Document Detail


Management of Kell isoimmunization--evaluation of a Doppler-guided approach.
MedLine Citation:
PMID:  16941575     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the role of peak systolic velocity in the middle cerebral artery (MCA-PSV) in the management of pregnancies complicated by Kell isoimmunization. METHODS: Sixteen fetuses were monitored by conventional protocol (Group 1) and eight fetuses by an MCA-PSV-guided protocol (Group 2). The conventional protocol included a weekly ultrasound evaluation and measurement of maternal anti-Kell titers every 4-6 weeks. In Group 2 Doppler assessment of the MCA-PSV was performed at intervals of 4 to 7 days and MCA-PSV>1.5 multiples of the median (MoM) was considered as an indication for fetal blood sampling (FBS). RESULTS: No parameter emerged as a reliable predictor of isoimmunization severity in Group 1. In Group 2, no FBS was necessary in one case since the MCA-PSV values obtained during the follow-up were <1.29 MoM. In two cases the first FBS was already indicated after 1 week of follow-up, but five other fetuses were followed for 3-9 weeks before FBS was indicated. All fetuses with MCA-PSV>1.5 MoM prior to intrauterine transfusion (IUT) had severe fetal anemia on FBS. In fetuses with severe anemia on the first FBS, the MCA-PSV values 7 days before the first FBS were <1.29 MoM (four cases), between 1.29 and 1.5 MoM (two cases) and >1.55 MoM (one case). CONCLUSIONS: In the management of Kell isoimmunization invasive procedures may be avoided by implementing MCA-PSV measurements. Delineation of appropriate intervals between reassessments, the reliability of MCA-PSV following repeated IUTs, and cut-off values for FBS await further study.
Authors:
E Rimon; R Peltz; R Gamzu; S Yagel; B Feldman; B Chayen; R Achiron; S Lipitz
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  28     ISSN:  0960-7692     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-30     Completed Date:  2007-09-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  814-20     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2006 ISUOG.
Affiliation:
Department of Obstetrics and Gynecology, Chaim Sheba Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel. rimoneli@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Anemia, Neonatal / embryology,  ultrasonography*
Blood Group Incompatibility / ultrasonography*
Female
Humans
Infant, Newborn
Kell Blood-Group System / analysis,  blood*
Middle Cerebral Artery / physiopathology,  ultrasonography*
Pregnancy
Ultrasonography, Doppler / instrumentation,  methods*
Chemical
Reg. No./Substance:
0/Kell Blood-Group System

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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