or two plasmacytoma bone lesions and no clonal plasma cells in their bone marrow biopsy specimens are treated by surgical removal or ...
In comparison to 0.8% of the general population, offspring of women with tetralogy have a 3–5% chance of developing congenital cardiac disease. If the 22q11 deletion is present, there is a 50% chance of transferring the damaged chromosome, with a high risk of a congenital cardiac abnormality.
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