Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention‐to‐treat

• Published in: BJOG : an international journal of obstetrics and gynaecology 2002-07, Vol.109 (7), p.746-752
• Main Authors: Zimmermann, Roland, Durig, Peter, Carpenter, Robert J., Mari, Giancarlo
• Format: Article
• Language: English
• Subjects: Anemia - diagnostic imaging; Anemia - immunology; Anemia - physiopathology; Biological and medical sciences; Blood Flow Velocity - physiology; Cerebral Arteries - embryology; Cerebral Arteries - physiopathology; Diseases of mother, fetus and pregnancy; Erythrocytes - immunology; Female; Fetal Diseases - diagnostic imaging; Fetal Diseases - immunology; Fetal Diseases - physiopathology; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Isoantibodies - immunology; Longitudinal Studies; Management. Prenatal diagnosis; Medical sciences; Pregnancy; Pregnancy. Fetus. Placenta; Prospective Studies; Rh Isoimmunization - immunology; Rh Isoimmunization - physiopathology; Systole; Ultrasonography, Prenatal - methods
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2002.01314.x

Objective To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery combined with B‐mode ultrasound imaging to predict anaemia in an unselected population of pregnancies complicated by alloimmune antibodies known to cause immunological hydrops. Design Prospective study on an intention‐to‐treat basis. Setting Multicentre study in five large tertiary referral centres. Population One hundred twenty‐five fetuses with maternal alloantibodies known to cause immunological hydrops. Methods If peak systolic velocity and B‐mode scan were reassuring the pregnancy was monitored at 7–14 days interval. If either method showed signs of anaemia, an umbilical fetal blood sampling was performed. When the gestational age was greater than 35 weeks, labour was induced. Main outcome measure Moderate to severe anaemia at delivery. Results Overall sensitivity to detect moderate to severe anaemia below 35 weeks (haemoglobin level below 0.65 multiples of median) was 88%. Specificity was 87%; positive predictive value was 53% and negative predictive value was 98%. The diagnosis of severe anaemia was missed in one fetus; however, the final outcome was good. The method was not useful after 35 weeks. Conclusions Middle cerebral artery peak systolic velocity is a highly sensitive non‐invasive means for determining the degree of anaemia present in red blood cell alloimmunised pregnancies. The widespread use of the Doppler method will minimise fetal complications associated with amniocentesis and fetal blood sampling. Non‐invasive measurement of middle cerebral artery peak systolic velocities is more convenient and acceptable to alloimmunised pregnancies and may significantly lower health care costs. A Doppler interval of seven days is recommended.