The value of Doppler determination of the maximum systolic blood flow velocity in the middle cerebral artery in the diagnosis of fetal anemia due to Rh-incompatibility in pregnancy
Timely and accurate diagnosis of fetal anemia due to immune incompatibility during pregnancy is of great importance in choosing the most rational tactics of pregnancy management, treatment options, and delivery methods and time. To successfully solve this problem, Doppler data are currently used to determine the maximum systolic blood flow velocity in the middle cerebral artery, which is measured using the tables specially drawn up by G. Mari et al. for this purpose. Similar tables using the same procedure were made by the authors (V.N. Demidov et al.). However, the authors’ studies have shown that the procedures used by foreign authors to calculate the blood flow velocity significantly overestimate its values in fetuses with moderate fetal hemolytic disease, unjustifiably transferring them to a severe patient group. This eventually leads either to a more frequent unjustified delivery or to unjustified cordocentesis. Instead of determining the maximum systolic blood flow velocity in the middle cerebral artery, the foreign authors presently propose to calculate an indicator, such as MoM, that is the quotient of the individual blood flow velocity by its average statistical value for each gestational age. However, from the author’s point of view, the certain disadvantage of this method is that the practitioner usually does not know what this indicator is, and acts, without understanding the essence of the phenomenon being studied. Moreover, MoM does not improve diagnostic accuracy at all, because it fully reflects the same process as blood flow velocity. The advantages of determining the blood flow velocity should include the fact that these indicators are generally accepted and allow a much better study of the essence of the phenomenon under study and especially the time course of its change, which is of great importance in choosing the optimal time of delivery.Demidov V.N.
Keywords
Rh-incompatibility in pregnancy
Doppler ultrasound
assessment of the information content of MoM and maximum systolic blood flow velocity
References
- Сидельникова В.М., Антонов А.Г. Гемолитическая болезнь плода и новорожденного. М.: Триада-Х; 2004.192с. [Sidelnikova V.M., Antonov A.G. Hemolytic disease of the fetus and newborn. Moscow: Triad-X; 2004. 192 p. (in Russian)].
- Ульм Б., Бернашек Г. Иммунная водянка плода, обусловленная резус-конфликтом. В кн.: Мерц Э. Ультразвуковая диагностика в акушерстве и гинекологии. т.1: Акушерство. Пер. с англ. Гус А.И., ред. М.: МЕДпресс-информ; 2011: 220-33. [Ulm B., Bernaschek G. Immune hydrops of the fetus due to rhesus-conflict. In: Merz E. Ultrasound diagnostics in obstetrics and gynecology. Vol.1: Obstetrics. Gus A.I., transl., ed. M.: MEDpress-inform; 2011: 220-33. (in Russian)].
- Айламазян Э.К., Павлова И.Г. Иммунизация при беременности. СПб.: В-П; 2012. 163с. [Aylamazyan E.K., Pavlova I.G. Immunization during pregnancy. St. Petersburg: V-P. 2012; 163 p. (in Russian)].
- Basu S., Kaur R., Kaur G. Hemolytic disease of the fetus and newborn: current trends and perspectives. Asian J. Transfus. Sci. 2011; 5(1): 3-7. https://dx.doi.org/10.4103/0973-6247.75963.
- Савельева Г.М., Коноплянникова А.Г., Курцер М.А., Панина О.Б. Гемолитическая болезнь плода и новорожденного. М.: ГЭОТАР-Медиа; 2012. 143с. [Savelyeva G.M., Konoplyannikov A.G., Kurtzer M.A., Panina O.B. Hemolytic disease of the fetus and newborn. Moscow: GEOTAR-Media; 2012.143p. (in Russian)].
- Резус-иммунизация. В кн.: Савельева Г.М., Серов В.Н., Сухих Г.Т., ред. Клинические рекомендации. Акушерство и гинекология. М.: ГЭОТАР-Медиа; 2015: 153-72. [RH-immunization. Obstetrics and gynecology. Clinical practice guidelines under the editorship of G.M. Savel'eva, V.N. Serov, G.T. Sukhikh. M.: GEOTAR-Media. 2015; 153-72. (in Russian).
