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Middle cerebral artery‐peak systolic velocity in dizygotic twins with anti‐E alloimmunization
Author(s) -
Satake Yumiko,
Sato Yukiyasu,
Matsumura Noriomi,
Tatsumi Keiji,
Fujiwara Hiroshi,
Konishi Ikuo
Publication year - 2010
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/j.1447-0756.2010.01314.x
Subject(s) - medicine , middle cerebral artery , gestation , obstetrics , fetus , anemia , twin pregnancy , pregnancy , dizygotic twin , gestational age , twin to twin transfusion syndrome , pediatrics , cardiology , twin study , ischemia , heritability , biology , genetics
Middle cerebral artery‐peak systolic velocity (MCA‐PSV) has been reported to predict fetal anemia with similar accuracy as amniotic ΔOD450 assay. Alloimmunized dizygotic twin pregnancy allows us to compare anemic and non‐anemic twins in the same intrauterine environment. We herein present a case of Rh (E)‐incompatible dizygotic twin pregnancy, where MCA‐PSV could precisely detect the anemia in one of the twins. A 36‐year‐old woman, whose previous child required exchange transfusion due to hemolytic anemia of newborn (HFDN), conceived twins after in vitro fertilization‐embryo transfer. At 24 weeks' gestation, MCA‐PSV of twin A and twin B were 23.9 cm/s (0.8 multiples of median; MoM) and 30.7 cm/s (1.0 MoM), respectively. At 31 weeks' gestation, MCA‐PSV values of both twins were sharply elevated to nearly 1.4 MoM. Thereafter, MCA‐PSV of twin A fell to 1.0 MoM, whereas MCA‐PSV of twin B exceeded 1.5 MoM at 34 weeks' gestation. Development of fetal anemia was suspected and emergency cesarean section was performed. Twin B showed moderate anemia with positive direct Coombs' test and was diagnosed as HFDN due to anti‐E alloimmunization. Twin B required phototherapy and red cell transfusion, but exchange transfusion was safely obviated.