title: Changes in fetal myocardial performance index following intravascular transfusion: preliminary report.
abstract: OBJECTIVE
  To investigate the changes in fetal left ventricle myocardial performance index (MPI) following intrauterine intravascular transfusion (IUT).
  
  
  METHODS
  Prospective study, including 25 IUT performed in 13 singleton pregnancies with maternal Rh D alloimmune disease. Left ventricle MPI was evaluated prior to transfusion and repeated 24 h after each procedure. Delta MPI was calculated as the difference between post- and pre-transfusion MPI z-scores. Multilevel regression analysis was used to examine the association between delta MPI and gestational age at procedure, fetal middle cerebral artery peak velocity MoM, pre- and post-MPI and hemoglobin z-score values, the volume of blood transfused and feto-placental volume percentage expansion. Adjustments were made for repeated measurements within the same fetus, and across different time points. The significance level was set as 0.05.
  
  
  RESULTS
  MPI z-score values increased significantly following transfusion (delta MPI = 1.10 ± 2.47, p=0.036). Delta MPI showed a significant correlation with gestational age at transfusion (r= -0.47, p=0.018), pre-transfusion MPI z-score (r= -0.50, p=0.012) and feto-placental volume percentage expansion (r= -0.41, p=0.044).
  
  
  CONCLUSIONS
  Left ventricle MPI increases significantly after intrauterine blood transfusion and greater changes are associated with procedures at an earlier gestational age, lower pre-transfusion MPI z-scores and smaller feto-placental volume expansion.
authors.affiliation: a Department of Obstetrics and Gynecology , Hospital das Clínicas, São Paulo University Medical School, Brazil , São Paulo , Brazil.
authors.forename: Renata Almeida
authors.initials: RA
authors.lastname: de Assunção
authors.affiliation: a Department of Obstetrics and Gynecology , Hospital das Clínicas, São Paulo University Medical School, Brazil , São Paulo , Brazil.
authors.forename: Adolfo Wenjaw
authors.initials: AW
authors.lastname: Liao
authors.affiliation: a Department of Obstetrics and Gynecology , Hospital das Clínicas, São Paulo University Medical School, Brazil , São Paulo , Brazil.
authors.forename: Maria de Lourdes
authors.initials: Mde L
authors.lastname: Brizot
authors.affiliation: a Department of Obstetrics and Gynecology , Hospital das Clínicas, São Paulo University Medical School, Brazil , São Paulo , Brazil.
authors.forename: Rossana Pulcineli Vieira
authors.initials: RP
authors.lastname: Francisco
authors.affiliation: a Department of Obstetrics and Gynecology , Hospital das Clínicas, São Paulo University Medical School, Brazil , São Paulo , Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Zugaib
mesh_terms: D001805:Blood Transfusion, Intrauterine; D005260:Female; D005318:Fetal Heart / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D020768:Middle Cerebral Artery / Q000196:embryology / Q000503:physiopathology; D009206:Myocardium; D011247:Pregnancy; D011446:Prospective Studies; D012203:Rh Isoimmunization / Q000628:therapy*; D012204:Rh-Hr Blood-Group System / Q000276:immunology
chemical_list: D012204:Rh-Hr Blood-Group System
keywords: Alloimmunization; Tei index; fetal cardiac function; intrauterine transfusion; myocardial performance index; pulsed-wave Doppler