Fetal middle cerebral artery Doppler to time intrauterine transfusion in red‐cell alloimmunization: a randomized trial

Abstract

Both Doppler measurement of MCA-PSV and estimation of the decrease in fetal Hct or hemoglobin can be used to determine the timing of second and subsequent IUTs in fetuses with red-cell alloimmunization. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

The near disappearance of fetal hydrops in relation to current state‐of‐the‐art management of red cell alloimmunization

“…We hypothesize that this is mainly due to the implementation of national guidelines on management of alloimmunization in pregnancy, covering screening, laboratory, and clinical monitoring and protocols for timely referral to the (single) fetal therapy center. The hydrops rates we found are comparable with those reported in other Western countries with similar screening programs, which vary between 8% and 16% . A study from Belgium also reported severe hydrops in 5% of red cell–immunized pregnancies…”

“…The hydrops rates we found are comparable with those reported in other Western countries with similar screening programs, which vary between 8% and 16%. [17][18][19][20][21][22][23] A study from Belgium also reported severe hydrops in 5% of red cell-immunized pregnancies. 18 Although the hydrops rate in pregnancies complicated by K antibodies has declined impressively since the introduction of routine first-trimester antibody screening, the odds of developing hydrops are still 3.5 times higher than when D immunization and transfusions are performed approximately 3 weeks earlier in anti-K cases.…”

The utility of MRI for measuring hematocrit in fetal anemia

“…Strengths and limitation MRI can directly estimate a wide range of hematocrit because it utilizes the physical property of blood while MCA Doppler measures a dynamic response of the cardiovascular system, which has a nonlinear range. Dodd et al 23 recently showed that the use of expected daily decline of hemoglobin or hematocrit after the transfusion is comparable with MCA Doppler for timing the following transfusions. However, this approach is limited to the diagnosis of hemolytic fetal anemia, while our research shows that the MRI estimates of fetal hematocrit is equally accurate in the setting of other causes of fetal anemia.…”

Medical therapy to attenuate fetal anaemia in severe maternal red cell alloimmunisation

“…Doppler colour flow ultrasound to measure the fetal middle cerebral artery peak systolic velocity (MCA‐PSV) is commonly utilised as a non‐invasive screening test with an acceptable sensitivity and specificity for detecting (and excluding) fetal anaemia 29–32 and has led to the near disappearance of fetal hydrops at presentation 33 . This has replaced the assessment of OD450 in amniotic fluid but care should be practiced in using this screening test in timing serial intrauterine transfusions 34 . Fetal hydrops is an abnormal collection of fluid visualised by ultrasound in two or more body compartments (usually pericardial or pleural effusions, ascites or skin oedema) 35 .…”