Noninvasive diagnosis by Doppler ultrasonography of fetal anemia resulting from parvovirus infection.
OBJECTIVE
The purpose of this study was to evaluate the feasibility of the middle cerebral artery peak systolic velocity for the detection of fetal anemia in pregnancies that are complicated by parvovirus B19 infection.


METHODS
Doppler measurements of the middle cerebral artery peak systolic velocity were performed weekly in 32 fetuses at risk for anemia because of maternal parvovirus infection documented by the presence of serum immunoglobulin M antibody. The values of the middle cerebral artery peak systolic velocity and hemoglobin were expressed as multiples of the median. These values were plotted on reference ranges that had been established previously. A cordocentesis was performed either because of fetal ascites or when the middle cerebral artery peak systolic velocity values suggested anemia (middle cerebral artery peak systolic velocity, >1.50 multiples of the median).


RESULTS
Gestational age at study entry ranged from 15.1 to 37 weeks. There were 17 fetuses with middle cerebral artery peak systolic velocity of >1.50 MoM (group 1). Sixteen cordocenteses were performed in these fetuses. All 16 fetuses were anemic (15 severely and 1 mildly). Thirteen fetuses had signs of hydrops (12 with severe and 1 with mild anemia). Group 2 included 15 fetuses with the middle cerebral artery peak systolic velocity values <1.50 MoM. Two cordocenteses were performed. One fetus was mildly anemic; the second fetus was not anemic. The remaining 13 fetuses of this group did not have any complications and were not anemic at birth. The sensitivity of the middle cerebral artery peak systolic velocity (>1.50 MoM) for the prediction of anemia because of parvovirus infection was 94.1%; the specificity was 93.3 %; the positive and negative predictive values were 94.1% and 93.3%, respectively.


CONCLUSIONS
Fetal anemia caused by parvovirus infection can be detected noninvasively by Doppler ultrasonography on the basis of an increase in the peak velocity of systolic blood flow in the middle cerebral artery.
Cosmi
Erich
E
Department of Obstetrics and Gynecology, University of Cincinnati, Ohio 45267, USA.
Mari
Giancarlo
G
Delle Chiaie
Loredana
L
Detti
Laura
L
Akiyama
Masashi
M
Murphy
June
J
Stefos
Theodor
T
Ferguson
James E
JE
Hunter
David
D
Hsu
Chaur-Dong
CD
Abuhamad
Alfred
A
Bahado-Singh
Ray
R
D000740:Anemia / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000821:virology*; D001783:Blood Flow Velocity; D017218:Cordocentesis; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000821:virology*; D005333:Fetus / Q000502:physiology; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000196:embryology; D010322:Parvoviridae Infections / Q000150:complications*; D016732:Parvovirus B19, Human; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D013599:Systole; D018608:Ultrasonography, Doppler