title: Changes in middle cerebral artery velocimetry of fetuses diagnosed postnatally with mild or moderate hemolytic disease.
abstract: OBJECTIVE
  To determine the longitudinal trends of middle cerebral artery peak systolic velocity (MCA PSV) in fetuses with mild or moderate hemolytic disease according to the need for postnatal therapy.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  University referral center.
  
  
  METHODS
  Twenty-three fetuses from singleton alloimmunized pregnancies.
  
  
  METHODS
  Serial measurements of MCA PSV were performed. After delivery, newborns were grouped by the need for postnatal management into mild hemolytic disease, which required no or only phototherapy (n = 14, group 1), and moderate hemolytic disease, where postnatal top-up or exchange transfusions were required (n = 9, group 2).
  
  
  METHODS
  Serial Doppler MCA PSV data transformed to multiples of the median, analyzed with linear regression and exponential models.
  
  
  RESULTS
  We performed 83 measurements in group 1: 3-8 per fetus; mean GA at inclusion, 23 weeks and 65 measurements in group 2: 4-15 per fetus; mean GA at inclusion, 22 weeks. The estimated mean slopes of the MCA PSVs increased with the degree of postnatal therapy required (group 1: MCA PSV = 0.003 GA + 1.298; group 2: MCA PSV = 0.035 GA + 0.436). The relative average increments (RAI) were 4.7% and 7.1%, respectively. The two groups exhibited significant differences in mean slope and RAI (p<0.05).
  
  
  CONCLUSIONS
  Fetuses that required postnatal transfusions due to hemolytic disease showed an enhanced progressive increase in MCA PSVs compared to those without transfusion requirement. This information might enable their identification during pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Czech Republic; Faculty of Surgical Studies, University of Ostrava, Ostrava, Czech Republic.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Simetka
authors.forename: Michal
authors.initials: M
authors.lastname: Petros
authors.forename: Marek
authors.initials: M
authors.lastname: Lubusky
authors.forename: Miroslav
authors.initials: M
authors.lastname: Liska
authors.forename: Erika
authors.initials: E
authors.lastname: Dolezalkova
authors.forename: David
authors.initials: D
authors.lastname: Matura
authors.forename: Hana
authors.initials: H
authors.lastname: Wiedermannova
authors.forename: Martin
authors.initials: M
authors.lastname: Procházka
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D001803:Blood Transfusion / Q000379:methods*; D015331:Cohort Studies; D018153:Czech Republic; D019468:Disease Management; D042241:Early Diagnosis; D004899:Erythroblastosis, Fetal / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000503:physiopathology; D005323:Fetal Monitoring / Q000379:methods; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011446:Prospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic; D016216:Ultrasonography, Prenatal / Q000379:methods
keywords: Doppler ultrasound; Middle cerebral artery; alloimmunization; fetal anemia; peak systolic velocity