Contribution of fetal brain MRI in management of severe fetal anemia

Ghesquière, Louise; Houfflin‐Debarge, V.; Verpillat, P.; Fourquet, T.; Joriot, Sylvie; Coulon, C.; Vaast, P.; