EP16.03: The role of middle cerebral artery Doppler in the detection of fetal anemia in pregnancy with decreased perception of fetal movements

Abstract

To analyse the role of middle cerebral artery (MCA) peak systolic velocity (PSV) in the prediction of severe fetal anemia in pregnancies with decreased perception of fetal movements and to compare it with standard cardiotocographic and biophysical assessment. This a prospective interventional study including all women with a viable singleton pregnancy who complain of reduced perception of fetal movements. Women participating were evaluated as per routine care with fetal biophysical profile assessment and these results were reported as usual. Additionally the middle cerebral artery peack sistolic velocity and the cerebroplacental ratio were assessed and the results were noted. Cytofluorimetric test for fetomaternal hemorrhage was performed if this condition was suspected. Overall we recruited 74 women who complain of decreased perception of fetal movements. Gestational age at admission was 34 ± 4 weeks and only two of these fetuses were small for gestational age (2.7 %). The cardiotocogram was non reactive in 4 cases (5.4%). Among these pregnancies the cerebral Doppler was abnormal only in one case (1.7%) and the cardiotocogram was reassuring for this patient. After an emergency Caesarean section performed at 31 weeks because of the suspected fetal anemia (peak systolic velocity < 1.4 MoM) a very anemic neonate was born. The most accurate predictor of fetal anemia was fetal MCA-PSV. CTG was sometimes abnormal but the pattern was frequently nonspecific and it was normal in the anemic fetus. We suggest to include fetal cerebral Doppler in the evaluation of patients with decreased fetal movements, particularly in those cases with ambiguous results of biophysical testing.