title: Middle cerebral artery peak systolic velocity to predict fetal hemoglobin levels in twin anemia-polycythemia sequence.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of middle cerebral artery peak systolic velocity (MCA-PSV) Doppler measurements in prediction of hemoglobin levels in twin anemia-polycythemia sequence (TAPS).
  
  
  METHODS
  This study involved a consecutive cohort comprising monochorionic twin pregnancies complicated by TAPS managed at three European fetal medicine centers between 2005 and 2013. The accuracy of MCA-PSV, measured immediately prior to fetal hemoglobin (Hb) measurement by fetal or cord blood sampling, for prediction of anemia and polycythemia was assessed using 2 × 2 tables.
  
  
  RESULTS
  A total of 116 measurements (74 recorded in donors and 42 in recipients) from 43 twin pregnancies complicated by TAPS were available for analysis. MCA-PSV multiples of the median (MoM) values correlated well with Hb levels (r = - 0.86; P < 0.001). The sensitivity of MCA-PSV ≥ 1.5 MoM to predict severe anemia (Hb deficit > 5 SD below the mean) in TAPS donors was 94% (95% CI, 85-98%); specificity was 74% (95% CI, 62-83%); positive and negative predictive values were 76% (95% CI, 65-85%) and 94% (95% CI, 83-98%), respectively. The sensitivity of MCA-PSV ≤ 1.0 MoM to predict polycythemia (Hb level > 5 SD above the mean) in TAPS recipients was 97% (95% CI, 87-99%); specificity was 96% (95% CI, 89-99%); positive and negative predictive values were 93% (95% CI, 81-97%) and 99% (95% CI, 93-100%), respectively.
  
  
  CONCLUSIONS
  MCA-PSV measurement has high diagnostic accuracy for predicting abnormal Hb levels in fetuses with TAPS.
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Slaghekke
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Pasman
authors.affiliation: Department of Obstetrics, University Hospital CMCO-HUS, Strasbourg, France.
authors.forename: M
authors.initials: M
authors.lastname: Veujoz
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Lewi
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Devlieger
authors.affiliation: Department of Obstetrics, University Hospital CMCO-HUS, Strasbourg, France.
authors.forename: R
authors.initials: R
authors.lastname: Favre
authors.affiliation: Department of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Lopriore
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
mesh_terms: D000740:Anemia / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D001783:Blood Flow Velocity / Q000502:physiology; D004200:Diseases in Twins / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000196:embryology; D005260:Female; D005315:Fetal Diseases / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D005319:Fetal Hemoglobin / Q000378:metabolism*; D005330:Fetofetal Transfusion / Q000097:blood; D006801:Humans; D007231:Infant, Newborn; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000196:embryology; D011086:Polycythemia / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D011237:Predictive Value of Tests; D011247:Pregnancy; D059285:Pregnancy, Twin; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D014430:Twins, Monozygotic; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000379:methods
chemical_list: D005319:Fetal Hemoglobin
keywords: Doppler; MCA-PSV; fetal anemia; fetal polycythemia; hemoglobin; monochorionic twins