Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation

A prospective multicentre trial with intention-to-treat

Roland Zimmermann, Peter Durig, Robert J. Carpenter, Giancarlo Mari

Research output: Contribution to journalArticle

140 Citations (Scopus)

Abstract

Objective: To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery combined with B-mode ultrasound imaging to predict anaemia in an unselected population of pregnancies complicated by alloimmune antibodies known to cause immunological hydrops. Design: Prospective study on an intention-to-treat basis. Setting: Multicentre study in five large tertiary referral centres. Population: One hundred twenty-five fetuses with maternal alloantibodies known to cause immunological hydrops. Methods: If peak systolic velocity and B-mode scan were reassuring the pregnancy was monitored at 7-14 days interval. If either method showed signs of anaemia, an umbilical fetal blood sampling was performed. When the gestational age was greater than 35 weeks, labour was induced. Main outcome measure: Moderate to severe anaemia at delivery. Results: Overall sensitivity to detect moderate to severe anaemia below 35 weeks (haemoglobin level below 0.65 multiples of median) was 88%. Specificity was 87%; positive predictive value was 53% and negative predictive value was 98%. The diagnosis of severe anaemia was missed in one fetus; however, the final outcome was good. The method was not useful after 35 weeks. Conclusions: Middle cerebral artery peak systolic velocity is a highly sensitive non-invasive means for determining the degree of anaemia present in red blood cell alloimmunised pregnancies. The widespread use of the Doppler method will minimise fetal complications associated with amniocentesis and fetal blood sampling. Non-invasive measurement of middle cerebral artery peak systolic velocities is more convenient and acceptable to alloimmunised pregnancies and may significantly lower health care costs. A Doppler interval of seven days is recommended.

Original languageEnglish (US)
Pages (from-to)746-752
Number of pages7
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume109
Issue number7
DOIs
StatePublished - Jul 1 2002

Fingerprint

Middle Cerebral Artery
Multicenter Studies
Anemia
Pregnancy
Fetal Blood
Edema
Fetus
Induced Labor
Umbilicus
Isoantibodies
Amniocentesis
Tertiary Care Centers
Health Care Costs
Population
Gestational Age
Ultrasonography
Hemoglobins
Erythrocytes
Mothers
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Cite this

@article{fc688cbdaed54bd29af1572ea2f47ccf,
title = "Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: A prospective multicentre trial with intention-to-treat",
abstract = "Objective: To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery combined with B-mode ultrasound imaging to predict anaemia in an unselected population of pregnancies complicated by alloimmune antibodies known to cause immunological hydrops. Design: Prospective study on an intention-to-treat basis. Setting: Multicentre study in five large tertiary referral centres. Population: One hundred twenty-five fetuses with maternal alloantibodies known to cause immunological hydrops. Methods: If peak systolic velocity and B-mode scan were reassuring the pregnancy was monitored at 7-14 days interval. If either method showed signs of anaemia, an umbilical fetal blood sampling was performed. When the gestational age was greater than 35 weeks, labour was induced. Main outcome measure: Moderate to severe anaemia at delivery. Results: Overall sensitivity to detect moderate to severe anaemia below 35 weeks (haemoglobin level below 0.65 multiples of median) was 88{\%}. Specificity was 87{\%}; positive predictive value was 53{\%} and negative predictive value was 98{\%}. The diagnosis of severe anaemia was missed in one fetus; however, the final outcome was good. The method was not useful after 35 weeks. Conclusions: Middle cerebral artery peak systolic velocity is a highly sensitive non-invasive means for determining the degree of anaemia present in red blood cell alloimmunised pregnancies. The widespread use of the Doppler method will minimise fetal complications associated with amniocentesis and fetal blood sampling. Non-invasive measurement of middle cerebral artery peak systolic velocities is more convenient and acceptable to alloimmunised pregnancies and may significantly lower health care costs. A Doppler interval of seven days is recommended.",
author = "Roland Zimmermann and Peter Durig and Carpenter, {Robert J.} and Giancarlo Mari",
year = "2002",
month = "7",
day = "1",
doi = "10.1111/j.1471-0528.2002.01314.x",
language = "English (US)",
volume = "109",
pages = "746--752",
journal = "BJOG: An International Journal of Obstetrics and Gynaecology",
issn = "1470-0328",
publisher = "Wiley-Blackwell",
number = "7",

}

TY - JOUR

T1 - Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation

T2 - A prospective multicentre trial with intention-to-treat

AU - Zimmermann, Roland

AU - Durig, Peter

AU - Carpenter, Robert J.

