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Lou Y, Zhao B, Pan M, Huang L, Lu X, Zhang X, Peng X. Quantitative Analysis of Morphology and Function in the Fetal Heart with Severe Tricuspid Regurgitation by Speckle Tracking Imaging. Pediatr Cardiol 2024; 45:740-748. [PMID: 38393337 DOI: 10.1007/s00246-024-03454-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
Morphology and function in a fetal heart with severe tricuspid regurgitation remains challenging. The aim of this study was to assess cardiac morphology and function in fetuses with severe tricuspid regurgitation by fetal heart quantification (HQ) and to assess the practical value of fetal HQ. Clinical information was analyzed for 63 pregnant women who underwent fetal cardiac ultrasonography. The women were divided into those who had a fetus with severe tricuspid regurgitation (n = 20) and those with a normal fetus (n = 40). The global sphericity index (GSI), fractional area change (FAC), and global longitudinal strain (GLS) of both ventricles and the sphericity index (SI) and fractional shortening (FS) of 24 segments were quantified by fetal HQ using speckle tracking imaging. Fetuses with severe tricuspid regurgitation had a significantly lower GSI (1.14 ± 0.10 vs. 1.26 ± 0.08, p < 0.001) and a higher GSI Z-score (-0.98 ± 1.01 vs. 0.25 ± 0.87, p < 0.001) as well as a significantly lower right ventricular FAC (36.50 ± 7.34% vs. 45.19 ± 3.39%, p < 0.001), FAC Z-score (-1.02 ± 1.41 vs. 0.49 ± 0.74, p < 0.001), and GLS (-21.01 ± 5.66% vs. 45.19 ± 3.49%, p < 0.001). The SI and SI Z-score were significantly lower in segments 1-18 of the right ventricle in fetuses with severe tricuspid regurgitation (p < 0.05); furthermore, FS of segments 1-12 and 19-24 and the FS Z-score of segments 18-24 were significantly lower in fetuses with severe tricuspid regurgitation (p < 0.05). Fetal HQ is useful for evaluation of cardiac morphology and function in fetuses with severe tricuspid regurgitation and can provide important reference information for both clinical diagnosis and treatment.
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Affiliation(s)
- Yang Lou
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, 310016, China
- Special Inspection Section, Hangzhou Xixi Hospital, Hangzhou, 310023, China
| | - Bowen Zhao
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, 310016, China.
| | - Mei Pan
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, 310016, China
| | | | - Xiaoxi Lu
- Hangzhou Women's Hospital, Zhejiang University, Hangzhou, 310016, China
| | - Xiaomin Zhang
- First People's Hospital of Linping District, Hangzhou City, Hangzhou, 311201, China
| | - Xiaohui Peng
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, 310016, China
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Dixit S, Dixit NA, Rawat A, Bajpai A, Alelyani M, Sabah ZU, Raghuwanshi S. Color Doppler ultrasound in high-low risk pregnancies and its relationship to fetal outcomes: a cross-sectional study. Front Pediatr 2024; 11:1221766. [PMID: 38444769 PMCID: PMC10912586 DOI: 10.3389/fped.2023.1221766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/26/2023] [Indexed: 03/07/2024] Open
Abstract
Objective To calculate the multivessel color Doppler indices in high-risk and low-risk pregnancies and relate these to fetal outcomes. Methods The investigation involved 60 patients who were pregnant. The patients were separated into groups according to assessment of low and high risk. The patients underwent color Doppler ultrasonography to detect the maternal and fetal blood vessels, and the measured Doppler indices were then analyzed for any association with fetal outcomes. Results The gestational stages (in weeks) of the participants at the respective times of investigation and delivery were 32.06 ± 2.98 and 36.2 ± 1.78 in the low-risk group and 29.21 ± 1.95 and 29.83 ± 1.86 in the high-risk group. The pulsatility index (PI), resistive index (RI), and systolic/diastolic ratio (SD) decreased with gestation length in the low-risk group, whereas in the high-risk group, these values increased in the uterine and umbilical arteries. With increased gestational stage, MCA-PSV (peak systolic velocity) in the middle cerebral artery (MCA) increased, while PI decreased. Pulsatile and reversal flow of the uterine vein, the vein of Galen, and the umbilical vein were noted in high-risk pregnancies, and these negatively affected the fetal outcome. The fetal venous parameters were more specific and sensitive for predicting an unfavorable fetal outcome than the arterial factors, with a greater negative predictive value. Conclusion The results of our study indicate that abnormal Doppler indices of the blood vessels in high-risk pregnant patients will result in adverse clinical outcomes. Therefore, the patients can be monitored and managed accordingly using Doppler ultrasonography.
