Comparison of the Performances of Middle Cerebral Artery Peak Systolic Velocity and Cardiothoracic Diameter Ratio in Predicting Fetal Anemia: Using Fetal Hemoglobin Bart’s Disease as a Study Model

2021 ◽  
pp. 1-8
Author(s):  
Wisit Chankhunaphas ◽  
Theera Tongsong ◽  
Fuanglada Tongprasert ◽  
Kasemsri Srisupundit ◽  
Suchaya Luewan ◽  
...  
Keyword(s):  
At Risk ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Gestational Age ◽  
Peak Systolic Velocity ◽  
Fetal Hemoglobin ◽  
Diameter Ratio ◽  
Fetal Anemia ◽  
Receiver Operating Characteristic Curves ◽  
Hb Bart's

<b><i>Objective:</i></b> The aim of the study was to compare the performances of cardiothoracic diameter ratio (CTR) and middle cerebral artery peak systolic velocity (MCA-PSV) in predicting fetal hemoglobin (Hb) Bart’s disease and identify the best CTR cut-off for each gestational period. <b><i>Methods:</i></b> Pregnancies at risk of fetal Hb Bart’s disease (gestational ages of 12–36 weeks) were prospectively recruited to undergo ultrasound examination. The measurements of CTR and MCA-PSV were performed and recorded before invasive diagnosis. <b><i>Results:</i></b> During the study period (2005–2019), a total of 1,717 pregnancies at risk of fetal Hb Bart’s disease met the inclusion criteria and were available for analysis, including 329 (19.2%) fetuses with Hb Bart’s disease. The mean gestational age at the time of diagnosis was 19.30 ± 5.6 weeks, ranging from 12 to 36 weeks. The overall performance of CTR <i>Z</i>-scores is superior to that of MCA-PSV multiple of median (MoM) values; area under curve of 0.866 versus 0.711, <i>p</i> value &#x3c;0.001. The diagnostic indices of CTR and MCA-PSV are increased with gestational age. Based on receiver operating characteristic curves of CTR <i>Z</i>-scores, the best cut-off points of CTR at 12–14, 15–17, 18–20, 21–23, and ≥24 weeks are 0.48, 0.49, 0.50, 0.51, and 0.54, respectively. The best cut-off of MCA-PSV is 1.3 MoM, giving the best performance at 21–23 weeks with a sensitivity of 91.8% and specificity of 85.5%. <b><i>Conclusion:</i></b> The performance of CTR is much better than MCA-PSV in predicting fetal anemia caused by Hb Bart’s disease. Nevertheless, whether this can be reproduced in anemia due to other causes, like isoimmunization, is yet to be explored.

Middle Cerebral Artery Doppler Changes following Fetal Transfusion Performed with and without Fetal Anesthesia

2017 ◽  
Vol 35 (07) ◽  
pp. 682-687 ◽  
Author(s):  
Kristen Uquillas ◽  
Myrna Aboudiab ◽  
Lisa Korst ◽  
Arlyn Llanes ◽  
Brendan Grubbs ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Umbilical Cord ◽  
Cerebral Artery ◽  
Gestational Age ◽  
Peak Systolic Velocity ◽  
Fetal Anemia ◽  
Intravenous Anesthesia ◽  
Intrauterine Transfusion ◽  
The Difference ◽  
The Relationship

Objective The objective of this study was to test the association between fetal intravenous anesthesia and the change in middle cerebral artery peak systolic velocity (MCA-PSV) in patients undergoing intrauterine transfusion (IUT) for suspected fetal anemia. Study Design We retrospectively examined data from all patients who underwent IUT via umbilical cord route from 2007 to 2016. We calculated the change of the MCA-PSV multiple of median (MoM) as the difference in MCA-PSV MoM between the pre- and immediate postoperative measurements for the first IUT. The change in MCA-PSV MoM was compared between those who did and did not receive fetal anesthesia using Kruskal–Wallis' testing. Results Of 62 patients, 37 (59.7%) received intravenous fetal anesthesia and 25 (40.3%) did not. The change in MCA-PSV MoM did not differ between those who did and did not receive fetal anesthesia (median: 0.57 [interquartile range, IQR: +0.42 to +0.76] vs. median 0.57 [IQR: +0.40 to +0.81], p = 1.000). The relationship remained insignificant when stratifying by gestational age, length of procedure, initial MCA-PSV, and when excluding hydropic fetuses. Conclusion Among women undergoing IUT, there was no evidence that the use of fetal anesthesia was associated with a change in the pre- versus postoperative change in MCA-PSV MoM.

