D Arora1, T K Bhattacharyya2, S K Kathpalia3, Sps Kochar4, G S Sandhu5, B K Goyal6. 1. Reader, Maternal & Foetal Medicine Specialist, Armed Forces Medical College, Pune - 411040. 2. Professor & Head, Armed Forces Medical College, Pune - 411040. 3. Senior Advisor (Obstetrics and Gynaecology), CH (Central Command), Lucknow. 4. Associate Professor & Gynaecologic Oncologist, Armed Forces Medical College, Pune - 411040. 5. Reader (Obstetrics and Gynaecology), Armed Forces Medical College, Pune - 411040. 6. Classified Specialist (Obstetrics and Gynaecology), AH R & R, Delhi Cantt.
Abstract
BACKGROUND: The aim of this study was to assess the role of middle cerebral artery peak systolic velocity (MCA-PSV), as measured by doppler ultrasound, in detecting foetal anaemia in Rh- isoimmunised pregnancies. Intra-uterine foetal blood transfusion was performed in such anaemic foetuses to tide over the crisis of foetal immaturity till considered fit for extra-uterine survival. METHODS: Rh-isoimmunised pregnancies reporting to a tertiary institute from 2003 to 2005, were screened by doppler ultrasound to estimate MCA-PSV to detect foetal anaemia. If the foetus developed MCA-PSV of more than 1.5 multiple of median (MoM) for the gestational age, foetal blood sampling through cordocentesis was performed to confirm foetal anaemia, followed by intrauterine foetal blood transfusion to all anaemic foetuses at the same sitting. Neonatal outcome was evaluated by recording gestational age at the time of delivery, duration of gestational time gained and need for blood transfusion in the neonatal period. RESULTS: A total of thirteen isoimmunised pregnancies were evaluated. Three pregnancies did not require in-utero foetal blood transfusion. Twenty-one intrauterine foetal blood transfusions were performed in the remaining ten patients. Five received blood transfusion in the neonatal period. Intra uterine foetal death occurred in one grossly hydropic foetus and favourable neonatal outcome was recorded in the rest. CONCLUSION: The clinical outcome of these pregnancies justifies the use of doppler studies of MCA-PSV in detecting foetal anaemia and intra uterine foetal blood transfusion is the only hope of prolonging pregnancy and salvaging such foetuses.
BACKGROUND: The aim of this study was to assess the role of middle cerebral artery peak systolic velocity (MCA-PSV), as measured by doppler ultrasound, in detecting foetal anaemia in Rh- isoimmunised pregnancies. Intra-uterine foetal blood transfusion was performed in such anaemic foetuses to tide over the crisis of foetal immaturity till considered fit for extra-uterine survival. METHODS: Rh-isoimmunised pregnancies reporting to a tertiary institute from 2003 to 2005, were screened by doppler ultrasound to estimate MCA-PSV to detect foetal anaemia. If the foetus developed MCA-PSV of more than 1.5 multiple of median (MoM) for the gestational age, foetal blood sampling through cordocentesis was performed to confirm foetal anaemia, followed by intrauterine foetal blood transfusion to all anaemic foetuses at the same sitting. Neonatal outcome was evaluated by recording gestational age at the time of delivery, duration of gestational time gained and need for blood transfusion in the neonatal period. RESULTS: A total of thirteen isoimmunised pregnancies were evaluated. Three pregnancies did not require in-utero foetal blood transfusion. Twenty-one intrauterine foetal blood transfusions were performed in the remaining ten patients. Five received blood transfusion in the neonatal period. Intra uterine foetal death occurred in one grossly hydropic foetus and favourable neonatal outcome was recorded in the rest. CONCLUSION: The clinical outcome of these pregnancies justifies the use of doppler studies of MCA-PSV in detecting foetal anaemia and intra uterine foetal blood transfusion is the only hope of prolonging pregnancy and salvaging such foetuses.
Authors: G Mari; R L Deter; R L Carpenter; F Rahman; R Zimmerman; K J Moise; K F Dorman; A Ludomirsky; R Gonzalez; R Gomez; U Oz; L Detti; J A Copel; R Bahado-Singh; S Berry; J Martinez-Poyer; S C Blackwell Journal: N Engl J Med Date: 2000-01-06 Impact factor: 91.245
Authors: Laura Detti; Giancarlo Mari; Masashi Akiyama; Erich Cosmi; Kenneth J Moise; Theodor Stefor; Mark Conaway; Russell Deter Journal: Am J Obstet Gynecol Date: 2002-10 Impact factor: 8.661
Authors: C P Weiner; R A Williamson; K D Wenstrom; S L Sipes; J A Widness; S S Grant; L Estle Journal: Am J Obstet Gynecol Date: 1991-11 Impact factor: 8.661