title: Management of Rh-isoimmunised Pregnancies : Our Experience.
abstract: BACKGROUND
  The aim of this study was to assess the role of middle cerebral artery peak systolic velocity (MCA-PSV), as measured by doppler ultrasound, in detecting foetal anaemia in Rh- isoimmunised pregnancies. Intra-uterine foetal blood transfusion was performed in such anaemic foetuses to tide over the crisis of foetal immaturity till considered fit for extra-uterine survival.
  
  
  METHODS
  Rh-isoimmunised pregnancies reporting to a tertiary institute from 2003 to 2005, were screened by doppler ultrasound to estimate MCA-PSV to detect foetal anaemia. If the foetus developed MCA-PSV of more than 1.5 multiple of median (MoM) for the gestational age, foetal blood sampling through cordocentesis was performed to confirm foetal anaemia, followed by intrauterine foetal blood transfusion to all anaemic foetuses at the same sitting. Neonatal outcome was evaluated by recording gestational age at the time of delivery, duration of gestational time gained and need for blood transfusion in the neonatal period.
  
  
  RESULTS
  A total of thirteen isoimmunised pregnancies were evaluated. Three pregnancies did not require in-utero foetal blood transfusion. Twenty-one intrauterine foetal blood transfusions were performed in the remaining ten patients. Five received blood transfusion in the neonatal period. Intra uterine foetal death occurred in one grossly hydropic foetus and favourable neonatal outcome was recorded in the rest.
  
  
  CONCLUSIONS
  The clinical outcome of these pregnancies justifies the use of doppler studies of MCA-PSV in detecting foetal anaemia and intra uterine foetal blood transfusion is the only hope of prolonging pregnancy and salvaging such foetuses.
authors.affiliation: Reader, Maternal & Foetal Medicine Specialist, Armed Forces Medical College, Pune - 411040.
authors.forename: D
authors.initials: D
authors.lastname: Arora
authors.affiliation: Professor & Head, Armed Forces Medical College, Pune - 411040.
authors.forename: T K
authors.initials: TK
authors.lastname: Bhattacharyya
authors.affiliation: Senior Advisor (Obstetrics and Gynaecology), CH (Central Command), Lucknow.
authors.forename: S K
authors.initials: SK
authors.lastname: Kathpalia
authors.affiliation: Associate Professor & Gynaecologic Oncologist, Armed Forces Medical College, Pune - 411040.
authors.forename: Sps
authors.initials: S
authors.lastname: Kochar
authors.affiliation: Reader (Obstetrics and Gynaecology), Armed Forces Medical College, Pune - 411040.
authors.forename: G S
authors.initials: GS
authors.lastname: Sandhu
authors.affiliation: Classified Specialist (Obstetrics and Gynaecology), AH R & R, Delhi Cantt.
authors.forename: B K
authors.initials: BK
authors.lastname: Goyal
keywords: Foetal anaemia; Foetal blood transfusion; Middle cerebral artery peak systolic velocity; Rh-isoimmunisation