Middle cerebral artery peak systolic velocity to predict fetal hemoglobin levels in twin anemia–polycythemia sequence

• Published in: Ultrasound in obstetrics & gynecology 2015-10, Vol.46 (4), p.432-436
• Main Authors: Slaghekke, F., Pasman, S., Veujoz, M., Middeldorp, J. M., Lewi, L., Devlieger, R., Favre, R., Lopriore, E., Oepkes, D.
• Format: Article
• Language: English
• Subjects: Accuracy; Anemia; Anemia - blood; Anemia - diagnosis; Anemia - diagnostic imaging; Anemia - therapy; Blood Flow Velocity - physiology; Diseases in Twins - blood; Diseases in Twins - diagnosis; Diseases in Twins - diagnostic imaging; Diseases in Twins - embryology; Doppler; Female; fetal anemia; Fetal Diseases - blood; Fetal Diseases - diagnosis; Fetal Diseases - diagnostic imaging; Fetal Diseases - therapy; Fetal Hemoglobin - metabolism; fetal polycythemia; Fetofetal Transfusion - blood; Hemoglobin; Humans; Infant, Newborn; MCA‐PSV; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - embryology; monochorionic twins; Polycythemia - blood; Polycythemia - diagnosis; Polycythemia - diagnostic imaging; Polycythemia - therapy; Predictive Value of Tests; Pregnancy; Pregnancy, Twin; Reproducibility of Results; Retrospective Studies; Treatment Outcome; Twins, Monozygotic; Ultrasonography, Doppler, Color - methods; Ultrasonography, Prenatal - methods
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.14925

ABSTRACT Objective To evaluate the diagnostic accuracy of middle cerebral artery peak systolic velocity (MCA‐PSV) Doppler measurements in prediction of hemoglobin levels in twin anemia–polycythemia sequence (TAPS). Methods This study involved a consecutive cohort comprising monochorionic twin pregnancies complicated by TAPS managed at three European fetal medicine centers between 2005 and 2013. The accuracy of MCA‐PSV, measured immediately prior to fetal hemoglobin (Hb) measurement by fetal or cord blood sampling, for prediction of anemia and polycythemia was assessed using 2 × 2 tables. Results A total of 116 measurements (74 recorded in donors and 42 in recipients) from 43 twin pregnancies complicated by TAPS were available for analysis. MCA‐PSV multiples of the median (MoM) values correlated well with Hb levels (r = − 0.86; P  5 SD below the mean) in TAPS donors was 94% (95% CI, 85–98%); specificity was 74% (95% CI, 62–83%); positive and negative predictive values were 76% (95% CI, 65–85%) and 94% (95% CI, 83–98%), respectively. The sensitivity of MCA‐PSV ≤ 1.0 MoM to predict polycythemia (Hb level > 5 SD above the mean) in TAPS recipients was 97% (95% CI, 87–99%); specificity was 96% (95% CI, 89–99%); positive and negative predictive values were 93% (95% CI, 81–97%) and 99% (95% CI, 93–100%), respectively. Conclusion MCA‐PSV measurement has high diagnostic accuracy for predicting abnormal Hb levels in fetuses with TAPS. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.