Aktuální management těhotenství s rizikem rozvoje anémie plodu

Actual Management of Pregnancies at Risk for Fetal Anemia

Objective:
To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery (MCA-PSV) to predict the degree of fetal anemia and to find out whether implementation of MCA-PSV into management of pregnancies at risk for fetal anemia enable to reduce the number of invasive procedures.

Design:
A prospective study.

Setting:
Department of Obstetrics and Gynecology, Department of Medical Genetics and Fetal Medicine, Neonatology Department, University Hospital, Olomouc.

Methods:
In 81 pregnancies at risk for fetal anemia MCA-PSV had been assessed and fetal blood sampling for measurement of hemoglobin concentration was obtained subsequently, either by cordocentesis or at delivery. The values of MCA-PSV and hemoglobin concentration were expressed as multiples of median (MoM). Anemia was defined as mild (hemoglobin

Results:
313 examinations were performed at 17-38 week’s gestation. An MCA-PSV >1.5 MoM detected 100% of severly anemic fetuses with a hemoglobin concentration

Conclusion:
Middle cerebral artery peak systolic velocity is a highly sensitive non-invasive means for determining the degree of fetal anemia and implementation of MCA-PSV into management of pregnancies at risk for fetal anemia enable to reduce the number of invasive procedures. This parameter should not yet be considered the global standard of care for diagnosis of fetal anemia because incorrect use by an unexperienced operator may cause more harm than good. However, if there is a reasonably close medical center with sonographers tranined to assess the MCA-PSV, patients at risk for fetal anemia should be reffered to this center.

Key words:
fetal anemia, middle cerebral artery peak systolic velocity, Doppler, red cell alloimmunization, intrauterine transfusion