scholarly journals A Study of Fetal Middle Cerebral Artery Peak Systolic Velocity to Diagnose Fetal Anemia in Rural Obstetric Population

2013 ◽  
Vol 4 (3) ◽  
pp. 83-87
Author(s):  
Sushil Kachewar ◽  
Sidappa G Gandage ◽  
Hemant J Pawar
Keyword(s):  
Statistical Analysis ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Gestational Age ◽  
Color Doppler ◽  
Peak Systolic Velocity ◽  
Steady Increase ◽  
Fetal Anemia ◽  
Experienced Radiologist ◽  
Obstetric Population

ABSTRACT Globally, fetal middle cerebral artery peak systolic velocity (MCA-PSV) is used for noninvasive diagnosis of fetal anemia. Although, incidence of anemia is common in rural setup, scientific studies describing utilization of this modality are lacking. This study throws light on how the use of fetal MCAPSV to diagnose fetal anemia can help in the decision-making process even in a rural setup. Context Fetal anemia can be adequately tackled only if it is diagnosed on time. Fetal MCA-PSV has the potential to reliably predict fetal anemia. Scientific studies across the globe are testimony to this fact. As such studies from rural setups are lacking, this study was initiated. Aims A study of fetal middle cerebral artery peak systolic velocity to diagnose fetal anemia in rural obstetric population. Settings and design The study was conducted in the ultrasound section of a rural medical college. Clearance from institutional ethical and research committee was obtained. Written informed consent was obtained from the pregnant mother. A prospective observational study was conducted over the last 12 months. Materials and methods Fetal MCA-PSV was measured in 26 pregnant women referred for ultrasound due to clinical suspicion of fetomaternal abnormality. Middle cerebral artery peak systolic velocity was measured by a single experienced radiologist on color Doppler ultrasound machine. Statistical analysis used The observations were entered in Microsoft Excel sheet, and statistical analysis was done by comparing with internationally accepted values at that gestational age. Karl Pearson's correlation coefficient was used to study the relation between fetal MCA-PSV and gestational age. Standard t-test was used to study the significance of difference. Results There was a steady increase in MCA-PSV with rising gestational age suggestive of positive correlation between them. When compared with internationally accepted values, significantly raised fetal MCA-PSV values were seen in six patients. These patients were followed up and the cause of fetal anemia in each was identified. Conclusion Fetal MCA-PSV can be successfully used to evaluate for anemia in fetuses in a rural setup provided correct methods are followed. An attempt to measure fetal MCA-PSV in face of every fetomaternal adversity is recommended so that none of the cases of fetal anemia go undiagnosed. Key messages Proper knowledge and routine measurement of fetal MCA-PSV value can be a life saving noninvasive practice to diagnose fetal anemia in a rural setup. How to cite this article Kachewar S, Gandage SG, Pawar HJ. A Study of Fetal Middle Cerebral Artery Peak Systolic Velocity to Diagnose Fetal Anemia in Rural Obstetric Population. Int J Infertility Fetal Med 2013;4(3):83-87.

scholarly journals An Untold Story of Indian Fetal Middle Cerebral Artery Peak Systolic Velocities

2014 ◽  
Vol 5 (1) ◽  
pp. 8-11
Author(s):  
Sidappa G Gandage ◽  
Hemant J Pawar ◽  
Sushil Kachewar
Keyword(s):  
Statistical Analysis ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Gestational Age ◽  
Normal Values ◽  
Color Doppler ◽  
Peak Systolic Velocity ◽  
Fetal Anemia ◽  
Cross Sectional ◽  
Indian Setting

