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Previous Volume 342:9-14 January 6, 2000 Number 1 Next

	Full Text PDF Editorial by Saade, G. R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Invasive techniques such as amniocentesis and cordocentesis are used for diagnosis and treatment in fetuses at risk for anemia due to maternal red-cell alloimmunization. The purpose of our study was to determine the value of noninvasive measurements of the velocity of blood flow in the fetal middle cerebral artery for the diagnosis of fetal anemia.

Methods We measured the hemoglobin concentration in blood obtained by cordocentesis and also the peak velocity of systolic blood flow in the middle cerebral artery in 111 fetuses at risk for anemia due to maternal red-cell alloimmunization. Peak systolic velocity was measured by Doppler velocimetry. To identify the fetuses with anemia, the hemoglobin values of those at risk were compared with the values in 265 normal fetuses.

Results Fetal hemoglobin concentrations increased with increasing gestational age in the 265 normal fetuses. Among the 111 fetuses at risk for anemia, 41 fetuses did not have anemia; 35 had mild anemia; 4 had moderate anemia; and 31, including 12 with hydrops, had severe anemia. The sensitivity of an increased peak velocity of systolic blood flow in the middle cerebral artery for the prediction of moderate or severe anemia was 100 percent either in the presence or in the absence of hydrops (95 percent confidence interval, 86 to 100 percent for the 23 fetuses without hydrops), with a false positive rate of 12 percent.

Conclusions In fetuses without hydrops that are at risk because of maternal red-cell alloimmunization, moderate and severe anemia can be detected noninvasively by Doppler ultrasonography on the basis of an increase in the peak velocity of systolic blood flow in the middle cerebral artery.

Source Information

From the Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Conn. Other authors were Russell L. Deter, M.D., and Robert L. Carpenter, M.D., Baylor College of Medicine, Houston; Feryal Rahman, M.D., King Faisal Hospital and Specialist Centre, Riyadh, Saudi Arabia; Roland Zimmerman, M.D., Klinik und Poliklinik für Geburtshilfe, Universitätsspital, Zurich, Switzerland; Kenneth J. Moise, Jr., M.D., and Karen F. Dorman, R.N., M.S., University of North Carolina, Chapel Hill; Avi Ludomirsky, M.D., Pennsylvania Hospital, Philadelphia; Rogelio Gonzalez, M.D., and Ricardo Gomez, M.D., Universidad Católica de Chile, Sótero del Río Hospital, Santiago, Chile; Utku Oz, M.D., Laura Detti, M.D., Joshua A. Copel, M.D., and Ray Bahado-Singh, M.D., Yale University School of Medicine, New Haven, Conn.; and Stanley Berry, M.D., Juan Martinez-Poyer, M.D., and Sean C. Blackwell, M.D., Wayne State University, Hutzel Hospital, Detroit.

Address reprint requests to Dr. Mari at the Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar St., P.O. Box 208063, New Haven, CT 06520-8063, or at giancarlo.mari{at}yale.edu.

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Noninvasive Diagnosis of Fetal Anemia by Doppler Ultrasonography
Nagey D. A., Laks M. P., Cohen T., Mari G., Zimmerman R., Oz U.
Extract | Full Text  
N Engl J Med 2000; 343:66-68, Jul 6, 2000. Correspondence

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