AU - Mari, Giancarlo

PY - 2002/7/1

Y1 - 2002/7/1

N2 - Objective: To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery combined with B-mode ultrasound imaging to predict anaemia in an unselected population of pregnancies complicated by alloimmune antibodies known to cause immunological hydrops. Design: Prospective study on an intention-to-treat basis. Setting: Multicentre study in five large tertiary referral centres. Population: One hundred twenty-five fetuses with maternal alloantibodies known to cause immunological hydrops. Methods: If peak systolic velocity and B-mode scan were reassuring the pregnancy was monitored at 7-14 days interval. If either method showed signs of anaemia, an umbilical fetal blood sampling was performed. When the gestational age was greater than 35 weeks, labour was induced. Main outcome measure: Moderate to severe anaemia at delivery. Results: Overall sensitivity to detect moderate to severe anaemia below 35 weeks (haemoglobin level below 0.65 multiples of median) was 88%. Specificity was 87%; positive predictive value was 53% and negative predictive value was 98%. The diagnosis of severe anaemia was missed in one fetus; however, the final outcome was good. The method was not useful after 35 weeks. Conclusions: Middle cerebral artery peak systolic velocity is a highly sensitive non-invasive means for determining the degree of anaemia present in red blood cell alloimmunised pregnancies. The widespread use of the Doppler method will minimise fetal complications associated with amniocentesis and fetal blood sampling. Non-invasive measurement of middle cerebral artery peak systolic velocities is more convenient and acceptable to alloimmunised pregnancies and may significantly lower health care costs. A Doppler interval of seven days is recommended.

AB - Objective: To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery combined with B-mode ultrasound imaging to predict anaemia in an unselected population of pregnancies complicated by alloimmune antibodies known to cause immunological hydrops. Design: Prospective study on an intention-to-treat basis. Setting: Multicentre study in five large tertiary referral centres. Population: One hundred twenty-five fetuses with maternal alloantibodies known to cause immunological hydrops. Methods: If peak systolic velocity and B-mode scan were reassuring the pregnancy was monitored at 7-14 days interval. If either method showed signs of anaemia, an umbilical fetal blood sampling was performed. When the gestational age was greater than 35 weeks, labour was induced. Main outcome measure: Moderate to severe anaemia at delivery. Results: Overall sensitivity to detect moderate to severe anaemia below 35 weeks (haemoglobin level below 0.65 multiples of median) was 88%. Specificity was 87%; positive predictive value was 53% and negative predictive value was 98%. The diagnosis of severe anaemia was missed in one fetus; however, the final outcome was good. The method was not useful after 35 weeks. Conclusions: Middle cerebral artery peak systolic velocity is a highly sensitive non-invasive means for determining the degree of anaemia present in red blood cell alloimmunised pregnancies. The widespread use of the Doppler method will minimise fetal complications associated with amniocentesis and fetal blood sampling. Non-invasive measurement of middle cerebral artery peak systolic velocities is more convenient and acceptable to alloimmunised pregnancies and may significantly lower health care costs. A Doppler interval of seven days is recommended.

UR - http://www.scopus.com/inward/record.url?scp=0036634662&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036634662&partnerID=8YFLogxK

U2 - 10.1111/j.1471-0528.2002.01314.x

DO - 10.1111/j.1471-0528.2002.01314.x

M3 - Article

VL - 109

SP - 746

EP - 752

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

IS - 7

ER -