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Affiliation(s)
- Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Nitin Arun Dixit
- Department of Radiodiagnosis, King George Medical University, Lucknow, India
| | - Anil Rawat
- Department of Radiodiagnosis, King George Medical University, Lucknow, India
| | - Akanksha Bajpai
- Department of Radiodiagnosis, Career Institute of Medical Sciences, Lucknow, India
| | - Magbool Alelyani
- Department of Radiological Sciences, College of Applied Medical Science, King Khalid University, Abha, Saudi Arabia
| | - Zia Ul Sabah
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Wen J, Guo X, Cai S, Xu D, Zhang G, Bai X. Fetal Ductus Arteriosus Premature Constriction. Int Heart J 2022; 63:722-728. [PMID: 35831144 DOI: 10.1536/ihj.21-723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the connections between the echocardiography indices of fetal ductus arteriosus premature constriction and newborn prognosis by analyzing 22 cases of spontaneous fetal ductus arteriosus premature constriction.An ultrasonic instrument was used to observe prenatal fetal heart state, combine clinical examination data and echocardiographic results after delivery, summarize the ultrasound manifestations and imaging characteristics, and analyze the prognosis of the fetus.In all cases, fetal ductus arteriosus premature constriction occurred in the third trimester of pregnancy (34 + 1 to 41 weeks), and no abnormality in extracardiac organs were observed. Seven neonates required respiratory support due to the accompanying severe tricuspid regurgitation. The remaining 15 neonates did not receive respiratory support, including 4 with severe tricuspid regurgitation, 5 with moderate regurgitation, and 6 with mild regurgitation. Significant differences were observed in the fetal right atrium size and tricuspid regurgitation severity between the neonatal respiratory support group and non-respiratory support group. Furthermore, there were statistical differences in the ductus arteriosus inner diameter and pulsation index between the two groups.The severity of fetal ductus arteriosus premature contraction accompanied by tricuspid regurgitation and right atrium enlargement can predict the immediate prognosis of the newborn and provide guidance for the clinical judgment of the timing of pregnancy termination.
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Affiliation(s)
- Jie Wen
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
| | - Xuedong Guo
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
| | - Shuping Cai
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
| | - Dong Xu
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
| | - Geer Zhang
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
| | - Xiaoxia Bai
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
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Riordan SL, Ryan GA, Cathcart B, Hughes H, Higgins S, Fitzgerald J, Corcoran S, Walsh J, Mahony R, Carroll S, Mcauliffe FM, Mcparland P. The Rate of Decline in Fetal Hemoglobin following Intrauterine Blood Transfusion in the Management of Red Cell Alloimmunization. Eur J Obstet Gynecol Reprod Biol 2022; 271:93-96. [DOI: 10.1016/j.ejogrb.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
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Diagnostic Performance of Doppler Ultrasonography for the Detection of Fetal Anemia: A Meta-analysis. Ultrasound Q 2020; 35:339-345. [PMID: 31166294 DOI: 10.1097/ruq.0000000000000450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study evaluates the diagnostic performance of Doppler ultrasound in diagnosing fetal anemia. Data were taken from relevant study reports published in peer-reviewed journals identified after a literature search in electronic databases. Random effects meta-analyses were performed by pooling the effect sizes of diagnostic indices (sensitivity, specificity, positive/negative predictive values, and false-positive rate) or correlation coefficients reported by individual studies. As a result, 31 studies (1848 pregnancies; gestation age, 28.25 weeks [95% confidence interval {CI}, 26.87-29.63]) were included in the meta-analysis. Anemia was found in 63.7% (95% CI, 49.7-77.7) fetuses, and severe anemia was found in 36.7% (95% CI, 26.9-46.4) fetuses. Sensitivity and specificity of Doppler ultrasound for detecting fetal anemia in alloimmunized fetuses at middle cerebral artery peak systolic velocity cutoff of 1.5 multiple of median for gestation age were 83.42% (95% CI, 71.75-95.09) and 80.30% (95% CI, 73.58-87.02), respectively. Positive predictive value, negative predictive value, and false-positive rate were 76.35% (95% CI, 65.98-86.72), 80.0% (95% CI, 76.63-83.37), and 10.4% (95% CI, 5.9-14.9), respectively. Correlation coefficient between hematological anemia and Doppler ultrasound-measured blood flow velocity was -0.706 (95% CI, -0.765 to -0.635; P < 0.00001). In conclusion, Doppler ultrasound-measured middle cerebral artery peak systolic velocity at 1.5 multiple of median provides good diagnostic strength for the detection of alloimmunized fetal anemia. A strong correlation between Doppler velocimetric measures and hematological anemia is also observed.
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Jørgensen DS, Vejlstrup N, Rode L, Ekelund CK, Macgowan CK, Jensen LN, Nørgaard LN, Portnoy S, Seed M, Sundberg K, Søgaard K, Forman JL, Tabor A. Magnetic Resonance Imaging: A New Tool to Optimize the Prediction of Fetal Anemia? Fetal Diagn Ther 2019; 46:257-265. [PMID: 30731466 DOI: 10.1159/000494615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The false-positive rate in the prediction of fetal anemia is 10-15%. We investigated if a new, noninvasive MRI method used as a supplement to ultrasound could improve the prediction. METHODS Fetuses suspected of anemia and controls were scanned in a 1.5-tesla MRI scanner 1-4 times during pregnancy. Cases were scanned before and after intrauterine blood transfusion with a T1-mapping MRI sequence in a cross-section of the umbilical vein. RESULTS Inclusion of 8 cases and 11 controls resulted in 10 case scans (2 cases were included twice) and 33 control scans. In controls, the T1 relaxation time was 1,005-1,391 ms; in cases with severe anemia, 1,505-1,595 ms, moderate anemia 1,503-1,525 ms, and no/mild anemia 1,245-1,410 ms. After blood transfusions, values dropped to 1,123-1,288 ms. The mean value in moderate and severe anemic cases was 275 ms higher than in controls (95% CI 210-341 ms, p < 0.0001), and after blood transfusion it was comparable to controls (3 ms, 95% CI -62 to 68 ms, p = 0.934). A 1,450-ms cut-off would have identified all cases in need of blood transfusion with no false-positive cases. CONCLUSIONS Our findings indicate a potential for this new MRI method to improve the prediction of fetal anemia as a supplement to ultrasound.
