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DOI: 10.1055/s-0029-1245537
© Georg Thieme Verlag KG Stuttgart · New York
Fetal Splenic Artery Peak Velocity (SPA-PSV) at Mid-Pregnancy as a Predictor of Hb Bart’s Disease
Spitzengeschwindigkeit in der fetalen A. lienalis (SPA-PSV) in der Schwangerschaftsmitte als Prädiktor der Hb-Bart-ErkrankungPublikationsverlauf
received: 12.9.2009
accepted: 1.6.2010
Publikationsdatum:
11. Januar 2011 (online)
Zusammenfassung
Ziel: Bewertung der Treffsicherheit der A.-lienalis-Maximalgeschwindigkeit zur Prädiktion einer fetalen Hämoglobin(Hb-)Bart-Erkrankung bei gefährdeten Feten in der Mitte der Schwangerschaft. Material und Methoden: Schwangere Frauen mit dem Risiko eines Hb-Bart-erkrankten Fetus wurden in der 18.–22. Schwangerschaftswoche (SSW) in die Studie aufgenommen und erhielten vor Chordozentese eine Messung der SPA-PSV. Die definitive Diagnose, die als Goldstandard herangezogen wurde, basierte auf fetaler Hb-Typisierung mittels Hochleistungsflüssigkeitschromatografie (HPLC). Ergebnisse: Insgesamt wurden 136 Feten aus 132 Einlingsschwangerschaften und 2 Zwillingsschwangerschaften in die Studie eingeschlossen. Das mittlere maternale Alter war 28,7 ± 5,4 Jahre, das mittlere Gestationsalter war 19,1 ± 1,02 Wochen, und die Inzidenz einer Hb-Bart-Erkrankung lag bei 23,5 % (32 Feten). Unter Verwendung des 1,51-fachem Medianwerts (MoM) der SPA-PSV als Diskriminationswert lag die Sensitivität, Spezifizität, der positiv prädiktive Wert und der negativ prädiktive Wert der SPA-PSV zur Identifikation von betroffenen Feten bei 84,4 % (32 von 36 Fällen), 98,1 %, 93,1 % bzw. 95,3 %. Fast alle gesunden Feten hatten eine normale SPA-PSV. Schlussfolgerung: SPA-PSV-Messungen in der Mitte der Schwangerschaft können als ergänzende Methode zur Identifizierung von Feten mit Hb-Bart-Erkrankung herangezogen werden und haben eine hohe, wenngleich nicht perfekte Treffsicherheit. Die Methode könnten helfen, bei manchen Feten das Risiko nicht erforderlicher Chordozentesen zu reduzieren.
Abstract
Purpose: To determine the accuracy of splenic artery peak systolic velocity (SPA-PSV) in predicting fetal hemoglobin (Hb) Bart’s disease at mid-pregnancy among fetuses at risk. Materials and Methods: Pregnant women at risk of having a fetus with Hb Bart’s disease were recruited into the study at 18 – 22 weeks of gestation and underwent SPA-PSV measurement before cordocentesis. The final diagnosis used as a gold standard was based on fetal hemoglobin typing using high performance liquid chromatography (HPLC). Results: A total of 136 fetuses from 132 singleton pregnancies and 2 twin pregnancies were recruited into the study. The mean maternal age was 28.7 ± 5.4 years, the mean gestational age was 19.1 ± 1.02 weeks, and the incidence of Hb Bart’s disease was 23.5 % (32 fetuses). Using SPA-PSV above 1.51 Multiple of Median (MoM) as a cut-off point, the sensitivity, specificity, positive predictive value and negative predictive value of SPA-PSV to identify affected fetuses was 84.4 % (32 from 36 cases), 98.1 %, 93.1 % and 95.3 % respectively. Nearly all normal fetuses had a normal SPA-PSV. Conclusion: SPA-PSV assessment at mid-pregnancy may be used as an adjunct method to identify fetuses with Hb Bart’s disease with high, but not perfect, accuracy and may reduce the risk from unnecessary cordocentesis in some fetuses.
Key words
pregnancy - fetus - ultrasound Doppler
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Prof. Theera Tongsong
Obstetrics and Gynecology, Chiang Mai University
110 Intavaroros Road
50200 Chiang Mai
Thailand
Telefon: ++ 66/53/94 64 29
Fax: ++ 66/53/94 61 12
eMail: ttongson@mail.med.cmu.ac.th