American Journal of Obstetrics & Gynecology
Volume 193, Issue 3, Supplement , Pages 1117-1120, September 2005

Correlation between middle cerebral artery peak systolic velocity and fetal hemoglobin after 2 previous intrauterine transfusions

  • Giancarlo Mari, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Wayne State University, Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI
    • Corresponding Author InformationReprints not available from the authors. Address correspondence to Giancarlo Mari, MD, Hutzel Women's Hospital, 4th Floor Rush Center-PRB Obstetrics and Gynecology, 3990 John R., Detroit, MI 48201.
    • ,
  • Roland Zimmermann, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University Hospital of Zurich, Zurich, Switzerland
    • ,
  • Kenneth J. Moise Jr., MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
    • ,
  • Russell L. Deter, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX

Received 1 March 2005; received in revised form 28 May 2005; accepted 2 June 2005.

Objective

The middle cerebral artery peak systolic velocity (MCA-PSV) has been successfully used for timing the first 2 transfusions in fetuses at risk for anemia because of maternal red cell alloimmunization. The objective of this study was to assess whether the correlation between the MCA-PSV and fetal hemoglobin is maintained in fetuses that had undergone 2 previous intrauterine transfusions.

Study design

Doppler measurement of MCA-PSV was performed before cordocentesis in 39 fetuses. The timing of the third transfusion was based on traditional criteria. The values of MCA-PSV and hemoglobin were expressed as multiples of the median (MoM). Anemia was defined as mild (hemoglobin <0.84 MoM for a given gestational age, moderate (hemoglobin <0.65 MoM), and severe (hemoglobin <0.55 MoM). Regression analysis was used to assess the correlation between the MCA-PSV MoM and fetal hemoglobin MoM.

Results

Gestational age at Doppler study ranged from 22 to 35 weeks. Six fetuses (15%) had normal hemoglobin concentration; 21 (53%) had mild anemia; 7 (20%) had moderate anemia; and 5 (12%) had severe anemia. There was a linear correlation between fetal hemoglobin (y) and the MCA-PSV (x): y=1.185 − 0.341x.

Conclusion

Previously, concerns have been expressed about the accuracy of Doppler prediction of anemia after previous transfusions. Our data suggest that there is a good correlation between the MCA-PSV and fetal hemoglobin in fetuses that have undergone 2 previous transfusions. Our findings expand the clinical situation in which Doppler can be used to monitor red cell alloimmunized pregnancies.

Key words: Fetal anemia, Red cell alloimmunization, Middle cerebral artery, Peak systolic velocity, Ultrasound, Intrauterine transfusion

 

 Presented at the Twenty-Fifth Annual Meeting of the Society for Maternal Fetal Medicine, February 7-12, 2005, Reno, Nev.

PII: S0002-9378(05)00981-6

doi:10.1016/j.ajog.2005.06.078

American Journal of Obstetrics & Gynecology
Volume 193, Issue 3, Supplement , Pages 1117-1120, September 2005