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Affiliation(s)
- Ditte S Jørgensen
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark, .,Faculty of Medicine and Health Sciences, University of Copenhagen, Copenhagen, Denmark,
| | - Niels Vejlstrup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Line Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Charlotte K Ekelund
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christopher K Macgowan
- Departments of Medical Biophysics and Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lisa N Jensen
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lone Nikoline Nørgaard
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sharon Portnoy
- Departments of Medical Biophysics and Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mike Seed
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Division of Paediatric Cardiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karin Sundberg
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Søgaard
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ann Tabor
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Medicine and Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Santana Suárez A, García Rodríguez R, García Delgado R, Armas Roca M, Medina Castellano M, Romero Requejo A, Hernández Febles M, Falcón M, García Hernández J. Diagnóstico ecográfico y manejo de la infección fetal por parvovirus B19. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2017. [DOI: 10.1016/j.gine.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Li L, Huang L, Luo G, Luo Y, Fang Q. Prenatal treatment of severe fetal hemolytic disease due to anti-M alloimmunization by serial intrauterine transfusions. Taiwan J Obstet Gynecol 2017; 56:379-381. [DOI: 10.1016/j.tjog.2017.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2016] [Indexed: 10/19/2022] Open
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Study of concentration of amniotic fluid alpha-fetal protein in thalassemia fetus. ASIAN PAC J TROP MED 2017; 10:201-203. [DOI: 10.1016/j.apjtm.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 11/22/2022] Open
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White J, Qureshi H, Massey E, Needs M, Byrne G, Daniels G, Allard S. Guideline for blood grouping and red cell antibody testing in pregnancy. Transfus Med 2016; 26:246-63. [DOI: 10.1111/tme.12299] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Affiliation(s)
- J White
- UK National External Quality Assessment Scheme for Blood Transfusion Laboratory Practice; Watford
| | - H Qureshi
- Department of Haematology; University Hospitals of Leicester
| | - E Massey
- NHS Blood and Transplant & University Hospitals Bristol NHS Foundation Trust
| | - M Needs
- Institute of Biomedical Scientists and NHS Blood and Transplant
| | - G Byrne
- Department of Haematology; University Hospitals of Leicester
| | - G Daniels
- International Blood Group Reference Laboratory; NHS Blood and Transplant
| | - S Allard
- Barts Health NHS Trust and NHS Blood and Transplant
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Lucewicz A, Fisher K, Henry A, Welsh AW. Review of the correlation between blood flow velocity and polycythemia in the fetus, neonate and adult: appropriate diagnostic levels need to be determined for twin anemia-polycythemia sequence. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:152-157. [PMID: 25580896 DOI: 10.1002/uog.14782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/01/2014] [Accepted: 01/02/2015] [Indexed: 06/04/2023]
Abstract
Twin anemia-polycythemia sequence (TAPS) is recognized increasingly antenatally by the demonstration of an anemic twin and a polycythemic cotwin using the middle cerebral artery peak systolic velocity (MCA-PSV). While the MCA-PSV has been shown to correlate well with anemia in singleton fetuses, the evidence to support its use to diagnose fetal polycythemia appears to be less clear-cut. We aimed to evaluate fetal, neonatal and adult literature used to support the use of MCA-PSV for the diagnosis of polycythemia. Comprehensive literature searches were performed for ultrasound evidence of polycythemia in the human fetus, neonate and adult using key search terms. Only manuscripts in the English language with an abstract were considered for the review, performed in June 2014. Fifteen manuscripts were found for the human fetus, including 38 cases of TAPS. Nine of these defined fetal polycythemia as MCA-PSV < 0.8 multiples of the median (MoM), five used < 1.0 MoM and one used 0.8-1.0 MoM. Only two studies, involving a total of 15 cases, proposed a diagnostic level, acknowledging false-positive and -negative cases, though neither reported sensitivities or specificities. Six neonatal studies (96 neonates) demonstrated evidence of decreased cerebral velocities in polycythemia and a consequent increase with hemodilution. In the adult, five studies (57 polycythemic adults) demonstrated increased flow or velocity with hemodilution. Neither neonatal nor adult studies conclusively defined levels for screening for polycythemia. Despite widespread adoption of a cut-off of < 0.8 MoM in the published literature for the polycythemic fetus in TAPS, this is based upon minimal evidence, with unknown sensitivity and specificity. We recommend caution in excluding TAPS based purely upon the absence of a reduced MCA-PSV.
