title: Middle cerebral artery Doppler velocimetric deceleration angle as a predictor of fetal anemia in Rh-alloimmunized fetuses without hydrops.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the screening performance of a new middle cerebral artery Doppler velocimetric index for the prediction of fetal anemia.
  
  
  METHODS
  Doppler velocimetry of the middle cerebral artery was performed before cordocentesis in 24 Rh-alloimmunized fetuses without hydrops on 52 occasions. The angle between the line describing the average slope during the diastolic phase of the cardiac cycle and the vertical, the middle cerebral artery standardized deceleration angle, was measured. The deceleration angle values were expressed in multiples of the median for gestational age. The screening performances of deceleration angle for the prediction of anemia (difference between expected mean hemoglobin level and measured value >/=2 g/dL) and severe anemia (hemoglobin deficit >/=5 g/dL) were determined.
  
  
  RESULTS
  The mean (+/-SD) gestational age at cordocentesis was 28.6 +/- 5.7 weeks' gestation. The risk of fetal anemia increased with decreasing deceleration angle values. The sensitivity and false-positive rate for the detection of anemia in cases with no previous transfusions (one measurement per patient) were 72.0% and 13.3%, respectively; among those with one previous transfusion the values were 90.0% and 0.0%, respectively. For severe anemia the corresponding values were 100% and 0%, respectively, among those with no previous transfusions and 100.0% and 16.7%, respectively, among those with one previous transfusion. There was no risk of severe anemia when the angle was >0.9 multiples of the median. The risk of anemia was significantly reduced with an angle greater than the median for gestational age (deceleration angle >1.0 multiples of the median; relative risk, 0.09; 95% confidence interval, 0.02-0.37). The risk was significantly increased with an angle less than the median for gestational age (deceleration angle <1.0 multiples of the median; relative risk, 30.0; 95% confidence interval, 5.9-158.4).
  
  
  CONCLUSIONS
  The risk of fetal hydrops is remote in the absence of severe anemia. With a new Doppler velocimetric index in the middle cerebral artery the risk of severe anemia was found to be low when the deceleration angle was >0.9 multiples of the median. Anemia can also be predicted with this index. The high sensitivities and acceptable false-positive rates support the potential clinical applicability of the method to reduce the reliance on cordocentesis in Rh alloimmunization. Our findings appear to validate the utility of the deceleration angle for the prediction of fetal anemia.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
authors.forename: R O
authors.initials: RO
authors.lastname: Bahado-Singh
authors.forename: A U
authors.initials: AU
authors.lastname: Oz
authors.forename: C
authors.initials: C
authors.lastname: Hsu
authors.forename: E
authors.initials: E
authors.lastname: Kovanci
authors.forename: O
authors.initials: O
authors.lastname: Deren
authors.forename: L
authors.initials: L
authors.lastname: Onderoglu
authors.forename: G
authors.initials: G
authors.lastname: Mari
mesh_terms: D000740:Anemia / Q000175:diagnosis* / Q000209:etiology; D017218:Cordocentesis; D005189:False Positive Reactions; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000209:etiology; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D017078:Laser-Doppler Flowmetry; D020768:Middle Cerebral Artery / Q000196:embryology* / Q000503:physiopathology; D011247:Pregnancy; D012372:ROC Curve; D012203:Rh Isoimmunization / Q000150:complications*; D012680:Sensitivity and Specificity