Diagnostic Accuracy of Fetal Middle Cerebral Artery Peak Systolic Velocity in the Detection of Fetal Anaemia Keeping Neonatal Hae Moglobin Estimation at Birth as the Gold Standard
DOI:
https://doi.org/10.51253/pafmj.v74i2.9605Keywords:
Anaemia, Fetus, Middle cerebral artery (MCA), Neonatal haemoglobin estimationAbstract
Objective: To assess whether monitoring the peak systolic velocity (PSV) in the middle cerebral artery (MCA) was a useful,
non-invasive method for predicting anaemia in fetuses.
Study Design: Cross-sectional study
Place and Duration of Study: Armed Forces Institute of Radiology, Rawalpindi Pakistan, from Feb and Aug 2022.
Methodology: Fifty pregnant women who did not have hydropic babies were included. The peak systolic velocity (PSV) was
measured in the middle cerebral artery (MCA). A positive result was determined when the MCA-PSV value exceeded 1.5
multiples of the median (MoM). The blood samples obtained from neonates were forwarded to the hospital laboratory to
estimate haemoglobin levels shortly after birth. The outcome of the method (MoM) was observed and subsequently compared
with neonatal haemoglobin levels.
Results: 60% of neonates were anaemic according to middle MCA-PSV while the haematology laboratory reported 74% of
neonates as anaemic according to cut-off haemoglobin of less than 13.5gm/dl. Sensitivity, specificity, positive predictive value
(PPV), negative predictive value (NPV), and accuracy of the MCA-PSV in detecting the anaemia were 93.75%, 61.1%, 81.08%,
84.62%, and 82%, respectively.
Conclusion: MCA-PSV Doppler is deemed valuable as a diagnostic technique for fetal anaemia, albeit secondary to the
primary approach of neonatal haemoglobin estimation upon birth.
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References
Bowman JM. Hemolytic disease (erythroblastosis fetalis).
Maternal fetal medicine, 4th ed. Philadelphia: WB Saunders, 1999.
Van Kamp IL, Klumper FJ, Bakkum RS, Oepkes D, Meerman RH,
Scherjon SA, et al. The severity of immune fetal hydrops is
predictive of fetal outcome after intrauterine treatment. Am J
Obstet Gynecol 2001; 185(3): 668-673.
https://doi.org/10.1067/mob.2001.116690
Soothill P. Fetal blood sampling before labor. High risk
pregnancy, management options. London: WB Saunders, 1999.
Nicolaides KH, Rodeck CH, Mibashan RS, Kemp JR. Have Liley
charts outlived their usefulness? Am J Obstet Gynecol 1986;
(1): 90-94. https://doi.org/10.1016/0002-9378(86)90085-2
Weiner CP, Okamwa K. Diagnostic fetal blood samplingtechnique related losses. Fetal Diagn Ther 1996;11(3): 169-175.
https://doi.org/10.1159/000264298
Hadley AG, Wilkes A, Goodrick J, Penman D, Soothill P, Lucas G,
et al. The ability of the chemiluminescence test to predict clinical
outcome and the necessity for amniocenteses in pregnancies at
risk of haemolytic disease of the newborn. BJOG; 105(2): 231-234.
https://doi.org/10.1111/j.1471-0528.1998.tb10059.x
Delle LC, Buck G, Grab D, Terinde R. Prediction of fetal anemia
with Doppler measurement of the middle cerebral artery peak
systolic velocity in pregnancies complicated by maternal blood
group alloimmunization or parvovirus B19 infection. Ultrasound
Obstet Gynecol 2001; 18(3): 232-236.
https://doi.org/10.1046/j.0960-7692.2001.00540.x
Dukler D, Oepkes D, Seaward G, Windrim R, Ryan G. Noninvasive tests to predict fetal anemia: a study comparing Doppler
and ultrasound parameters. American J Obstet Gynecol 2003;
(5): 1310-1314. https://doi.org/10.1067/mob.2003.265
Brennand J. Middle cerebral artery Doppler. Aust J Ultrasound
Med 2009; 12(3): 35.
https://doi.org/10.1002/j.2205-0140.2009.tb00058.x
Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise
KJ Jr, et al. Non-invasive diagnosis by Doppler ultrasonography
of fetal anemia due to maternal red-cell alloimmunization. N Eng
J Med; 2000; 342(1): 9-14.
https://doi.org/10.1056/NEJM200001063420102
Schenone MH, Mari G, The MCA Doppler and its role in the
evaluation of fetal anemia and fetal growth restriction. Clin
Perinatol 2011; 38(1): 83-102.
https://doi.org/10.1016/j.clp.2010.12.003
Hanif F, Drennan K, Mari G. Variables that affect the middle
cerebral artery peak systolic velocity in fetuses with anemia and
intrauterine growth restriction. Am J Perinatol 2007; 24(08): 501-
https://doi.org/10.1055/s-2007-986683
Teixeira JM, Duncan K, Letsky E, Fisk NM. Middle cerebral
artery peak systolic velocity in the prediction of fetal anemia.
Ultrasound Obstet Gynecol 2000; 15(3): 205-208.
https://doi.org/10.1046/j.1469-0705.2000.00070.x
Ahmed B, Ghaffari Z, Ismail RS, Saleh N. Non-invasive
diagnosis of fetal anemia due to maternal red-cell
alloimmunization. Saudi Med J 2005; 26(2): 256-259.
Mari G, Rahman F, Olofsson P, Ozcan T, Copel JA. Increase of
fetal hematocrit decreases the middle cerebral artery peak
systolic velocity in pregnancies complicated by rhesus
alloimmunization. J Matern Fetal Med 1997; 6(4): 206-208.
https://doi.org/10.1002/(SICI)15206661(199707/08)6:4<206::AI
D-MFM3>3.0.CO;2-N
Moise KJ Jr. The usefulness of middle cerebral artery Doppler
assessment in the treatment of the fetus at risk for anemia. Am J
Obstet Gynecol 2008; 198(2): 161.
https://doi.org/10.1016/j.ajog.2007.10.788
Ghidini A, Sepulveda W, Lockwood CJ, Romero R.
Complications of fetal blood sampling. Am J Obstet Gynecol
; 168(5): 1339-1344.
https://doi.org/10.1016/s0002-9378(11)90761-3
Johnstone-Ayliffe C, Prior T, Ong C, Regan F, Kumar S. Early
procedure-related complications of fetal blood sampling and
intrauterine transfusion for fetal anemia. Acta Obstet Gynecol
Scand 2012; 91(4): 458-462.