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Affiliation(s)
- A Lucewicz
- Department of Obstetrics & Gynaecology, Westmead Hospital, Westmead, NSW, Australia
| | - K Fisher
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - A Henry
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW, Australia
- Department of Obstetrics and Gynaecology, St George Hospital, Kogarah, NSW, Australia
- Australian Centre for Perinatal Science, University of New South Wales, Randwick, NSW, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia
| | - A W Welsh
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW, Australia
- Australian Centre for Perinatal Science, University of New South Wales, Randwick, NSW, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia
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Recommendations for the prevention and treatment of haemolytic disease of the foetus and newborn. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:109-34. [PMID: 25633877 DOI: 10.2450/2014.0119-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Sainio S, Nupponen I, Kuosmanen M, Aitokallio-Tallberg A, Ekholm E, Halmesmäki E, Orden MR, Palo P, Raudaskoski T, Tekay A, Tuimala J, Uotila J, Stefanovic V. Diagnosis and treatment of severe hemolytic disease of the fetus and newborn: a 10-year nationwide retrospective study. Acta Obstet Gynecol Scand 2015; 94:383-90. [DOI: 10.1111/aogs.12590] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 01/14/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Irmeli Nupponen
- Department of Pediatrics; Helsinki University Central Hospital; Helsinki Finland
| | | | | | - Eeva Ekholm
- Department of Obstetrics and Gynecology; Turku University Central Hospital; Turku Finland
| | - Erja Halmesmäki
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Maija-Riitta Orden
- Department of Obstetrics and Gynecology; Kuopio University Hospital; Kuopio Finland
| | - Pertti Palo
- Department of Obstetrics and Gynecology; Turku University Central Hospital; Turku Finland
| | - Tytti Raudaskoski
- Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
| | - Aydin Tekay
- Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
| | | | - Jukka Uotila
- Department of Obstetrics and Gynecology; Tampere University Hospital; Tampere Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
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Nishie EN, Liao AW, de Loudes Brizot M, Assunção RA, Zugaib M. Prediction of the rate of decline in fetal hemoglobin levels between first and second transfusions in red cell alloimmune disease. Prenat Diagn 2012; 32:1123-6. [DOI: 10.1002/pd.3966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Estela Naomi Nishie
- Department of Obstetrics and Gynecology; São Paulo University Medical School; São Paulo Brazil
| | - Adolfo Wenjaw Liao
- Department of Obstetrics and Gynecology; São Paulo University Medical School; São Paulo Brazil
| | - Maria de Loudes Brizot
- Department of Obstetrics and Gynecology; São Paulo University Medical School; São Paulo Brazil
| | - Renata A. Assunção
- Department of Obstetrics and Gynecology; São Paulo University Medical School; São Paulo Brazil
| | - Marcelo Zugaib
- Department of Obstetrics and Gynecology; São Paulo University Medical School; São Paulo Brazil
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Kachewar SG, Gandage SG, Pawar HJ. A prospective cross-sectional study of fetal middle cerebral artery peak systolic velocity in a normal obstetric population attending an Indian Medical College. Jpn J Radiol 2012; 30:575-81. [PMID: 22722953 DOI: 10.1007/s11604-012-0090-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/13/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Fetal middle cerebral artery peak systolic velocity (MCA-PSV) is now an established method of noninvasive diagnosis of moderate to severe fetal anemia of different origins. This being a population-based parameter, it may have different values in individuals from different locations. A standard local reference range of normal individuals specific to each geographic locality is therefore needed. MATERIALS AND METHODS Fetal MCA-PSV was measured in 1,015 healthy pregnant women attending the antenatal ultrasound clinic at least once between 12 and 40 weeks of gestation (35 patients per week of gestation). Statistical analysis was done using the SPSS 12 software. RESULTS A positive correlation between MCA-PSV and gestational age was found. MCA-PSV was seen to increase with advancing gestational age. The Tukey-Kramer multiple comparisons test showed a normal distribution that was highly significant (p < 0.01). The multiples of median values of fetal MCA-PSV to label a fetus as severely anemic were consistently and significantly lower than internationally accepted values. CONCLUSIONS A normal reference range of fetal MCA-PSV for local use was thus scientifically and successfully constructed. Significant differences between local values and internationally accepted value were found.
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Affiliation(s)
- Sushil G Kachewar
- Radio-diagnosis Department, Rural Medical College, PIMS (DU), Pravara Medical Trust, Loni, Rahata, Ahmednagar, 413 736 Maharashtra, India.
