Abstract
As many as one fourth of fetuses at risk of immunological hydrops from maternal alloantibodies such as Rh D require intrauterine transfusion for severe anemia, and another 40% are expected to have mild to moderate hemolytic anemia and hyperbilirubinemia after delivery. Because B-mode ultrasonography does not reliably detect a fetal hemoglobin deficit at an early stage, and because umbilical fetal blood sampling carries risks of preterm delivery and abortion, this prospective study evaluated Doppler assessment of peak systolic velocity (PSV) in the middle cerebral artery. The study population consisted of 124 consecutive women carrying 125 fetuses at risk for alloimmune anemia. Women had the option of traditional management by amniocentesis and/or fetal blood sampling, or serial PSV studies. A PSV in the middle cerebral artery greater than 1.5 multiples of the median (MoM) was taken as evidence of moderate or severe fetal anemia. Doppler studies were done at 3-day to 4-week intervals. Treatment was instituted in 35 instances where the PSV was reproducibly increased. The remaining 90 fetuses had a PSV within the normal range and no indication of severe anemia on two-dimensional ultrasonography. The two groups had comparable mean gestational ages when enrolled in the study. The PSV was 88% sensitive in detecting a hemoglobin below 0.65 MoM before 35 weeks' gestation. Its specificity was 87%, and its positive and negative predictive values, 53% and 98%, respectively. Severe anemia was missed in one fetus, but the final outcome in this case was good. Estimating the PSV did not prove helpful after 35 weeks' gestation. The combination of B-mode ultrasonography and estimating PSV in the middle cerebral artery is a reliable and noninvasive alternative to fetal blood sampling for pregnancies complicated by alloantibody-induced hemolytic anemia.
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