Noninvasive Diagnosis Of Fetal Anemia Research Articles

Non-invasive diagnosis of fetal anemia: Multicentric nationwide input for a worldwide output

PurposeTo perform a nationwide multicentric validatation of the nomogram of fetal middle cerebral artery peak systolic velocity (MCA-PSV); previously constructed by us and to compare and contrast it with similar studies in the world for an effective output. Materials and methodsFetal MCA-PSV was measured in normal 1015 pregnant women attending the antenatal ultrasound clinic at least once between 12 and 40 weeks of gestation (35 patients per week of gestation), at this institute and a nomogram was constructed. MCA-PSV in 30 patients each at 12, 24 and 36 weeks of gestation (GA) were measured at multiple centers [other institutes by different observers] in this nation. Their mean values were compared with the mean values mentioned in the nomogram prepared by us. Similarly the linear correlation diagrams as well as the regression equations of this large local study were compared with those from other worldwide published studies. Statistical analysis was done using the SPSS 12 software. ResultsA nationwide comparison of the mean and standard deviation (SD) values of MCA-PSV at 12, 24 and 36 weeks of gestation calculated at 95% confidence interval, in our study with studies from different other centers, using ANOVA the calculated F value was far too high than the table value. So, null hypothesis that the nomogram previously prepared by us at this center can be comfortably followed at other centers in this nation is rejected. Comparative analysis of linear correlation between GA (weeks) and MCA-PSV (cm/s) in our study and other studies also displayed a disparity. ConclusionsA significant difference was found between local study and multicentric nation wide studies, as well as between local values and worldwide values. A multicentric nationwide input for a worldwide output thus enabled us not only to construct and compare normal local reference range of fetal MCA-PSV but also to validate it effectively and to realize its limitations. Hence it is time to say goodbye to the “One Size Fits All Theory” of fetal MCA-PSV and to welcome efforts to scientifically construct regional reference range all over the world.

A Study of Fetal Middle Cerebral Artery Peak Systolic Velocity to Diagnose Fetal Anemia in Rural Obstetric Population

ABSTRACTGlobally, fetal middle cerebral artery peak systolic velocity (MCA-PSV) is used for noninvasive diagnosis of fetal anemia. Although, incidence of anemia is common in rural setup, scientific studies describing utilization of this modality are lacking. This study throws light on how the use of fetal MCAPSV to diagnose fetal anemia can help in the decision-making process even in a rural setup.ContextFetal anemia can be adequately tackled only if it is diagnosed on time. Fetal MCA-PSV has the potential to reliably predict fetal anemia. Scientific studies across the globe are testimony to this fact. As such studies from rural setups are lacking, this study was initiated.AimsA study of fetal middle cerebral artery peak systolic velocity to diagnose fetal anemia in rural obstetric population.Settings and designThe study was conducted in the ultrasound section of a rural medical college. Clearance from institutional ethical and research committee was obtained. Written informed consent was obtained from the pregnant mother. A prospective observational study was conducted over the last 12 months.Materials and methodsFetal MCA-PSV was measured in 26 pregnant women referred for ultrasound due to clinical suspicion of fetomaternal abnormality. Middle cerebral artery peak systolic velocity was measured by a single experienced radiologist on color Doppler ultrasound machine.Statistical analysis usedThe observations were entered in Microsoft Excel sheet, and statistical analysis was done by comparing with internationally accepted values at that gestational age. Karl Pearson's correlation coefficient was used to study the relation between fetal MCA-PSV and gestational age. Standard t-test was used to study the significance of difference.ResultsThere was a steady increase in MCA-PSV with rising gestational age suggestive of positive correlation between them. When compared with internationally accepted values, significantly raised fetal MCA-PSV values were seen in six patients. These patients were followed up and the cause of fetal anemia in each was identified.ConclusionFetal MCA-PSV can be successfully used to evaluate for anemia in fetuses in a rural setup provided correct methods are followed. An attempt to measure fetal MCA-PSV in face of every fetomaternal adversity is recommended so that none of the cases of fetal anemia go undiagnosed.Key messagesProper knowledge and routine measurement of fetal MCA-PSV value can be a life saving noninvasive practice to diagnose fetal anemia in a rural setup.How to cite this articleKachewar S, Gandage SG, Pawar HJ. A Study of Fetal Middle Cerebral Artery Peak Systolic Velocity to Diagnose Fetal Anemia in Rural Obstetric Population. Int J Infertility Fetal Med 2013;4(3):83-87.

Noninvasive diagnosis of fetal anemia in RH-alloimmunized pregnancies by color Doppler

INTRODUCTION Fetal anemia is usually diagnosed by invasive procedures, such as amniocentesis and cordocentesis. As these procedures carry a substantial risk for pregnancy loss, a nonivasive method for diagnosing fetal anemia is needed. Doppler allows measurement of blood flow velocity in fetal vessels. In anemic fetuses increased velocities in medial cerebral artery (MCA) are registered. The aim of our study was to evaluate if there were changes in blood flow waveforms in anemic fetuses' MCA, and if these changes correlated with values of fetal hematological parameters. A clinical study evaluated 172 pregnancies of gestational age between 28 and 32 weeks, in which cordocentesis was performed due to maternal Rh-alloimmunization. During sonographic examination we evaluated blood flow velocities and pulsatility index (Pi) in MCA. We registered hematological parameters such as hemoglobin and hematocrit. Based on hemoglobin levels, all fetuses were divided into four groups: nonanemic (140 g/l); mild anemia (120-139.9 g/l); moderate anemia (100-119.9 g/l) and severe anemia requiring intrauterine transfusion (99.9 g/l). We compared mean systolic velocities and Pi between groups and studied the correlation between MCA mean systolic velocities and hemoglobin and hematocrit values. Statistical analysis was done using ANOVA test and parameter linear correlation. The difference was considered to be significant if p < 0. 05. Out of 172 fetuses, 60 (34.09%) were nonanemic, 56 (31.82%) showed mild anemia, 56 (31.82%) moderate anemia and 24 (13.64%) fetuses had severe anemia. Anemic fetuses had significantly higher MCA flow velocities compared to nonanemic fetuses. Values of Pi decreased in severe forms of fetal anemia, but the difference wasn't significant. Levels of hemoglobin and hematocrit showed inverse correlation with the values of MCA mean systolic velocities, while correlation with the values of Pi wasn't observed. Cerebral blood flow velocity in medial cerebral artery was assessed to diagnose fetal anemia. MCA mean systolic velocity is increased in anemic fetuses and correlates with the degree of anemia. The main advantage of this parameter is that advanced software programs are not necessary. We can conclude that in cases of Rh-alloimmunization in anemic fetuses increased MCA mean systolic velocities are registered. There is an inverse correlation between MCA mean systolic velocities and hemoglobin and hematocrit values. We suggest that measurements of MCA mean systolic velocities should be used in fetuses at risk for anemia and in selection of fetuses requiring invasive procedures.

Fetal anemia: new technologies.

The purpose of this review is to summarize recently published studies on noninvasive diagnosis of fetal anemia in order to give recommendations for the use of these new tools. Red cell alloimmunization remains one of the most common causes of fetal anemia. Amniocentesis and cordocentesis have been used for many years to diagnose fetal anemia due to red cell aloimmunization. These techniques, however, are invasive and many complications are associated with their use. Noninvasive diagnosis of fetal anemia has been performed with Doppler ultrasonography. Based on robust data, several authors recommend the use of middle cerebral artery peak systolic velocity in the management of fetuses at risk for anemia because of red cell alloimmunization. This Doppler parameter can also diagnose fetal anemia due to other conditions. Middle cerebral artery peak systolic velocity appears to be the best test for the noninvasive diagnosis of fetal anemia. It is important to emphasize that training of sonographers and sonologists is the 'conditio sine qua non' for the correct sampling of the middle cerebral artery.

Noninvasive Diagnosis of Fetal Anemia by Doppler Ultrasonography

Noninvasive Diagnosis of Fetal Anemia by Doppler Ultrasonography