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A classification of patterns of fetal middle cerebral artery velocity waveforms as seen on Doppler ultrasound. Jpn J Radiol 2012; 30:582-8. [DOI: 10.1007/s11604-012-0091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/13/2012] [Indexed: 10/28/2022]
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Trieu NT, Weingertner AS, Guerra F, Dautun D, Kohler M, Vayssière C, Nisand I, Favre R. Evaluation of the measurement of the middle cerebral artery peak systolic velocity before and after placental laser coagulation in twin-to-twin transfusion syndrome. Prenat Diagn 2012; 32:127-30. [DOI: 10.1002/pd.2907] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ngoc-Tu Trieu
- Fetal Diagnosis and Medicine; CMCO; Schiltigheim; France
| | | | - F. Guerra
- Fetal Diagnosis and Medicine; CMCO; Schiltigheim; France
| | - D. Dautun
- Fetal Diagnosis and Medicine; CMCO; Schiltigheim; France
| | - M. Kohler
- Fetal Diagnosis and Medicine; CMCO; Schiltigheim; France
| | - C. Vayssière
- Fetal Diagnosis and Medicine; CMCO; Schiltigheim; France
| | - I. Nisand
- Service de Gynécologie Obstétrique; Hôpitaux Universitaires de Strasbourg; Strasbourg; France
| | - R. Favre
- Fetal Diagnosis and Medicine; CMCO; Schiltigheim; France
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Hermann M, Poissonnier MH, Grangé G, Bernaux M, Lefèvre M, Tsatsaris V, Lepercq J. Intérêt du pic systolique de vélocité dans l’artère cérébrale moyenne en fin de grossesse après exsanguino-transfusions itératives. ACTA ACUST UNITED AC 2011; 40:675-81. [DOI: 10.1016/j.jgyn.2011.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 07/14/2011] [Accepted: 08/17/2011] [Indexed: 10/17/2022]
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Fetal middle cerebral artery peak systolic velocities in a local Indian scenario. Jpn J Radiol 2011; 29:725-9. [DOI: 10.1007/s11604-011-0625-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 07/10/2011] [Indexed: 11/25/2022]
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Borna S, Mirzaie F, Hanthoush-Zadeh S, Khazardoost S, Rahimi-Sharbaf F. Middle cerebral artery peak systolic velocity and ductus venosus velocity in the investigation of nonimmune hydrops. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:385-388. [PMID: 19582828 DOI: 10.1002/jcu.20613] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE This study was performed to investigate the cause of nonimmune hydrops fetalis by measuring the peak systolic velocity (PSV) in the middle cerebral artery (MCA) and velocity waveforms of the ductus venosus (DV) with Doppler. METHODS This cross-sectional study was done on 19 pregnancies referred to three university teaching hospitals for further investigation of nonimmune hydrops fetalis in 2007 and 2008. The MCA-PSV and DV velocity waveforms were recorded in all fetuses. Anemia was investigated in cases with MCA-PSV values greater than 1.50 MoM (multiple of the median). Cardiovascular causes and chromosomal abnormalities were investigated in fetuses with abnormal DV velocity. RESULTS Four of 19 fetuses had MCA-PSV values greater than 1.50 MoM. The causes of anemia were cytomegalovirus, parvovirus B19 infections, congenital heart disease, and Turner syndrome. Four cases had reversed flow in the DV; three of them had congenital heart disease on echocardiography; and one had a normal echocardiogram, but an abnormal karyotype was detected. CONCLUSION Assessment of the MCA-PSV and DV velocity waveforms during sonographic examination of fetuses with nonimmune hydrops fetalis may improve our knowledge about the etiology of this condition.
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Affiliation(s)
- Sedigheh Borna
- Department of Obstetrics and Gynecology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Pretlove SJ, Fox CE, Khan KS, Kilby MD. Noninvasive methods of detecting fetal anaemia: a systematic review and meta-analysis. BJOG 2009; 116:1558-67. [DOI: 10.1111/j.1471-0528.2009.02255.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maciuleviciene R, Gaurilcikas A, Simanaviciute D, Nadisauskiene RJ, Gintautas V, Vaitkiene D, Baliutaviciene DK. Fetal middle cerebral artery Doppler velocimetry in cases of rhesus alloimmunization. J Matern Fetal Neonatal Med 2009; 21:361-5. [DOI: 10.1080/14767050802037787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Srisupundit K, Piyamongkol W, Tongsong T. Identification of fetuses with hemoglobin Bart's disease using middle cerebral artery peak systolic velocity. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:694-697. [PMID: 19350531 DOI: 10.1002/uog.6342] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To determine the sensitivity and specificity of middle cerebral artery peak systolic velocity (MCA-PSV) in mid-pregnancy for the identification of homozygous alpha-thalassemia-1 (hemoglobin (Hb) Bart's disease) in fetuses at risk of the disease. METHODS A total of 88 pregnancies (91 fetuses) at risk of Hb Bart's disease and undergoing MCA-PSV measurement before cordocentesis at 18-22 weeks of gestation were recruited into the study. Definitive diagnosis was made using the gold standard technique of Hb typing by high-performance liquid chromatography. RESULTS The mean +/- SD age of the 88 pregnant women recruited into the study was 28.3 +/- 5.7 years, the gestational age was 18.8 +/- 1.1 weeks and the incidence of Hb Bart's disease was 22% (20 fetuses). Using MCA-PSV above 1.5 multiples of the median as a cut-off point, the sensitivity of MCA-PSV for detecting affected fetuses was 85% (17/20 cases), with a specificity of 100%, and positive and negative predictive values of 100% and 95.9% respectively. Three of 20 fetuses with Hb Bart's disease had normal MCA-PSV. CONCLUSIONS MCA-PSV assessment in mid-pregnancy is a useful method for identifying Hb Bart's disease with high sensitivity and specificity among fetuses at risk, and may allow avoidance of unnecessary cordocentesis in some cases.
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Affiliation(s)
- K Srisupundit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Kim GJ, Lee ES. Prenatal diagnosis of transient abnormal myelopoiesis in a Down syndrome fetus. Korean J Radiol 2009; 10:190-3. [PMID: 19270866 PMCID: PMC2651437 DOI: 10.3348/kjr.2009.10.2.190] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 07/22/2008] [Indexed: 11/21/2022] Open
Abstract
We report a case of transient abnormal myelopoiesis in a Down syndrome fetus diagnosed at 28+3 weeks of gestation that rapidly progressed to intrauterine death 10 days later. Fetal hepatosplenomegaly with cerebral ventriculomegaly, although not specific, may be a suggestive finding of Down syndrome with transient abnormal myelopoiesis. Prompt fetal blood sampling for liver function test and chromosomal analysis are mandatory for early detection and management.
