Performance of fetal middle cerebral artery peak systolic velocity for prediction of anemia in untransfused and transfused fetuses: systematic review and meta‐analysis

Martínez-Portilla, Raigam Jafet; López-Félix, Jana; Hawkins-Villareal, Ameth; Villafán-Bernal, José Rafael; Miño, F. Paz y; Figueras, F.; Borrell, Antoni

doi:10.1002/uog.20273

Cited by 45 publications

(38 citation statements)

References 51 publications

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“…The first large series investigating the performance of MCA-PSV in the prediction of moderate or severe fetal anemia reported an extremely high sensitivity and specificity, both in the setting of alloimmunization (100% and 88%, respectively) 130 and in the setting of parvovirus infection (94% and 93%, respectively) 128 . Several publications followed, reporting similar performance 131,132 , and a 2019 meta-analysis reported a sensitivity of 79% and specificity of 73% for the prediction of moderate/severe fetal anemia (of any cause), when using 1.5 MoM as the cut-off for MCA-PSV 133 .…”

Section: Management Of Maternal and Fetal Parvovirus B19 Infectionmentioning

confidence: 88%

ISUOG Practice Guidelines: role of ultrasound in congenital infection

Khalil

Sotiriadis

Chaoui³

et al. 2020

Ultrasound in Obstet & Gyne

130

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ISUOG Practice Guidelines: role of ultrasound in congenital infection Clinical Standards Committee The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, and high-quality teaching and research related to diagnostic imaging in women's healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care, because interpretation of the evidence that underpins the Guidelines may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG (

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Section: Management Of Maternal and Fetal Parvovirus B19 Infectionmentioning

confidence: 88%

ISUOG Practice Guidelines: role of ultrasound in congenital infection

Khalil

Sotiriadis

Chaoui³

et al. 2020

Ultrasound in Obstet & Gyne

130

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“…Fetal MCA Doppler may also be used for the determination of subsequent IUTs. The study of Martínez-Portilla et al [22] provided further evidence that MCA-PSV ≥1.5 multiples of the median is a moderate predictor of moderate-severe anemia in untransfused fetuses, but its accuracy significantly declines with an increasing number of IUTs.…”

Section: Discussionmentioning

confidence: 99%

The Outcome of Hemolytic Disease of the Fetus and Newborn Caused by Anti-Rh17 Antibody: Analysis of Three Cases and Review of the Literature

Dajak

Ipavec

Cuk

et al. 2019

Transfus Med Hemother

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Background: Anti-Rh17 is a rare red blood cell (RBC) antibody to high-frequency antigens that may cause severe hemolytic disease of the fetus and newborn (HDFN). Despite the rarity of HDFN caused by Anti-Rh17, this antibody was reported in many different populations. Emergency transfusions, especially exchange transfusions, present a huge problem if no compatible RBCs of phenotype D-- are available. Methods: Here we report obstetrical histories of three women and describe their pregnancies complicated by anti-Rh17 antibodies. We summarized published cases of pregnancies complicated by anti-Rh17 and reviewed transfusion treatment and outcomes. Additionally, a simplified flowchart for the management of such pregnancies is proposed. Results: Four pregnancies were affected by severe HDFN, and three of them ended with perinatal death. In the fourth case, the baby was born hydropic and icteric and the condition was rapidly deteriorating. Emergency exchange transfusion was performed with incompatible O-negative RBC units in AB-negative plasma. The baby was discharged on the 14th day in good health. In the available literature, 15 women and 22 pregnancies were reported, 20 of them developed severe HDFN. According to the data, intrauterine transfusion for treatment of HDFN was the most common form of treatment with the donation of the mother’s blood. Different options for exchange transfusion were described, including incompatible RBCs. Conclusion: In more than 90% of described pregnancies of HDFN caused by anti-Rh17 antibody, transfusion treatment was required. Therefore, RBC from D-- phenotype has to be available. According to published data, in emergent circumstances when maternal and blood from donor with phenotype D-- is not available, incompatible exchange transfusion is a better choice than delaying transfusion when it is necessary. It is of essential importance that pregnancies with high risk of HDFN due to anti-Rh17 are managed by a multidisciplinary team (transfusion medicine specialist, obstetrician, neonatologist) in a highly specialized tertiary institution.

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“…Detection of antenatal TAPS is crucial, as it affects management of the pregnancy [18,30] and gives patients the information necessary to choose how they wish to proceed with their pregnancies. MCA-PSV Doppler measurement is a non-invasive test that has become the standard assessment for diagnosis of fetal anemia in singletons in a variety of fetal diseases with high diagnostic accuracy [31] and high diagnostic accuracy for moderate-severe anemia in transfused and untransfused singletons [32].…”

Section: Introductionmentioning

confidence: 99%

“…In addition to cut-off values, whether or not a fetus has been transfused can also affect the accuracy of MCA-PSV Doppler measurements for TAPS. A 2019 meta-analysis by Martinez-Portilla et al examined observational studies evaluating the performance of MCA-PSV using a 1.5 MoM threshold for the prediction of fetal anemia [32]. The reference standard was fetal anemia by blood sampling.…”

Section: Introductionmentioning

confidence: 99%

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Dispelling Myths about Antenatal TAPS: A Call for Action for Routine MCA-PSV Doppler Screening in the United States

Nicholas

Fischbein

Aultman

et al. 2019

JCM

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In the United States, routine middle cerebral artery peak systolic velocity (MCA-PSV) Doppler screening for the detection of antenatal twin anemia-polycythemia sequence (TAPS) is not recommended. The current and only national clinical guideline from the highly-influential Society for Maternal-Fetal Medicine states that, “There is no evidence that monitoring for TAPS with MCA PSV Doppler at any time, including > 26 weeks, improves outcomes, so that this additional screening cannot be recommended at this time.” We argue this recommendation has disproportionate influence on patients and the care they are offered and receive. We use current evidence to highlight and dispel pervasive myths surrounding antenatal TAPS and the value of routine MCA-PSV screening. An ethical framework that illustrates the importance of giving patients the opportunity for routine screening is presented. Findings demonstrate that: (1) both spontaneous and post-laser TAPS is a serious, potentially life-threatening complication, (2) treatment for TAPS is effective and includes expectant management, intrauterine transfusion (IUT), or surgery, (3) and routine MCA-PSV, which has satisfactory diagnostic accuracy, is currently the only way to provide early detection of TAPS. We conclude that routine TAPS screening is a medically proven valuable resource that should be offered to patients in need and to the clinicians who are trying to act toward their benefit.

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Performance of fetal middle cerebral artery peak systolic velocity for prediction of anemia in untransfused and transfused fetuses: systematic review and meta‐analysis

Cited by 45 publications

References 51 publications

ISUOG Practice Guidelines: role of ultrasound in congenital infection

ISUOG Practice Guidelines: role of ultrasound in congenital infection

The Outcome of Hemolytic Disease of the Fetus and Newborn Caused by Anti-Rh17 Antibody: Analysis of Three Cases and Review of the Literature

Dispelling Myths about Antenatal TAPS: A Call for Action for Routine MCA-PSV Doppler Screening in the United States

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