Year-end Sale % OFF 
Abstract
In the United States, routine middle cerebral artery peak systolic velocity (MCA-PSV) Doppler screening for the detection of antenatal twin anemia-polycythemia sequence (TAPS) is not recommended. The current and only national clinical guideline from the highly-influential Society for Maternal-Fetal Medicine states that, “There is no evidence that monitoring for TAPS with MCA PSV Doppler at any time, including > 26 weeks, improves outcomes, so that this additional screening cannot be recommended at this time.” We argue this recommendation has disproportionate influence on patients and the care they are offered and receive. We use current evidence to highlight and dispel pervasive myths surrounding antenatal TAPS and the value of routine MCA-PSV screening. An ethical framework that illustrates the importance of giving patients the opportunity for routine screening is presented. Findings demonstrate that: (1) both spontaneous and post-laser TAPS is a serious, potentially life-threatening complication, (2) treatment for TAPS is effective and includes expectant management, intrauterine transfusion (IUT), or surgery, (3) and routine MCA-PSV, which has satisfactory diagnostic accuracy, is currently the only way to provide early detection of TAPS. We conclude that routine TAPS screening is a medically proven valuable resource that should be offered to patients in need and to the clinicians who are trying to act toward their benefit.
Highlights
Monochorionic (MC) twin pregnancies have long been fraught with a mortality rate that exceeds dichorionic twins by over seven times [1]
Such refusal can be seen in published clinical guidelines put forth by the Society for Maternal-Fetal Medicine (SMFM), wherein their recommendation states, “There is no evidence that monitoring for twin anemia-polycythemia sequence (TAPS) with MCA PSV Doppler at any time, including > 26 weeks, improves outcomes; so that this additional screening cannot be recommended at this time” [11]
Our research revealed that the reasons Maternal-Fetal Medicine Specialists (MFMs) do not conduct routine middle cerebral artery peak systolic velocity (MCA-PSV) screening mirror the hesitation voiced by the SMFM statement: reasons were not due to lack of time or inability to obtain reimbursement for the screening, but rather the belief that MCA-PSV Doppler is not a reliable test, the belief that there is unclear treatment protocol for TAPS, the belief that there is only value in post-laser TAPS screening, and a lack of familiarity with TAPS monitoring methods [12]
Summary
Monochorionic (MC) twin pregnancies have long been fraught with a mortality rate that exceeds dichorionic twins by over seven times [1]. When health care providers refuse to perform routine MCA-PSV screening for TAPS detection, all subsequent advancements and innovative technologies related to treatment are rendered useless, and shared decision making between provider and patient is impaired Such refusal can be seen in published clinical guidelines put forth by the Society for Maternal-Fetal Medicine (SMFM), wherein their recommendation states, “There is no evidence that monitoring for TAPS with MCA PSV Doppler at any time, including > 26 weeks, improves outcomes; so that this additional screening cannot be recommended at this time” [11]. The postulates, theoretical support, and argumentative framework substantiate our descriptive claims to achieve valid and sound logical argumentation to be considered for the advancement of future research and discussion in this area
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
