Conventional management of maternal red cell alloimmunization compared with management by Doppler assessment of middle cerebral artery peak systolic velocity

Leonardo Pereira, Thomas M. Jenkins, Vincenzo Berghella

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

OBJECTIVE: This study was undertaken to compare management of red blood cell alloimmunization by Doppler measurement of middle cerebral artery peak systolic velocity (MCA-PSV) to conventional management with amniocentesis. STUDY DESIGN: A historical cohort of 28 fetuses at risk for anemia caused by red blood cell alloimmunization was followed between 1999 and 2002 at a single institution. The decision to perform percutaneous umbilical cord blood sampling (PUBS) was based on conventional management. MCA-PSV Doppler was measured before amniocentesis or PUBS but not used clinically. RESULTS: Twenty-eight fetuses were followed up: 4 had severe anemia, 1 had moderate anemia, 3 had mild anemia, and 20 were nonanemic. Conventional management had a sensitivity and positive predictive value for moderate-to-severe anemia of 80% and 44%, with a false-positive rate of 56%. In the same patients, MCA-PSV Doppler had a sensitivity and positive predictive value for moderate-to-severe anemia of 100% and 71%, with a false-positive rate of 28%. CONCLUSION: Compared with conventional management, MCA-PSV Doppler may have a better predictive accuracy for moderate-to-severe fetal anemia in red blood cell alloimmunization. Management by MCA-PSV Doppier may eliminate the need for amniocentesis and reduce the number of PUBS performed in red blood cell-alloimmunized pregnancies.

Original languageEnglish (US)
Pages (from-to)1002-1006
Number of pages5
JournalAmerican Journal of Obstetrics and Gynecology
Volume189
Issue number4
DOIs
StatePublished - Oct 2003
Externally publishedYes

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Cordocentesis
Middle Cerebral Artery
Anemia
Mothers
Amniocentesis
Erythrocytes
Fetal Blood
Fetus
Pregnancy

Keywords

  • Doppler
  • Fetal anemia
  • Hemolytic disease of the newborn infant
  • Middle cerebral artery peak systolic velocity
  • Red blood cell alloimmunization

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

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title = "Conventional management of maternal red cell alloimmunization compared with management by Doppler assessment of middle cerebral artery peak systolic velocity",
abstract = "OBJECTIVE: This study was undertaken to compare management of red blood cell alloimmunization by Doppler measurement of middle cerebral artery peak systolic velocity (MCA-PSV) to conventional management with amniocentesis. STUDY DESIGN: A historical cohort of 28 fetuses at risk for anemia caused by red blood cell alloimmunization was followed between 1999 and 2002 at a single institution. The decision to perform percutaneous umbilical cord blood sampling (PUBS) was based on conventional management. MCA-PSV Doppler was measured before amniocentesis or PUBS but not used clinically. RESULTS: Twenty-eight fetuses were followed up: 4 had severe anemia, 1 had moderate anemia, 3 had mild anemia, and 20 were nonanemic. Conventional management had a sensitivity and positive predictive value for moderate-to-severe anemia of 80{\%} and 44{\%}, with a false-positive rate of 56{\%}. In the same patients, MCA-PSV Doppler had a sensitivity and positive predictive value for moderate-to-severe anemia of 100{\%} and 71{\%}, with a false-positive rate of 28{\%}. CONCLUSION: Compared with conventional management, MCA-PSV Doppler may have a better predictive accuracy for moderate-to-severe fetal anemia in red blood cell alloimmunization. Management by MCA-PSV Doppier may eliminate the need for amniocentesis and reduce the number of PUBS performed in red blood cell-alloimmunized pregnancies.",
keywords = "Doppler, Fetal anemia, Hemolytic disease of the newborn infant, Middle cerebral artery peak systolic velocity, Red blood cell alloimmunization",
author = "Leonardo Pereira and Jenkins, {Thomas M.} and Vincenzo Berghella",
year = "2003",
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T1 - Conventional management of maternal red cell alloimmunization compared with management by Doppler assessment of middle cerebral artery peak systolic velocity

AU - Pereira, Leonardo

AU - Jenkins, Thomas M.

AU - Berghella, Vincenzo

PY - 2003/10

Y1 - 2003/10

N2 - OBJECTIVE: This study was undertaken to compare management of red blood cell alloimmunization by Doppler measurement of middle cerebral artery peak systolic velocity (MCA-PSV) to conventional management with amniocentesis. STUDY DESIGN: A historical cohort of 28 fetuses at risk for anemia caused by red blood cell alloimmunization was followed between 1999 and 2002 at a single institution. The decision to perform percutaneous umbilical cord blood sampling (PUBS) was based on conventional management. MCA-PSV Doppler was measured before amniocentesis or PUBS but not used clinically. RESULTS: Twenty-eight fetuses were followed up: 4 had severe anemia, 1 had moderate anemia, 3 had mild anemia, and 20 were nonanemic. Conventional management had a sensitivity and positive predictive value for moderate-to-severe anemia of 80% and 44%, with a false-positive rate of 56%. In the same patients, MCA-PSV Doppler had a sensitivity and positive predictive value for moderate-to-severe anemia of 100% and 71%, with a false-positive rate of 28%. CONCLUSION: Compared with conventional management, MCA-PSV Doppler may have a better predictive accuracy for moderate-to-severe fetal anemia in red blood cell alloimmunization. Management by MCA-PSV Doppier may eliminate the need for amniocentesis and reduce the number of PUBS performed in red blood cell-alloimmunized pregnancies.

AB - OBJECTIVE: This study was undertaken to compare management of red blood cell alloimmunization by Doppler measurement of middle cerebral artery peak systolic velocity (MCA-PSV) to conventional management with amniocentesis. STUDY DESIGN: A historical cohort of 28 fetuses at risk for anemia caused by red blood cell alloimmunization was followed between 1999 and 2002 at a single institution. The decision to perform percutaneous umbilical cord blood sampling (PUBS) was based on conventional management. MCA-PSV Doppler was measured before amniocentesis or PUBS but not used clinically. RESULTS: Twenty-eight fetuses were followed up: 4 had severe anemia, 1 had moderate anemia, 3 had mild anemia, and 20 were nonanemic. Conventional management had a sensitivity and positive predictive value for moderate-to-severe anemia of 80% and 44%, with a false-positive rate of 56%. In the same patients, MCA-PSV Doppler had a sensitivity and positive predictive value for moderate-to-severe anemia of 100% and 71%, with a false-positive rate of 28%. CONCLUSION: Compared with conventional management, MCA-PSV Doppler may have a better predictive accuracy for moderate-to-severe fetal anemia in red blood cell alloimmunization. Management by MCA-PSV Doppier may eliminate the need for amniocentesis and reduce the number of PUBS performed in red blood cell-alloimmunized pregnancies.

KW - Doppler

KW - Fetal anemia

KW - Hemolytic disease of the newborn infant

KW - Middle cerebral artery peak systolic velocity

KW - Red blood cell alloimmunization

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