Fetal hydrops and middle cerebral artery Doppler in prediction degree of fetal anemia and the best timing for therapy

Clin Exp Obstet Gynecol. 2017;44(3):423-428.

Abstract

Purpose: To determine the role of fetal multiples of the median of middle cerebral artery peak systolic velocity (MoM MCA-PSV), in predicting the degree of fetal anemia for determination of the best timing for the second intrauterine intravascular transfusion (IUIVT) in hydropic fetuses with Rh alloimmunization.

Materials and methods: Prospective study of 30 monofetal pregnancies with maternal Rh D alloimmunization and hydrops fetalis, from 2005 to 2012 that underwent first and second IUIVT were assessed.

Results: Thirty IUIVT were performed at 26.9 weeks (standard deviation, SD 4.3). Mean interval to the second procedure was 11.23 (SD 6.21) days and average hematocrit decline rate was 1.45%/day. The study did not demonstrated statistical significance between MCA-MoM-3 before the second IUIVT, and the mean decline rate in fetal hematocrit levels (expressed in percentage/day) r = 0.220; p = 0.242, and between MCA-MoM-3 and the time interval between both procedures (T) r = -0.157; p = 0.408.

Conclusion: The measurements fetal MoM-MCA before every IUIVT cannot be useful as predictor for the best timing for the next IUIVT, but it can be useful in predicting severity of fetal anemia.

MeSH terms

  • Adult
  • Anemia / diagnosis*
  • Anemia / etiology
  • Anemia / therapy*
  • Blood Flow Velocity
  • Blood Transfusion, Intrauterine
  • Female
  • Fetal Diseases / therapy
  • Hematocrit
  • Humans
  • Hydrops Fetalis / diagnostic imaging*
  • Middle Cerebral Artery / diagnostic imaging*
  • Pregnancy
  • Prospective Studies
  • Ultrasonography, Doppler*
  • Ultrasonography, Prenatal*