Increased Systolic Peak Velocity in Fetal Middle Cerebral Artery Blood Flow Shown by Doppler Sonography in Acute Fetomaternal Hemorrhage

Wong, Geoffrey Yuet Mun; Levine, Deborah

doi:10.7863/jum.2005.24.2.243

Cited by 14 publications

(19 citation statements)

References 20 publications

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“…Placental vascular connections and the attendant hemodynamic changes in this group probably account for this difference. The brain-sparing effect oc- [56] Twin transfusion syndrome [57] Acute fetomaternal hemorrhage [58] Parvovirus B19 infection [59] curred commonly without clinical twin transfusion syndrome. Periods of high PSV with low PI in the MCA were followed by lower PSV in the same fetus.…”

Section: Complicated Pregnancies and Deliveriesmentioning

confidence: 99%

Fetal Cerebrovascular Circulation: A Review of Prenatal Ultrasound Assessment

Degani¹

2008

Gynecol Obstet Invest

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Antenatal intrauterine cerebrovascular events were found to play an important role in the pathogenesis of perinatal brain damage. Changes in placental vascular resistance, cardiac contractibility, vessel compliance, and blood viscosity alter the normal dynamics of fetal cerebral circulation. The circulatory mechanisms described in animal fetuses also operate in the human fetus. The isthmus of the aorta represents a watershed area reflecting the redistribution of blood during increased peripheral resistance and hypoxia. The fetal cerebrovascular system acts locally within the skull and interacts with the other components of fetal circulation to compensate by redistribution of blood in case of shortage in resources. The introduction of various sonographic techniques and the collection of data from the arterial and venous cerebral circulation have improved our understanding of the regulatory mechanisms involved in fetal cerebral hemodynamic events. Anatomical and physiological considerations of cerebral vasculature in health and disease are relevant in the research of variations in fetal brain blood perfusion. Changes in flow characteristics in fetal cerebral vasculature can be used for clinical decisions. However, caution is advised before applying research data into practice. The clinical utility is well established in situations of fetal compromise such as growth restriction and anemia.

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Section: Complicated Pregnancies and Deliveriesmentioning

confidence: 99%

Fetal Cerebrovascular Circulation: A Review of Prenatal Ultrasound Assessment

Degani¹

2008

Gynecol Obstet Invest

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“…We investigated first the indication for referral, the CTG pattern and MCA-PSV value of all cases. When more than one sonographic assessment was performed, we collected data about the first one reported (the first MCA-PSV assessment and the subsequent hemoglobin concentration before intrauterine transfusion or at birth) [8,10,13,14,[16][17][18][19][20][21][22][24][25][26] .…”

Section: Systematic Reviewmentioning

confidence: 99%

“…Identification of potentially relevant studies was carried out through abstract scanning and the full text of 628 articles was retrieved. Of these, after removal of duplicates, 16 studies were deemed appropriate to be included in the final review [8,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26] . Studies were found suitable for inclusion in the systematic review after critical appraisal according to the published guidelines we used [28] .…”

Section: Systematic Reviewmentioning

confidence: 99%

“…A decreased perception of fetal movements [7][8][9][10][11][12] and abnormal cardiotocography (CTG) [3,10] are usually present. More recently, increased peak velocities in the middle cerebral arteries (MCA-PSV) detected by Doppler ultrasound have been described [8,[13][14][15][16][17][18][19][20][21][22][23][24][25][26] . Our objective was to evaluate the role of MCA-PSV in the prediction of severe FMH and to compare it with standard methods of biophysical assessment in our own experience and in a systematic review of the available literature.…”

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confidence: 99%

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

et al. 2016

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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.

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“…In recent years, ultrasound examinations have been used to measure fetal MCA-PSV, so that fetal anemia due to FMH might be detected [8,9] . However, proper estimation of MCA-PSV is difficult in some cases such as twin pregnancies, due to fetal presentation.…”

Section: Commentsmentioning

confidence: 99%

Sinusoidal Heart Rate Patterns as a Manifestation of Massive Fetomaternal Hemorrhage in a Monochorionic-Diamniotic Twin Pregnancy: A Case Report

et al. 2010

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Objective: A case of fetomaternal hemorrhage (FMH) in monochorionic twins is reported. Method: Case report. Result: The patient felt a decrease in fetal movements at 32 gestational weeks. Cardiotocography showed sinusoidal heart rate patterns in both fetuses. The fetal hemoglobin level in maternal blood was 6.6% (normal 0.0–1.0%). Since the patient was diagnosed with massive FMH, cesarean section was performed and both babies delivered to receive neonatal treatment. Severe anemia was apparent in both infants, based on red blood cell count, hemoglobin concentration, and hematocrit of 86 × 10 and 85 × 10⁴/mm³ (normal 376–456 × 10⁴/mm³), 3.1 g/dl each (normal 10.9–13.5 g/dl), and 10.7 and 10.4% (normal 32.2–41.2%), respectively. Severe anemia may develop in both fetuses following massive FMH in monochorionic twins. As such, if abnormal circulation is detected in 1 monochorionic twin, the other fetus will also require special attention.

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Increased Systolic Peak Velocity in Fetal Middle Cerebral Artery Blood Flow Shown by Doppler Sonography in Acute Fetomaternal Hemorrhage

Cited by 14 publications

References 20 publications

Fetal Cerebrovascular Circulation: A Review of Prenatal Ultrasound Assessment

Fetal Cerebrovascular Circulation: A Review of Prenatal Ultrasound Assessment

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

Sinusoidal Heart Rate Patterns as a Manifestation of Massive Fetomaternal Hemorrhage in a Monochorionic-Diamniotic Twin Pregnancy: A Case Report

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