It is unclear what the best treatment option for TAPS is. There are several ways a TAPS pregnancy can be managed:
Laser treatment is a laparoscopic procedure (keyhole surgery) which treats the cause of TAPS during pregnancy. During laser treatment, a fetoscope (camera) with laser fiber is inserted into the the womb. The connecting vessels on the placenta that cause TAPS will be blocked with the laser under direct vision. In this way, the unbalanced blood flow between the twins will be stopped and the shared blood circulation will be separated artificially.
Intrauterine blood transfusion
An intrauterine blood transfusion (IUT) is performed during pregnancy. With an IUT, extra blood is given to the anemic TAPS donor. This procedure can be combined with a partial exchange transfusion (PET) for the TAPS recipient. The aim of a PET is to dilute the thick blood of the polycythemic TAPS twin. However, IUT (with PET) is not a definitive treatment and has only a temporary effect. Therefore, reintervention might be necessary. On average, treatment with transfusions takes place twice during a TAPS pregnancy, but this can vary from 1 to 4 times, depending on the severity of the disease and the gestational age.
With expectant management no intervention will be performed, but the condition of the twins will be monitored closely using ultrasound. Depending on the severity of TAPS, the ultrasound exams will be increased to once or even twice a week. If the health of one or both babies is deteriorating, a hospital admission might necessary for intensified monitoring with cardiotocography (CTG). In case of further deterioration, an intervention or preterm delivery can still be decided.
Preterm delivery is also an option for twin pregnancies with TAPS. During delivery, the children will be separated from the placenta and won’t be able to give blood to each other. Delivery will end the cause of TAPS. The disadvantage of this treatment is that the children will be born prematurely and might experience problems related to this. It is preferable to continue the pregnancy as long as possible. However, in some cases of TAPS, the babies are so severely ill, that it is considered to be better to be born prematurely than letting the babies be exposed any longer. In those cases, the doctor can opt for preterm delivery.
In some cases of TAPS, it might happen that IUT (with PET) or laser surgery is technically infeasible, or that one of the twins is so sick that it endangers the condition of the (more healthy) co-twin. In those cases, selective reduction might be the treatment of choice. During selective reduction, the umbilical cord of the sickest baby is closed, causing the baby to die. The aim of selective reduction is to increase the chance of survival of the (healthier) co-twin.