title: Diagnosis of severe fetal anemia based on perinatal outcomes: a comparative analysis of the current reference values.
abstract: Objectives. To compare current criteria for severe fetal anemia diagnosis. Methodology. A cohort study analyzed 105 alloimmunized fetuses that underwent cordocentesis due to risk of anemia. Concordance among the diagnostic criteria for severe fetal anemia, hemoglobin deficit >7 g/dL, hemoglobin deficit ≥5 g/dL, and hemoglobin concentration <0.55 MoM, was analyzed using Cohen's Kappa index. Perinatal mortality, fetal hydrops, and fetal acidosis were used to discuss discordances. Results. There was fair concordance among the three criteria analyzed: 0.80 (Kappa index, IC 95%: 0.67 to 0.93) when comparing hemoglobin deficit >7.0 g/dL and hemoglobin concentration <0.55 MoM criteria, 0.63 (Kappa index, IC 95%: 0.47 to 0.69) when comparing hemoglobin deficit ≥5.0 g/dL and hemoglobin deficit >7.0 g/dL reference, and 0.77 (Kappa index, IC 95%: 0.64 to 0.90) when comparing hemoglobin deficit≥5.0 g/dL and hemoglobin concentration <0.55 MoM standards. Eighteen cases were classified differently depending on the criteria used. The cut-off point of hemoglobin deficit ≥5 g/dL was the best criterion to discriminate fetuses with poor perinatal outcome in our study. Conclusions. Relevant discordances in classification of severe fetal anemia were pointed out. Some criteria may underestimate the real gravity of fetal anemia.
authors.affiliation: Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Brazil ; Obstetrics and Gynaecology Department, Universidade Federal de Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190, Funcionários, Belo Horizonte, 30.130.100 Minas Gerais, Brazil.
authors.forename: Zilma Silveira Nogueira
authors.initials: ZS
authors.lastname: Reis
authors.affiliation: Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Brazil.
authors.forename: Gabriel Costa
authors.initials: GC
authors.lastname: Osanan
authors.affiliation: Federal University of Minas Gerais, Brazil.
authors.forename: Tiago Lanfernini Ricardo
authors.initials: TL
authors.lastname: Coelho
authors.affiliation: Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Brazil.
authors.forename: Cezar Alencar De Lima
authors.initials: CA
authors.lastname: Rezende
authors.affiliation: Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Brazil.
authors.forename: Henrique Vitor
authors.initials: HV
authors.lastname: Leite
authors.affiliation: Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Brazil.
authors.forename: Antônio Carlos Vieira
authors.initials: AC
authors.lastname: Cabral