Middle cerebral artery peak systolic velocity: is it the standard of care for the diagnosis of fetal anemia?

OBJECTIVE: The aim of this work was to review the use of middle cerebral artery peak systolic velocity (MCA PSV) for the diagnosis of fetal anemia.
METHODS: With the use of a computerized database (MEDLINE), articles on the diagnosis of fetal anemia with ultrasonography were reviewed. Other pertinent references were obtained from the references cited in these articles. In addition, my own institution's clinical experience of the past 18 years was reviewed.
RESULTS: Several ultrasonographic parameters have been used to diagnose noninvasive fetal anemia. On the basis of robust data, the MCA PSV is the best ultrasonographic parameter used in the management of fetuses at risk for anemia due to different causes. It is also superior to amniocentesis for the diagnosis of fetal anemia in cases of red cell alloimmunization.
CONCLUSIONS: Middle cerebral artery peak systolic velocity is effective for diagnosis of noninvasive moderate and severe fetal anemia. This parameter should not yet be considered the global standard of care for diagnosis of fetal anemia because incorrect use by an inexperienced operator may cause more harm than good; however, if there is a reasonably close medical center with sonographers or sonologists trained to assess the MCA PSV, patients at risk for fetal anemia should be referred to this center.