Diagnosis of Severe Fetomaternal Hemorrhage with Fetal Cerebral Doppler: Case Series and Systematic Review

Abstract

Objectives: To analyze the role of middle cerebral artery (MCA) peak systolic velocity (PSV) in the prediction of severe fetomaternal hemorrhage (FMH) and to compare it with standard biophysical assessment. Data Sources: Retrospective review of cases of FMH seen in our unit and systematic review of the literature. Results: We followed the MOOSE guidelines to review the literature. From 838 articles, 16 were selected. In total, 35 women, including 3 cases from our center and 32 obtained from the literature search were included. Diagnosis of FMH was always confirmed by laboratory tests. Patients were seen at 31 ± 5 weeks' gestation (range 16-39) and the most frequent indication for referral was decreased perception of fetal movements. Cardiotocography (CTG) upon admission was sinusoidal in 18 cases, nonreactive in 6, decelerative in 2 and tachycardic in one. MCA-PSV was abnormal in all cases but one. There were 2 perinatal deaths. The mean hemoglobin concentration at birth or at intrauterine transfusion was 4.8 ± 1.9 g/dl. Discussion: The most accurate predictor of FMH was fetal MCA-PSV. CTG was always abnormal but the pattern was frequently nonspecific. We suggest including fetal cerebral Doppler in the evaluation of patients with decreased fetal movements, particularly in those cases with ambiguous results of biophysical testing.

The Recurrence Risk of Fetomaternal Hemorrhage

“…The MCA-PSV recorded at admission in our cases with signs/symptoms of proven fetal anemia was abnormal in all cases, except 1. This confirms that MCA-PSV is a good indicator of severe fetal anemia independent of the etiology [14, 37, 38]. Furthermore, the mean value of MCA-PSV before each new episode of FMH was increasingly lower from the first to the third IUT.…”

Síndrome de Transfusión Feto-Materna. A propósito de dos casos.

“…Ambas madres cursaban embarazos fisiológicos bien controlados y no fue posible diagnosticar precozmente la transfusión fetomaterna, sino hasta que la anemia fetal se asoció a manifestaciones clínicas por compromiso hipóxico. De hecho, en varias publicaciones el signo clínico más frecuentemente reportado (>35%) es la disminución o ausencia de movimientos fetales 11,23 .…”

“…Teóricamente, un peak sistólico de ACM mayor a 1.5 MoM (múltiplos de la mediana) implica anemia fetal significativa. Es importante mencionar que esta técnica se relaciona con la experiencia del operador y presenta una tasa de falsos positivos de aproximadamente 12% 23 . En el caso clínico 2, el peak sistólico fue de 115 cm/s, valor mayor a 1.5 MoM, concordante con una anemia fetal severa.…”

An unusual case of rapidly progressive hemolytic anemia in the late preterm period: case report and literature review

“…study of karyotype, thalassemia, hemophilia, infections, anemia) and therapeutic (transfusion, and administration of antiarrhythmic agents, thyroid hormones or genetic therapy) objectives 12 and among them; the blood sampling for suspicion of fetal anemia is the most frequent indication (9) . We suspected this diagnosis based on the measurement of the MCA-PSV, which detects fetal anemia independently of the cause 13 and is accuracy is very acceptable. In the classic study by Mari, 14 moderate or severe anemia was detected in 100% of fetuses, with a false positive rate of 12%, when evaluating 111 fetuses of Rh-negative mothers (antibody titers >= 16) and 265 control fetuses, with a cut point of 1.5 MoM.…”