title: Diagnosis of Severe Fetomaternal Hemorrhage with Fetal Cerebral Doppler: Case Series and Systematic Review.
abstract: OBJECTIVE
  To analyze the role of middle cerebral artery (MCA) peak systolic velocity (PSV) in the prediction of severe fetomaternal hemorrhage (FMH) and to compare it with standard biophysical assessment.
  
  
  METHODS
  Retrospective review of cases of FMH seen in our unit and systematic review of the literature.
  
  
  RESULTS
  We followed the MOOSE guidelines to review the literature. From 838 articles, 16 were selected. In total, 35 women, including 3 cases from our center and 32 obtained from the literature search were included. Diagnosis of FMH was always confirmed by laboratory tests. Patients were seen at 31 ± 5 weeks' gestation (range 16-39) and the most frequent indication for referral was decreased perception of fetal movements. Cardiotocography (CTG) upon admission was sinusoidal in 18 cases, nonreactive in 6, decelerative in 2 and tachycardic in one. MCA-PSV was abnormal in all cases but one. There were 2 perinatal deaths. The mean hemoglobin concentration at birth or at intrauterine transfusion was 4.8 ± 1.9 g/dl.
  
  
  CONCLUSIONS
  The most accurate predictor of FMH was fetal MCA-PSV. CTG was always abnormal but the pattern was frequently nonspecific. We suggest including fetal cerebral Doppler in the evaluation of patients with decreased fetal movements, particularly in those cases with ambiguous results of biophysical testing.
authors.affiliation: Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Bellussi
authors.forename: Antonella
authors.initials: A
authors.lastname: Perolo
authors.forename: Tullio
authors.initials: T
authors.lastname: Ghi
authors.forename: Aly
authors.initials: A
authors.lastname: Youssef
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Pilu
authors.forename: Giuliana
authors.initials: G
authors.lastname: Simonazzi
mesh_terms: D000328:Adult; D001805:Blood Transfusion, Intrauterine; D005260:Female; D005331:Fetomaternal Transfusion / Q000000981:diagnostic imaging*; D005434:Flow Cytometry; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal