Abstract
Introduction
This study aimed to evaluate the efficacy of middle cerebral artery peak
systolic velocity measurement in predicting moderate-to-severe fetal anemia
and assess perinatal outcomes in patients who underwent intrauterine
transfusion for fetal anemia.
Patients and Methods
A retrospective cohort of 91 pregnant women at risk of fetal anemia,
delivered between 2016 and 2024, was studied. The efficacy of middle
cerebral artery peak systolic velocity in predicting moderate-severe fetal
anemia was assessed. Additionally, the perinatal outcomes of fetuses
undergoing intrauterine transfusion were analyzed.
Results
The middle cerebral artery peak systolic velocity threshold of 1.5 multiples
of the median demonstrated a sensitivity of 92.3% and a specificity of 85.7%
in predicting moderate-to-severe fetal anemia before the 35th gestational
week. After the 35th gestational week, sensitivity and specificity were
73.3% and 79.1%, respectively. A total of 53 intrauterine transfusion
procedures were conducted on 24 patients. The survival rate among fetuses
appropriately treated with intrauterine transfusion (n=22) was 68.2%, and
the complication rate per procedure was 11.3%. All intrauterine and neonatal
deaths (n=9) occurred in hydropic fetuses. All neonates who had undergone
intrauterine transfusion were admitted to the neonatal intensive care unit
for advanced care.
Conclusions
Middle cerebral artery Doppler is a valuable method for the screening and
monitoring of fetal anemia, particularly before the 35th gestational week.
Intrauterine transfusion should be considered the preferred treatment for
moderate-to-severe fetal anemia. Given the potential risks and complications
associated with intrauterine transfusion, hydropic fetuses appear to be at
an elevated risk.
Keywords
doppler ultrasound - fetal anemia - middle cerebral artery - intrauterine transfusion
