P02.02: Accuracy of middle cerebral artery blood flow velocimetry in determining anemia in fetuses undergoing intrauterine transfusion

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To study the correlation between PSV-MCA and fetal hematocrit/hemoglobin in fetuses undergoing intrauterine transfusion (IUT). Fetuses at risk of anemia and treated by IUT at San Jose Hospital were identified from a prospectively collected computerized database. Medical records were reviewed for information on pre- and post-transfusion Doppler findings and hematological values. Doppler indices obtained after January 2000 were prospectively plotted against a Mari's nomogram (N Engl J Med 2000, 342: 9–14) and used for pregnancy management. However, Doppler values obtained before that date were retrospectively analyzed for the purposes of this study. During the study period from October 1996 to April 2002, a total of 25 women underwent 52 IUTs. Among them, 32 interventions had complete information for analysis. The primary indication for surveillance was Rh isoimmunization in all cases. In 5 (16%) the PSV-MCA was normal and in the remaining 27 (4%) above the 1.29 MoM for gestational age. In 8 cases (25%) the PSV-MCA indicated mild anemia, in 3 (9%) moderate anemia and in 15 (47%) severe anemia. Among the 5 fetuses with normal PSV-MCA values, 3 had mild anemia and 2 were not anemic. Of the 8 fetuses with mild anemia according to the PSV-MCA, 5 had mild, 1 moderate, and 2 severe anemia. Of the 3 fetuses with moderate anemia according to the PSV-MCA values, 1 had no anemia and 2 had severe anemia. Of the 15 fetuses with severe anemia according to the PSV-MCA values, 1 had mild anemia, 3 moderate anemia, and 11 severe anemia. After IUT, 23 fetuses showed normal values of PSV-MCA, 7 showed values consistent with mild anemia, and 1 showed values consistent with severe anemia. According to Mari's nomogram, PSV-MCA shows a better correlation with fetal hematocrit/hemoglobin in cases of moderate and severe anemia than in cases with mild anemia. There was a significant reduction of the PSV-MCA in almost all fetuses undergoing IUT.