Abnormal dopplers in monochorionic twins: Is TAPS or maternal anemia at play?
Ola Hadaya and Meike Schuster
Rutgers Robert Wood Johnson Medical School, USA
: Androl Gynecol: Curr Res
Abstract
Abnormal Middle Cerebral Artery Peak Systolic Velocities (MCA-PSV) in monochorionic twins raise concern for Twin-Twin Transfusion Syndrome (TTTS) and Twin Anemia-Polycythemia Sequence (TAPS) as well as other causes of fetal anemia, including infectious and alloimmunizing etiologies. Rarely, severe maternal anemia considered the culprit behind the abnormal Dopplers. We present a case of a 32-year-old primigravida with monochromic diamniotic twins found to have an elevated MCAPSV of initially one and then both twins, with no other ultrasonographic evidence suggestive of TAPS. Her workup was negative for parvovirus infection and alloimmunization but remarkable for severe maternal iron deficiency anemia. Treatment with IV iron was initiated and the MCA-PSV’S normalized. A comparison of hemoglobin levels of the twins following delivery did not fulfill TAPS post-natal criteria. The significance of this case report is that presents a unique case, not before described in the literature, of severe maternal iron deficiency anemia resulting in abnormal fetal MCA-PSV’s. The fetus may not be as impervious to maternal iron deficiency anemia as has long been believed, but these effects appear to be reversible with treatment.
Biography
Ola Hadaya is currently a Resident in Obstetrics and Gynecology at Rutgers Robert Wood Johnson Medical School, USA. She has graduated Magna Cum Laude from Rutgers University where she obtained her Bachelor of Arts degree and later obtained her Doctor of Medicine from Wayne State University School of Medicine. ohadaya@rwjms.rutgers.edu
