Noninvasive methods of detecting fetal anaemia: a systematic review and meta‐analysis

Abstract

Objectives To estimate in a systematic review of the literature the diagnostic value of ultrasound and Doppler blood flow velocity in the evaluation of fetal anaemia.Study selection and data extraction Literature from 2000 to 2008 was identified using MEDLINE and EMBASE, the Cochrane Library and relevant specialist register of the Cochrane Collaboration, and by checking reference lists of known primary studies and review articles. Studies were selected if the accuracy of the fetal ultrasound parameters or Doppler studies of blood flow in the fetal vessels was estimated compared with a reference standard. Data from the selected studies were abstracted as 2 · 2 tables comparing the diagnostic test result with the reference standard. Results were pooled where appropriate. Diagnostic accuracy was expressed as likelihood ratios.Results Twenty-five primary studies were identified containing suitable data on middle cerebral artery Doppler peak systolic velocity (MCA-PSV). The largest group of studies whose data could be pooled containing nine studies gave a positive likelihood ratio of 4.30 (95% CI: 2.50 to 7.41) and a negative likelihood ratio of 0.30 (95% CI: 0.13 to 0.69) for 675 cases in detecting severe anaemia in the analysis.Discussion Although middle cerebral artery peak systolic velocity Doppler has limited diagnostic accuracy, it remains the gold standard for noninvasive screening of fetal anaemia.

Fetal myocardial peak systolic strain before and after intrauterine red blood cell transfusion – a tissue Doppler imaging study

“…Mari et al [20] showed that the maximum blood stream velocity ( V max ) in the MCA correlates with the severity of fetal anemia, establishing the threshold to normal as 1.5 times the age-appropriate median of systolic V max of blood fl ow in the MCA. These fi ndings were confi rmed by others, and the velocity threshold was introduced into clinical routine to detect fetal anemia of immune, infectious, or other origin [22,28,29,33] .…”

Phenotypic Analyses of T, B, NK and NKT Cells in a Human Fetus with D and C Alloimmune Anemia

“…Approximately 10% of alloimmunised women have a child affected in the uterus by severe hemolytic anemia. These pregnancies therefore require proper monitoring with ultrasonography and evaluation of the middle cerebral artery peak systolic velocity (MCA-PSV), which is considered the gold standard for noninvasive diagnosis of fetal anemia [9], and is effective for identification of the correct time for treatment to prevent fetal hydropsy [9,10]. …”

Management of Fetal Hydrops due to Maternal Antibodies against a Low Incidence Paternal Red Cell Antigen: A Novel Insight from Clinical Practice

“…It is now generally accepted that although MCA Dopplers have limited diagnostic accuracy in mild anaemia, it has been shown to be highly predictive of moderate-to-severe fetal anaemia. Evidence supports the use of MCA Dopplers to predict fetal anaemia of any cause [6,7]. Results from the MCA Dopplers can be used to help time in utero blood sampling and transfusion appropriately to maximise fetal outcome and minimise fetal risk by unnecessary intervention.…”