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Affiliation(s)
- Gwang Jun Kim
- Department of Obstetric and Gynecology, Chung-Ang University School of Medicine, Seoul, Korea
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Tongsong T, Wanapirak C, Sirichotiyakul S, Tongprasert F, Srisupundit K. Middle cerebral artery peak systolic velocity of healthy fetuses in the first half of pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1013-7. [PMID: 17646363 DOI: 10.7863/jum.2007.26.8.1013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The purpose of this study was to establish normative data of middle cerebral artery (MCA) peak systolic velocity (PSV) in the first half of normal pregnancies (11-22 weeks). METHODS A prospective cross-sectional descriptive study was conducted in which low-risk pregnant women whose pregnancies were singleton with accurate gestational age were recruited into the study. All neonates were subsequently proven to be healthy at birth. The sonographic measurements of MCA PSV were performed by the same examiner with a high-resolution machine. RESULTS The total number of measurements was 410, and the number of measurements for each gestational week ranged from 30 to 40. The best regression model between gestational week and placental thickness was observed to be a linear function, and reference curves were constructed. The results showed a continuous increase in MCA PSV over the period from 11 to 22 weeks. During the period of study, 3 fetuses with hemoglobin Bart disease in the first half of pregnancy were encountered, and all of them had PSV of greater than the 95th percentile as well as 1.5 multiples of the median for each gestational week. CONCLUSIONS A nomogram of MCA PSV for each gestational age from 11 to 22 weeks was constructed. These reference ranges may be useful noninvasive tools in risk assessment for fetal anemia in early pregnancy, especially due to hemoglobin Bart disease.
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Affiliation(s)
- Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Gooch A, Parker J, Wray J, Qureshi H. Guideline for blood grouping and antibody testing in pregnancy. Transfus Med 2007; 17:252-62. [PMID: 17680951 DOI: 10.1111/j.1365-3148.2007.00767.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gadelha-Costa A, Spara-Gadelha P, Filho FM, Gadelha EB. Hemodynamic changes in the fetal arteries during the second half of pregnancy assessed by Doppler velocimetry. Eur J Obstet Gynecol Reprod Biol 2007; 132:148-53. [PMID: 17194521 DOI: 10.1016/j.ejogrb.2006.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Revised: 10/04/2006] [Accepted: 11/13/2006] [Indexed: 11/28/2022]
Abstract
The applicability of Doppler velocimetry has been well established regarding intrauterine growth restriction and fetal hypoxia. This method can also be used to determine fetal anemia and cardiac malformations. The main fetal arteries evaluated by Doppler velocimetry are the middle cerebral artery and the umbilical artery. However, the fetal aorta is responsible for the distribution of blood flow to the upper and lower extremities of the human body and should also be properly valued. In order to characterize abnormalities in the arteries of high-risk fetuses, it is necessary to know the hemodynamic modifications of normal fetuses. On this basis, the authors performed a review of fetal hemodynamics evaluated by Doppler velocimetry in the fetal aorta and middle cerebral and umbilical arteries during the second half of pregnancy. The study of fetal vessels by Doppler velocimetry indirectly evaluates the hemodynamic changes occurring in fetuses at risk. In this respect, we emphasize the changes in Doppler velocimetry occurring in fetal anemia, in restricted intrauterine growth, and in normal fetuses.
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Affiliation(s)
- Antonio Gadelha-Costa
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, São Paulo University, Av. Bandeirantes, 3.900, Monte Alegre, CEP: 14048-900, Ribeirão Preto-São Paulo-Brazil.
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Rujiwetpongstorn J, Phupong V. Doppler waveform indices of the Middle Cerebral Artery of normal fetuses in the first half of pregnancy in the Thai population. Arch Gynecol Obstet 2007; 276:351-4. [PMID: 17361402 DOI: 10.1007/s00404-007-0352-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2006] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To establish the reference ranges of middle cerebral artery (MCA) Doppler indices including pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV) of the Thai fetuses at gestational age of 11-20 weeks. METHODS A descriptive cross-sectional study was conducted at Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Normal singleton pregnancies between 11 and 20 weeks of gestation were recruited into the study for measurements of MCA Doppler indices between November 2005 and August 2006. The trans-abdominal ultrasound, Aloka Model Prosound 5000 (Tokyo) was used. The MCA Doppler data were analyzed for median, 5th, and 95th percentile for each gestational week. The best-fit mathematical model was derived. RESULTS A total of 300 measurements, with average of 30 +/- 7.35 per gestational week (mean +/- SD) and range 23-45 per gestational week, were obtained from 149 patients. Regression analysis yielded the best-fitted equation of quadratic function as follows: PI = 8.421 - 0.705(GA) + 0.018(GA(2)) (r (2) = 0.452), RI = 1.54 - 0.073(GA) + 0.002(GA(2)) (r (2) = 0.309), PSV = -63.456 + 9.425(GA) - 0.262(GA(2)) (r (2) = 0.504). CONCLUSION A nomogram for MCA Doppler indices, including PI, RI and PSV ratio for each gestational age during 11-20 weeks was constructed. This may be a useful aid in the early detection of abnormalities in fetal cerebral blood flow, especially in fetal anemia secondary to hemoglobin Bart's disease.
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Affiliation(s)
- Jittima Rujiwetpongstorn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand.