- Mari G., Moise K.J. Jr., Deter R.L., Carpenter R.J. Jr. Flow velocity waveforms of the umbilical and cerebral arteries before and intravascular transfusion. Obstet. Gynecol. 1990; 75(4): 584-9.
- Mari G., Moise K.J. Jr., Deter R.L., Kirshon B., Stefos T., Carpenter R.J. Jr. Flow velocity waveforms of the vascular system in the anemic fetus before and after intravascular transfusion for severe red-cell alloimmunization. Am. J. Obstet. Gynecol. 1990; 162(7): 1060-4. https://dx.doi.org/10.1016/0002-9378(90)91315-4.
- Mari G., Adrignolo A., Abuhamad A.Z., Pirhonen J., Jones D.C., Ludomirsky A., Copel J.A. Diagnosis of fetal anemia with Doppler ultrasound in the pregnancy complicated by maternal blood group immunization. Ultrasound Obstet. Gynecol. 1995; 5(6): 400-5. https://dx.doi.org/10.1046/j.1469-0705.1995.05060400.x.
- Мари Г., Детти Л. Использование ультразвуковой допплерометрии для оценки состояния плода. В кн.: Флейшер А., Мэнинг Ф., Дженти П., Ромеро Р. Эхография в акушерстве и гинекологии. Теория и практика. Пер. с англ. М.: Издательский дом Видар-М; 2004; ч. 1: 269-306. [Fleischer A., Manning F., Genti P., Romero R. Use of ultrasound dopplerometry to assess the condition of the fetus. Echography in obstetrics and gynecology. M.: Vidar. 2004; Part One: 269-306. (in Russian)].
- Mari G., Deter R.L., Carpenter R.L., Rahman F., Zimmerman R., Moise K.J. Jr. For the collaborative group for Doppler assessment of the blood velocity in anemic fetuses. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. N. Engl. J. Med. 2000; 342(1): 9-14. https://dx.doi.org/10.1056/NEJM200001063420102.
- Демидов В.Н., Белоусов Д.М., Воронкова М.А., Хорошкеева О.В. Применение допплерографии для оценки выраженности гемолитической болезни плода при Rh-конфликтной беременности. В кн.: Амбулаторно-поликлиническая помощь – в эпицентре женского здоровья. Юбилейный Всероссийский конгресс с международным участием. Сборник тезисов. Москва 18-21 марта 2014. М.: МЕДИ-Экспо; 2014: 36-7. [Demidov V.N., Belousov D.M., Voronkova M.A., Khorosheva O.V. The use of dopplerography to assess the severity of fetal hemolytic disease in Rh-conflict pregnancy. Outpatient care – in the epicenter of women's health. M.: MEDI-Expo. 2014; 36-7. (in Russian)].
- Демидов В.Н. Допплерография. В кн.: Савельева Г.М., Сухих Г.Т., Серов В.Н., Радзинский В.Е., ред. Акушерство. Национальное руководство. М.: ГЭОТАР-Медиа; 2015: 131-7. [Demidov V.N. Dopplerography. Obstetrics. National guide, ed. by G.M. Savel’yeva, G.T. Sukhykh, V.N. Serov, Radzinsky V.E.. M.: GEOTAR-Media. 2015; 131-7. (in Russian)].
Received 26.05.2020
Accepted 02.10.2020
About the Authors
Vladimir N. Demidov, MD, Professor, Department of functional and ultrasound diagnostics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russian Federation. Tel.: +7(910)451-25-68. E-mail: demydow@yandex.ru.4 Ac. Oparina str., Moscow, Russia, 117977.
For citation: Demidov V.N. The value of Doppler determination of the maximum systolic blood flow velocity in the middle cerebral artery in the diagnosis of fetal anemia due to Rh-incompatibility in pregnancy.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2020; 10: 190-194 (in Russian)
https://dx.doi.org/10.18565/aig.2020.10.190-194
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