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Re: Ultrasound markers of fetal anemiaFrom: art fougner, md (evsono@pipeline.com)Mon Jan 18 11:54:26 1999
Hi - doppler is still controversial and probably not quite ready for prime time. here are a couple of pertinent references: Ultrasound Obstet Gynecol 1995 Jun;5(6):400-5 Diagnosis of fetal anemia with Doppler ultrasound in the pregnancy complicated by maternal blood group immunization. Mari G, Adrignolo A, Abuhamad AZ, Pirhonen J, Jones DC, Ludomirsky A, Copel JA Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA. We investigated whether Doppler measurement of the fetal middle cerebral artery peak systolic velocity can be used to detect fetal anemia in pregnancies complicated by maternal blood group immunization. We first studied normal values for the middle cerebral artery peak systolic velocity in 135 fetuses (Group A), and also in 23 fetuses at risk for anemia who underwent 56 cordocenteses to assess the fetal hematocrit (Group B). A test to detect fetal anemia, based on the middle cerebral artery peak systolic velocity, was developed by using the data of the fetuses of Group A and Group B. Successively, the middle cerebral artery peak systolic velocity was prospectively determined in 16 fetuses at risk for anemia who underwent 42 cordocenteses (Group C) to assess the test developed, in a multicenter prospective fashion, by using the data of Group A and Group B. In the normal fetuses an exponential model expressed the increase of the middle cerebral artery peak systolic velocity values with advancing gestation. By using the data of the fetuses of Group A and Group B, four zones of anemia risk were identified. In Group C, none of the anemic fetuses had the middle cerebral artery peak velocity below the normal mean value, whereas all of the anemic fetuses had the peak velocity above the normal mean. The middle cerebral artery blood velocity increases with advancing gestation and is a non-invasive method of detecting anemia in pregnancies complicated by maternal blood group immunization. But then see - Obstet Gynecol 1995 Jan;85(1):122-8 Fetal venous, arterial, and intracardiac blood flows in red blood cell isoimmunization. Hecher K, Snijders R, Campbell S, Nicolaides K Harris Birthright Research Centre for Fetal Medicine, Department of Obstetrics and Gynecology, King's College Hospital Medical School, London, United Kingdom. OBJECTIVE: To investigate the effect of anemia on fetal venous, arterial, and intracardiac blood flows. METHODS: Color flow Doppler was used to record flow-velocity waveforms from the atrioventricular valves, ductus venosus, right hepatic vein, inferior vena cava, middle cerebral artery, and descending thoracic aorta from 38 cases of red blood cell isoimmunized pregnancies. Immediately after the Doppler studies, funipuncture was performed and the fetal hemoglobin concentration was measured. RESULTS: Blood flow velocities in the thoracic aorta, middle cerebral artery, and the ductus venosus were increased compared to reference ranges established previously; however, a significant association with the degree of anemia was found only for the velocity in the thoracic aorta. Pulsatility indices in arteries and veins and the ratio of early to late atrioventricular inflow velocities were not significantly different from normal. CONCLUSIONS: Fetal anemia is associated with a hyperdynamic circulation in both arterial and venous vessels. Even in severe anemia, there is no evidence of congestive heart failure. Venous and intracardiac Doppler studies do not provide a clinically useful contribution in the management of red blood cell isoimmunization. am sure more to follow Art
At Sun, 17 Jan 1999, Dr. Matias Elena wrote:
>
-- art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com
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