[Monitoring of pregnancy complicated by maternal-fetal isoimmunization. A comparison between two clinical protocols].
OBJECTIVE
Invasive techniques such as amniocentesis and cordocentesis are used for the diagnosis and treatment of fetus at risk for anemia due to maternal red-cell alloimmunization. The purpose of this study was to determine the value of non invasive measurements of the peak velocity middle cerebral artery in the fetus (PVMCA) for the diagnosis of fetal anemia.


METHODS
From 1996 to September 2002, we studied 23 pregnancies with anti D title >1:32. In the 1(st) group of 11 women (from 1996 to 1999) fetal anemia was detected by invasive techniques (amniocentesis and cordocentesis). In the 2(nd) group of 12 women (from 1999 to 2002) fetal anemia was suspected on the basis of PVMCA. When PVMCA was significantly increased, cordocentesis was performed in order to rule out fetal anemia and to provide in utero transfusions.


RESULTS
In the 1(st) period we performed 23 invasive techniques (7 amniocentesis and 16 cordocentesis) in 11 women, but we identified fetal anemia only in 4 cases. In the 2(nd) period we performed only 2 cordocentesis in women in which PVMCA was increased; the blood sampling confirmed fetal anemia in both cases.


CONCLUSIONS
PVMCA and fetal hematocrit are highly significantly correlated: high values of PVMCA are associated with fetal anemia. Doppler velocity of PVMCA is related to fetal anemia with positive predictive value 100% and negative predictive value 100%. The middle cerebral artery blood velocity is a non invasive technique for detecting anemia in pregnancies complicated by alloimmunization.
Clinica Ginecologico-Ostetrica, Università degli Studi di Brescia, Spedali Civili, Brescia, Italy.
E
E
Vignoni
C
C
Daldoss
M
M
Soregaroli
F
F
Taddei
A
A
Valcamonico
T
T
Frusca
U A
UA
Bianchi
D000328:Adult; D000649:Amniocentesis; D000740:Anemia / Q000175:diagnosis*; D001783:Blood Flow Velocity; D002985:Clinical Protocols; D017218:Cordocentesis; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D005323:Fetal Monitoring / Q000379:methods*; D006801:Humans; D020768:Middle Cerebral Artery / Q000503:physiopathology; D012203:Rh Isoimmunization