title: Accuracy of Middle Cerebral Artery Doppler Assessment between 34 and 37 Weeks in Fetuses with Red Cell Alloimmunization.
abstract: BACKGROUND
  The Doppler measurement of middle cerebral artery peak systolic velocity (MCA-PSV) is considered the gold standard for the noninvasive detection of moderate to severe anemia. However, the accuracy of this test has not been evaluated so far, specifically beyond 34 weeks.
  
  
  OBJECTIVE
  To assess the accuracy of MCA-PSV to detect moderate to severe fetal anemia and to identify risk factors associated with false-positive and false-negative MCA-PSV values after 34 weeks.
  
  
  METHODS
  We studied a retrospective cohort of 150 pregnant women with severe alloimmunization who delivered between 2010 and 2014 and correlated MCA-PSV and fetal or neonatal hemoglobin levels.
  
  
  RESULTS
  Sensitivity to predict severe anemia was 69%, with a false-negative rate of 3.6%. When MCA Doppler assessment was normal, the identification of serosal effusions increased the detection rate of severe fetal anemia to 94%, with a false-negative rate of 0.8%. False-positive MCA-PSV measurements were more frequent in fetuses with 1 previous intrauterine transfusion (p = 0.0002), but were not associated with MCA resistance index, intrauterine growth restriction and fetal heart rate.
  
  
  CONCLUSIONS
  Between 34 and 37 weeks, sensitivity of MCA-PSV Doppler assessment alone is 69% and increases to 94% when also considering signs of hydrops. False-positive MCA-PSV measurements are more frequent in case of former fetal transfusion.
authors.affiliation: Department of Fetal Medicine, Hôpital Trousseau, Paris, France.
authors.forename: Emeline
authors.initials: E
authors.lastname: Maisonneuve
authors.forename: Aude
authors.initials: A
authors.lastname: Jayot
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Friszer
authors.forename: Vanina
authors.initials: V
authors.lastname: Castaigne
authors.forename: Evelyne
authors.initials: E
authors.lastname: Cynober
authors.forename: Françoise
authors.initials: F
authors.lastname: Pernot
authors.forename: Agnès
authors.initials: A
authors.lastname: Mailloux
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Jouannic
authors.forename: Anne
authors.initials: A
authors.lastname: Cortey
authors.forename: Bruno
authors.initials: B
authors.lastname: Carbonne
mesh_terms: D000740:Anemia / Q000000981:diagnostic imaging* / Q000276:immunology; D001783:Blood Flow Velocity; D005260:Female; D005865:Gestational Age; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011247:Pregnancy; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal
keywords: Alloimmunization; Anemia; Doppler ultrasound; Doppler velocimetry; Fetal transfusion; Intrauterine transfusion; Middle cerebral artery Doppler assessment