Laura Detti

Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization

Background Invasive techniques such as amniocentesis and cordocentesis are used for diagnosis and treatment in fetuses at risk for anemia due to maternal red-cell alloimmunization. The purpose of our study was to determine the value of noninvasive measurements of the velocity of blood flow in the fetal middle cerebral artery for the diagnosis of fetal anemia. Methods We measured the hemoglobin concentration in blood obtained by cordocentesis and also the peak velocity of systolic blood flow in the middle cerebral artery in 111 fetuses at risk for anemia due to maternal red-cell alloimmunization. Peak systolic velocity was measured by Doppler velocimetry. To identify the fetuses with anemia, the hemoglobin values of those at risk were compared with the values in 265 normal fetuses. Results Fetal hemoglobin concentrations increased with increasing gestational age in the 265 normal fetuses. Among the 111 fetuses at risk for anemia, 41 fetuses did not have anemia; 35 had mild anemia; 4 had moderate anemia; an...

Superior mesenteric artery flow velocity waveforms in small for gestational age fetuses.

The objective of this study was to analyze the superior mesenteric artery flow velocity waveforms in small-for-gestational-age fetuses and to compare its contribution in their management with that already provided by the middle cerebral artery and umbilical artery flow velocity waveforms. Middle cerebral artery, umbilical artery, and superior mesenteric artery flow velocity waveforms were prospectively obtained in 41 small-for-gestational-age fetuses with color Doppler ultrasonography. The pulsatility index was used to quantify the waveforms. Poor perinatal outcome was defined by cesarean section for fetal distress, perinatal death, need for assisted ventilation, and necrotizing enterocolitis. In the small-for-gestational age fetuses, the middle cerebral artery pulsatility index was abnormal in 22/41, the umbilical artery in 26/41, and the superior mesenteric artery in 17/41. Coincident with abnormal umbilical and middle cerebral artery flow velocity waveforms were greater occurrences of poor perinatal outcome. The abnormality of an increased pulsatility index in the superior mesenteric artery velocity waveforms of small-for-gestational-age fetuses suggests greater vascular resistance and an overall reduction in visceral perfusion. However, the study of the superior mesenteric artery only seemed to support the information already provided for by the middle cerebral and umbilical arteries.