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Prospective non‐invasive monitoring of pregnancies complicated by red cell alloimmunization
Author(s) -
Iskaros J.,
Kingdom J.,
Morrison J. J.,
Rodeck C.
Publication year - 1998
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.1998.11060432.x
Subject(s) - medicine , amniocentesis , hematocrit , fetus , anemia , blood sampling , gestation , obstetrics , prospective cohort study , pregnancy , surgery , gastroenterology , prenatal diagnosis , genetics , biology
Our purpose was to evaluate the impact of non‐invasive assessment of fetal anemia and anti‐D antibody quantification on the timing and frequency of invasive procedures in pregnancies complicated by rhesus alloimmunization. Nineteen consecutive non‐hydropic pregnancies referred to the fetal medicine center were assigned a prior risk category (none/mild, moderate or severe) and monitored by: (1) serial fetal measurements of umbilical vein maximal flow velocity (UVVmax), liver length and spleen perimeter measurements; and (2) serial anti‐D antibody concentration. Invasive tests for fetal anemia (amniocentesis or fetal blood sampling) were deferred in the absence of abnormal ultra‐sound findings and/or rising antibody levels. In six cases serial non‐invasive tests were normal with stable antibody levels, and no invasive tests were performed; four infants were mildly affected, one was unaffected and one required postnatal exchange transfusion. In the remaining 13 affected cases, amniocentesis was performed in nine cases for: elevated UVVmax alone ( n = 3), elevated UVVmax and an increased antibody level ( n = 2), or normal UVVmax with an increased antibody level (>15 IU/ml) and severe prior risk category ( n = 4). Six fetuses underwent fetal blood sampling (initial hematocrit 9–29%), and five of these had an elevated UVVmax. Liver length and spleen perimeter measurements were increased in only one anemic fetus (hematocrit 13%). Of 17 infants born alive, an elevated UVVmax prior to delivery was predictive of the need for exchange transfusion (six of seven cases with an elevated UVVmax vs. one of ten with a normal UVVmax; χ2 = 5.73, p = 0.017 with Yates' correction). These preliminary data suggest that pregnancies with a mild or no history of fetal anemia may be monitored by a combination of serial antibody quantification and Doppler monitoring of UVVmax. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology