Increasing the noninvasive management of rhesus isoimmunization

• Published in: International journal of gynecology and obstetrics 2008-06, Vol.101 (3), p.281-284
• Main Authors: Papantoniou, Nikolaos, Daskalakis, George, Anastasakis, Eleftherios, Marinopoulos, Spyros, Mesogitis, Spyros, Antsaklis, Aris
• Format: Article
• Language: English
• Subjects: Anemia - diagnostic imaging; Anemia - etiology; Anemias. Hemoglobinopathies; Biological and medical sciences; Blood Flow Velocity; Cardiovascular system; Cordocentesis; Diseases of red blood cells; Doppler assessment; Female; Fetal anemia; Fetal Blood - chemistry; Fetal Diseases - diagnostic imaging; Gestational Age; Greece; Gynecology. Andrology. Obstetrics; Hematologic and hematopoietic diseases; Hemoglobins - analysis; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Middle cerebral artery; Middle Cerebral Artery - diagnostic imaging; Obstetrics and Gynecology; Peak systolic velocity; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Outcome; Red cell alloimmunization; Rh Isoimmunization - complications; Rh Isoimmunization - diagnostic imaging; Rh Isoimmunization - therapy; Ultrasonic investigative techniques; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2007.11.021

Abstract Objective To determine the clinical outcome of isoimmunized pregnancies managed by middle cerebral artery peak systolic velocity (MCA-PSV) in an intention-to-treat study. Method Rhesus isoimmunized pregnancies were managed with serial ultrasound and Doppler studies at 7-day intervals up to 34 weeks of gestation, between 2001 and 2005. Invasive diagnostic and therapeutic procedures were carried out when MCA-PSV was indicative of moderate or severe anemia. Results The overall sensitivity in detecting moderate to severe fetal anemia at less than 34 weeks was 100% (95% confidence interval, 54.1–100.0 L). Twenty-two cases were managed with MCA-PSV. Twelve cases needed fetal blood sampling and 6 cases needed intrauterine transfusion. Cordocentesis revealed a hematocrit of more than 26% in 6 fetuses. Conclusion Management by MCA-PSV Doppler at weekly intervals is a highly sensitive method for detecting fetal anemia. It reduces the number of fetal blood samples needed and significantly lowers interventional procedures.