Predictors of Adverse Perinatal Outcome in Twin Anemia Polycythemia Sequence: Evidence From a Single Center Cohort Study

Objective To evaluate the perinatal outcome of monochorionic pregnancies complicated by Twin Anemia‐Polycythemia Sequence (TAPS) and identify prognostic factors associated with adverse outcomes. Methods A retrospective study (2012–2024) analyzed TAPS cases at a tertiary center. Demographic, obstetric, and neonatal outcomes were compared between conservative management and interventions (intrauterine transfusion, laser surgery, or selective feticide). TAPS characteristics were also analyzed in three subgroups: deliveries before/after 32 weeks, CNS findings on MRI, and dual versus single/no survival. Result Of 32 TAPS cases, 68.75% were spontaneous, and 31.25% followed TTTS laser treatment. Conservative management was used in 62.5%, while 21.9% received intrauterine transfusions, 9.4% underwent laser treatment, and 9.4% had selective feticide. Gestational age at diagnosis and delivery was earlier in the intervention group (25 vs. 27 weeks, p = 0.05; 30.6 vs. 32.6 weeks, p = 0.04). CNS abnormalities (25%) were linked to earlier diagnosis. Perinatal survival was 86%, with dual, single, and no survival rates of 78.1%, 15.6%, and 6.2%, respectively. Patients with single/no survival were characterized by an earlier gestational age at diagnosis of TAPS compared to those with dual survival (21 vs. 27 weeks, p < 0.01). Conclusion Earlier TAPS diagnosis is associated with poorer outcomes, including reduced survival and increased risk of brain injury.