Document Detail


Prediction of fetal anemia in rhesus disease by measurement of fetal middle cerebral artery peak systolic velocity.
MedLine Citation:
PMID:  15133790     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In red blood cell (RBC) isoimmunized pregnancies fetal anemia is associated with a hyperdynamic circulation. The aim of the present study was to examine further the possible value of fetal middle cerebral artery peak systolic velocity (MCA-PSV) in the management of affected pregnancies. METHODS: A reference range of fetal MCA-PSV with gestation was constructed from the study of 813 normal singleton pregnancies at 20-40 weeks' gestation. Fetal MCA-PSV was also measured in 58 fetuses from RBC isoimmunized pregnancies, with maternal hemolytic antibody concentration of >15 IU/mL at 19-38 weeks' gestation and within 10 days of measurement of fetal hemoglobin concentration in blood obtained either by cordocentesis (n = 43) or at delivery (n = 15). In the RBC isoimmunized pregnancies each of the measured MCA-PSV and hemoglobin concentrations was expressed as a delta value (difference in SDs from the normal mean for gestation). Regression analysis was used to determine the significance of the association between delta MCA-PSV and delta fetal hemoglobin concentration. RESULTS: In the normal pregnancies there was a significant increase in fetal MCA-PSV with gestation (mean MCA-PSV = 10(0.0223 x GA + 0.963)). In RBC isoimmunized pregnancies the fetal MCA-PSV was increased and there was a significant association between delta MCA-PSV and delta hemoglobin concentration (delta hemoglobin = (delta MCA-PSV + 0.093)/-0.356; R(2) = 0.638, P < 0.0001). An MCA-PSV of mean + 1.5 SDs detected 96% of severely anemic fetuses, with a hemoglobin deficit of at least 6 SDs, for a false-positive rate of 14%. CONCLUSION: Measurement of fetal MCA-PSV is a useful method of assessing fetal anemia. In the clinical management of isoimmunized pregnancies a cut-off in MCA-PSV of mean + 1.5 SDs can identify nearly all severely anemic fetuses with a low false-positive rate.
Authors:
M Scheier; E Hernandez-Andrade; A Carmo; V Dezerega; K H Nicolaides
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  23     ISSN:  0960-7692     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-05-10     Completed Date:  2004-09-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  432-6     Citation Subset:  IM    
Copyright Information:
Copyright 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Anemia / ultrasonography*
Blood Flow Velocity
Cross-Sectional Studies
Erythroblastosis, Fetal / ultrasonography*
Female
Fetal Blood / chemistry
Fetal Diseases / ultrasonography
Gestational Age
Hemoglobins / analysis
Humans
Middle Cerebral Artery / ultrasonography*
Predictive Value of Tests
Pregnancy
Regression Analysis
Systole
Ultrasonography, Prenatal
Chemical
Reg. No./Substance:
0/Hemoglobins

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