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- Title
Prediction of Fetal Anemia in Subsequent Transfusions: Is There a Need to Change the Threshold of the Peak Systolic Velocity of the Middle Cerebral Artery?
- Authors
Radhakrishnan, Prathima; Venkataravanappa, Shailaja; Acharya, Veena; Sahana, Reeth; Shettikeri, Anitha
- Abstract
<bold>Introduction: </bold>Peak systolic velocity (PSV) of the middle cerebral artery (MCA) shows 100% sensitivity for predicting fetal anemia before the first intrauterine transfusion (IUT). However, its ability to predict subsequent transfusions has remained mostly controversial.<bold>Objectives: </bold>To assess if there is a need to change the threshold of MCA-PSV from 1.5 to 1.69 multiples of the median (MoM) to predict fetal anemia and the need for subsequent IUT.<bold>Methods: </bold>This is a retrospective audit, wherein case records of mothers who underwent IUT at the Bangalore Fetal Medicine Centre between April 2008 and May 2017 were reviewed; 86 cases were included, and the data were analyzed using MS Excel. The MCA-PSV and pretransfusion Hb were converted into MoM. 40 fetuses that had more than 1 IUT were included in the analysis. -Results: 31/40 fetuses that had >1 IUT had an MCA-PSV >1.5 MoM, of which 29 were anemic according to the post-IUT Hb MoM. 20/29 (69%) had an MCA-PSV >1.69, whereas 9/29 (31%) had an MCA-PSV between 1.5 and 1.69 MoM. Our study shows that changing the MCA-PSV threshold from 1.5 to 1.69 MoM will reduce the detection of fetal anemia and hence the need for repeat IUT by 31%.<bold>Conclusions: </bold>Increasing the fetal MCA-PSV threshold from 1.5 to 1.69 will miss out one-third of the fetuses that will require a 2nd, 3rd, or 4th IUT. This is more relevant in geographical areas where the parents must travel long distances for IUTs, which are performed in tertiary fetal care centers.
- Subjects
INDIA; ANEMIA treatment; ANEMIA diagnosis; DIAGNOSIS of fetal diseases; REFERENCE values; HEMATOCRIT; HEMOGLOBINS; GESTATIONAL age; RETROSPECTIVE studies; RH isoimmunization; CEREBRAL arteries; FETAL diseases; INTRAUTERINE blood transfusion; ANEMIA; DESCRIPTIVE statistics; HEMODYNAMICS; BLOOD flow measurement
- Publication
Fetal Diagnosis & Therapy, 2020, Vol 47, Issue 6, p491
- ISSN
1015-3837
- Publication type
journal article
- DOI
10.1159/000505398