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Scheier M, Hernandez-Andrade E, Fonseca EB, Nicolaides KH. Prediction of severe fetal anemia in red blood cell alloimmunization after previous intrauterine transfusions. Am J Obstet Gynecol 2006; 195:1550-6. [PMID: 16796991 DOI: 10.1016/j.ajog.2006.03.060] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Revised: 03/03/2006] [Accepted: 03/18/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to determine the detection of fetal anemia and false-positive rates by fetal middle cerebral artery peak systolic velocity (MCA-PSV) and the estimated daily decrease of hemoglobin (Hb) in red blood cell alloimmunized pregnancies that had previous fetal transfusions. STUDY DESIGN We examined the relation between MCA-PSV measured before cordocentesis, and fetal Hb at the time of the second (n = 42) and third (n = 31) intrauterine blood transfusions. In addition, the daily Hb drop between the transfusions was calculated. RESULTS The MCA-PSV provided significant prediction of severe anemia (Hb deficit > or = 6 g/dL) for the second but not for the third transfusion. Detection of 95% of severely anemic fetuses was achieved with a false-positive rate of 37% for the second transfusion and 90% for the third, compared with 14% in our previous study for the first transfusion. In patients who had received 2 previous transfusions, the only significant predictor of fetal anemia was the estimation of the Hb from the measured posttransfusion Hb after the second transfusion and the assumption that the rate of decrease in fetal Hb is 0.3 g/dL per day. CONCLUSION Prediction of severe fetal anemia after one transfusion is less accurate than in nontransfused fetuses. The MCA-PSV is not useful in predicting severe anemia in fetuses that already had 2 previous transfusions.
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Affiliation(s)
- Matthias Scheier
- Harris Birthright Research Center for Fetal Medicine, King's College Hospital, London, United Kingdom
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Lydaki E, Nikoloudi I, Kaminopetros P, Bolonaki I, Sifakis S, Kikidi K, Koumantakis E, Foundouli K. Serial blood donations for intrauterine transfusions of severe hemolytic disease of the newborn with the use of recombinant erythropoietin in a pregnant woman alloimmunized with anti-Ku. Transfusion 2005; 45:1791-5. [PMID: 16271105 DOI: 10.1111/j.1537-2995.2005.00604.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The management of a pregnant woman with the rare Ko phenotype and anti-Ku is a special challenge, because matched blood is extremely rare and the possibility of severe hemolytic disease of the newborn is high. CASE REPORT A 30-year-old woman with rare Ko (Knull) phenotype presented at 18 weeks of gestation with positive indirect agglutination test results. She had anti-Ku due to previous blood transfusion, one pregnancy, and two abortions. STUDY DESIGN AND METHODS During this pregnancy, anti-Ku titers ranged from 1024 to 4096. At the 26th week of gestation ultrasound showed a hydropic fetus and urgent intrauterine exchange transfusion was performed with the maternal red blood cells (RBCs). Recombinant human erythropoietin (rHu-EPO) and intravenous (IV) iron were administered to the mother to ensure an adequate supply of matched RBCs for intrauterine transfusions and possible perinatal hemorrhage. RESULTS Intrauterine transfusions were repeated every 1 to 3 weeks. By 35 weeks 2 days of gestation, the mother had donated 4 units of blood, and four intrauterine transfusions had been performed. Cesarean section was then decided and a healthy male newborn was born. He was treated with phototherapy but without exchange transfusions. By the 15th day of life rHu-EPO was administrated to the newborn because of anemia. The maternal RBCs completely disappeared from the child's blood by Day 100. CONCLUSIONS As shown in this case, treatment with rHu-EPO and IV Fe has effectively increased the mother's capacity to donate RBCs for autologous use and intrauterine transfusions, with no adverse effects to the mother or the child.
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Affiliation(s)
- Evaggelia Lydaki
- Department of Transfusion Medicine, University Hospital of Heraklion, Crete, Greece.
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Mari G. Middle cerebral artery peak systolic velocity: is it the standard of care for the diagnosis of fetal anemia? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:697-702. [PMID: 15840801 DOI: 10.7863/jum.2005.24.5.697] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The aim of this work was to review the use of middle cerebral artery peak systolic velocity (MCA PSV) for the diagnosis of fetal anemia. METHODS With the use of a computerized database (MEDLINE), articles on the diagnosis of fetal anemia with ultrasonography were reviewed. Other pertinent references were obtained from the references cited in these articles. In addition, my own institution's clinical experience of the past 18 years was reviewed. RESULTS Several ultrasonographic parameters have been used to diagnose noninvasive fetal anemia. On the basis of robust data, the MCA PSV is the best ultrasonographic parameter used in the management of fetuses at risk for anemia due to different causes. It is also superior to amniocentesis for the diagnosis of fetal anemia in cases of red cell alloimmunization. CONCLUSIONS Middle cerebral artery peak systolic velocity is effective for diagnosis of noninvasive moderate and severe fetal anemia. This parameter should not yet be considered the global standard of care for diagnosis of fetal anemia because incorrect use by an inexperienced operator may cause more harm than good; however, if there is a reasonably close medical center with sonographers or sonologists trained to assess the MCA PSV, patients at risk for fetal anemia should be referred to this center.
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Affiliation(s)
- Giancarlo Mari
- Department of Obstetrics and Gynecology, Wayne State University, Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Detroit, MI 48201, USA
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Mari G. Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia: the untold story. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:323-330. [PMID: 15789353 DOI: 10.1002/uog.1882] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- G Mari
- Department of Obstetrics and Gynecology, Wayne State University, Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, USA.