ABSTRACT Although noninvasive diagnosis of anemia in fetus by measuring the middle cerebral artery peak systolic velocity (MCA-PSV) is practised and extensively researched in the developed world, such studies from the developing world are rare. India is the home for many hemoglobinopathies and cases of Rh alloimmunization are also reported here. Hence, it is expected that fetal anemias will be quite common. So in addition to an awareness about the correct method of measuring MCA-PSV and knowledge about changes that occur in the waveforms with advancing gestational age, it is important to know the normal values at various gestational ages in an Indian setting. Demonstrating these normal values was the primary goal of the current study. Context Fetal anemia can be adequately tackled only if it is diagnosed on time. Fetal MCA-PSV has the potential to reliably predict fetal anemia. Scientific studies across the globe are a testimony to this fact. As such studies from rural setups are lacking, this study was initiated. Aims To demonstrate the normal values of fetal MCA-PSV at various gestational ages in an Indian setting by using the standard internationally accepted protocol. Settings and design The ultrasound wing of radiodiagnosis department of a rural medical college was the site of this study. Permission from institutional research cell and ethical committee was obtained for study on fetal MCA-PSV. Written informed consent from every pregnant mother who participated in the study was also obtained. A cross-sectional and prospective observational study was conducted over the last 9 months. Materials and methods A total of 60 measurements of fetal MCA-PSV were conducted in normal 20 pregnant women referred for routine obstetric scan at 12, 24, and 36 weeks of gestation respectively, by a single radiologist on color Doppler ultrasound machine. In each fetus the proximal MCA, soon after its origin, was evaluated. Statistical analysis The observations were entered in Microsoft Excel sheet and statistical analysis was done by using SPSS statistical software version 12. The relation between fetal MCAPSV and gestational age was studied using the Karl Pearson's correlation coefficient. The significance of difference was studied using the t-test. Results MCA-PSV increased with increasing gestational age, suggesting positive correlation between the two. Better waveforms and increasing PSV were visualized with advancing gestational age. Conclusion Fetal anemia can be accurately predicted only if the MCA-PSV is scientifically measured and compared with normal values in a given setting. This study demonstrates the normal values at various gestational ages in an Indian setting. How to cite this article Kachewar S, Gandage SG, Pawar HJ. An Untold Story of Indian Fetal Middle Cerebral Artery Peak Systolic Velocities. Int J Infertil Fetal Med 2014;5(1):8-11.

scholarly journals Doppler Flow Velocity Indices (RI, PI, S/D & PSV) of Fetal Middle Cerebral Artery in Normal Pregnancies: Correlation with Gestational Age of 20 to 40 Weeks

2012 ◽  
Vol 2 (2) ◽  
pp. 77-80
Author(s):  
Md Abu Taher ◽  
Nuzhat Tasmin ◽  
AS Mohiuddin ◽  
Md Mohit Ul Alam ◽  
Md Mofazzal Sharif ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Gestational Age ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
Doppler Flow ◽  
Significant Difference ◽  
Before And After ◽  
Doppler Indices

This observational type of descriptive study was carried out in the Department of Radiology and Imaging, BIRDEM selecting 70 Bangladeshi pregnant babies with the aim to find out the normogram of foetal middle cerebral artery Doppler flow velocity indices and correlation between Doppler flow velocity indices [Resistance Index (RI), Pulsatility Index (PI), Systolic/Diastolic ratio (S/D) & Peak Systolic Velocity (PSV)] of foetal middle cerebral artery and gestational age in normal pregnancies of 20 to 40 weeks. It was observed that RI, PI and S/D were decreased with the advance of gestational age but PSV was increases with the advance of gestational age. Statistical analyses showed there were significant difference between mean PSV, RI and PI before and after 25 weeks of gestation. No significant difference was found between mean S/D before and after 25 weeks of gestation. It was observed from Correlation analysis between Doppler indices with independent gestational age that all the Doppler indices of foetal middle cerebra artery was positively correlated with the whole gestation period. The statistical analysis showed only PSV and RI were significantly correlated with the gestational age. Simple regression analysis between dependent Doppler index with independent gestational age before and after 25 weeks revealed that all the Doppler indices had positive relationship with the corresponding gestational age but relationship between PSV and PI (before 25 weeks) with their corresponding gestational ages were only statistically significant.DOI: http://dx.doi.org/10.3329/birdem.v2i2.12306 Birdem Med J 2012; 2(2) 77-80

scholarly journals OP24.07: Prediction of moderate fetal anemia risk by longitudinal assessments of middle cerebral artery peak systolic velocity

2010 ◽  
Vol 36 (S1) ◽  
pp. 123-123
Author(s):  
M. Pětroš ◽  
M. Liška ◽  
D. Matura ◽  
P. Kordoš ◽  
O. Šimetka ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Peak Systolic Velocity ◽  
Fetal Anemia
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