Treatment

TAPS is treatable.  When it is diagnosed in utero, there are several options available [6, 18-19].

Tollenaar et al. [7] suggest that management decisions should be made after careful evaluation of different factors, including TAPS stage, gestational age, and the feasibility of the different types of intra-uterine intervention.

Expectant Management

This is a watch and wait approach. Because of the slow nature of TAPS, regular MCA dopplers can gauge how fast it is progressing.  In this situation, you’ll be monitored closely every few days to check how things are going, but there will be no intervention unless something changes.

Laser Surgery

Much like in TTTS, laser surgery will sever the connections between the babies and stop the blood passing from one to the other.  Laser surgery is the only causal treatment for TAPS. The Solomon technique is used, drawing a line down the placenta and dividing it into 2 (like the story of King Solomon), and cutting the connections between the babies.  This is usually performed between 16 and 28 weeks.

Intra-Uterine Transfusions

In later pregnancy, this method buys some extra time for the babies.  The donor is given a blood transfusion in utero, however this can cause risks for the recipient. For this reason, intraperitoneal IUT is preferred, since intraperitoneal transfusion may allow slower absorption of red blood cells into the fetal circulation, preventing rapid loss of transfused blood in the circulation of the recipient twin [20].

Early delivery

In some cases, it’s essential to deliver earlier than expected.  This is usually when the window of laser surgery has closed, and things are deteriorating rapidly.

Selective Reduction/Termination

In some cases, where TAPS has caused a lot of problems, the option is there to terminate the pregnancy, or selectively reduce the number of babies in the hope of giving the healthier baby the chance to grow stronger and survive.

After Birth

After the babies are born, TAPS is usually treated with a partial exchange transfusion for the recipient, and blood transfusions for the donor.