Simetka O, Petros M, Lubusky M, Liska M, Dolezalkova E, Matura D (Changes in middle cerebral artery velocimetry of fetuses diagnosed postnatally with mild or moderate hemolytic disease)
ABSTRACT
Objectives. To determine the longitudinal trends of middle cerebral artery peak
systolic velocity (MCA PSV) in fetuses with mild or moderate hemolytic disease
according to the need for postnatal therapy. Design. Prospective cohort study.
Setting. University referral center. Sample. Twenty-three fetuses from singleton
alloimmunized pregnancies. Methods. Serial measurements of MCA PSV were
performed. After delivery, newborns were grouped by the need for postnatal
management into mild hemolytic disease, which required no or only phototherapy
(n = 14, group 1), and moderate hemolytic disease, where postnatal top-up or
exchange transfusions were required (n = 9, group 2). Main outcome
measures. Serial Doppler MCA PSV data transformed to multiples of the median,
analyzed with linear regression and exponential models. Results. We performed
83 measurements in group 1: 3-8 per fetus; mean GA at inclusion, 23 weeks and
65 measurements in group 2: 4-15 per fetus; mean GA at inclusion, 22 weeks.
The estimated mean slopes of the MCA PSVs increased with the degree of postnatal
therapy required (group 1: MCA PSV = 0.003 GA + 1.298; group 2: MCA
PSV = 0.035 GA + 0.436). The relative average increments (RAI) were 4.7% and
7.1%, respectively. The two groups exhibited significant differences in mean slope
and RAI (p<0.05). Conclusions. Fetuses that required postnatal transfusions due
to hemolytic disease showed an enhanced progressive increase in MCA PSVs
compared to those without transfusion requirement. This information might
enable their identification during pregnancy.