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Bartha JL, Illanes S, Abdel-Fattah S, Hunter A, Denbow M, Soothill PW. Comparison of different reference values of fetal blood flow velocity in the middle cerebral artery for predicting fetal anemia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:335-340. [PMID: 15704240 DOI: 10.1002/uog.1814] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To compare different normal reference ranges of fetal blood flow velocity in the middle cerebral artery for predicting fetal anemia. METHODS Eight reference ranges of either middle cerebral artery peak or time-averaged mean velocities were compared using the area under the receiver-operating characteristics (ROC) curve for 113 fetal blood samples from 60 women at risk of fetal red blood cell alloimmunization. RESULTS The areas under the ROC curves of the different ranges were not significantly different but there were marked differences in sensitivity (range, 7.14-91.78%) and specificity (range, 31.25-96.88%) with the currently used cut-offs. Except for Mari's range, the best theoretical cut-offs, defined as those having the best sensitivity with the best specificity, differed from those in current use, especially when using time-averaged mean velocity. CONCLUSIONS Any of the previously reported reference ranges perform well in the non-invasive prediction of fetal anemia. However, with the exception of Mari's curve, the currently employed cut-offs for predicting fetal anemia should be changed, some of them markedly, in order to provide reliable support for clinical decisions.
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Affiliation(s)
- J L Bartha
- Fetal Medicine Unit, St Michael's Hospital, Bristol, UK.
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Imbar T, Lev-Sagie A, Cohen S, Yanai N, Yagel S. Diagnosis, surveillance, and treatment of the anemic fetus using middle cerebral artery peak systolic velocity measurement. Prenat Diagn 2005; 26:45-51. [PMID: 16374898 DOI: 10.1002/pd.1346] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The in utero course of the anemic fetus has improved dramatically, owing to early diagnosis and cordocentesis transfusion. In utero invasive procedures such as amnio- and cordocentesis have become important modalities in the evaluation and treatment of anemic fetuses. However, they carry risks for both the mother and fetus. A valid and sensitive noninvasive means of following the anemic fetus is the evaluation of changes in the middle cerebral artery peak systolic flow velocity (MCA-PSV). This is a sensitive tool for both the evaluation of fetal anemia and response to treatment. Intracerebral vessels respond earliest to the fetal anemic state, and are readily accessible for ultrasound examination. We describe the methodology and evolving clinical applications of MCA-PSV measurement in the fetus, through an overview of the literature describing the development and application of MCA-PSV measurement in fetuses at risk of fetal anemia of various immune and nonimmune etiologies, illustrated by index cases from our center. MCA-PSV measurement is essential in the diagnosis, evaluation, and management of cases of fetal anemia. The use of this modality lessens the need for invasive procedures. The method is readily accessible and should be integrated into the repertoire of all obstetric ultrasound centers.
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Affiliation(s)
- Tal Imbar
- Department of Obstetrics and Gynecology, Hadassah University Hospital-Mt. Scopus, Jerusalem, Israel
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Hernandez-Andrade E, Scheier M, Dezerega V, Carmo A, Nicolaides KH. Fetal middle cerebral artery peak systolic velocity in the investigation of non-immune hydrops. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 23:442-445. [PMID: 15133792 DOI: 10.1002/uog.1009] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE In some cases of non-immune hydrops there is congenital or acquired fetal anemia. The aim of this study was to investigate the potential value of fetal middle cerebral artery peak systolic velocity (MCA-PSV) in the assessment and management of non-immune hydrops due to anemia. METHODS Fetal MCA-PSV and fetal hemoglobin concentration, in blood obtained by cordocentesis, were measured in 16 singleton pregnancies referred to our unit for further investigations because of a diagnosis of non-immune hydrops fetalis. In all cases a detailed ultrasound examination demonstrated moderate or severe ascites, with or without skin edema, and pericardial or pleural effusions. Furthermore, there were no obvious malformations to account for the hydrops. In each fetus the measured MCA-PSV and hemoglobin concentration were expressed as delta values (the difference in SD 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. In addition, we searched our database to identify the sonographic features and hemoglobin concentration of fetuses with congenital infection. RESULTS In the 16 cases of non-immune hydrops there were seven with parvovirus B19 infection, one each of alpha-thalassemia and primary cardiomyopathy and seven with no obvious explanation for the hydrops. There was a significant association between delta MCA-PSV and delta hemoglobin concentration (delta hemoglobin = (delta MCA-PSV + 0.1437)/-0.4154; R(2) = 0.7202; P < 0.0001). In 10 of the cases the fetal hemoglobin concentration was more than 4 SD below the normal mean for gestation and in all these cases the MCA-PSV was more than 2 SD above the normal mean for gestation. Our computer search identified an additional nine fetuses with parvovirus B19 infection and in all cases the predominant sonographic finding was ascites and the hemoglobin concentration was more than 4 SD below the normal mean. In contrast, only 3/14 fetuses with cytomegalovirus, toxoplasmosis, coxsackie B or Treponema infection had ascites and only 2/14 had a hemoglobin deficit of 4-6 SD. CONCLUSION In the management of non-immune hydrops, measurement of fetal MCA-PSV can help identify the subgroup with fetal anemia.
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Affiliation(s)
- E Hernandez-Andrade
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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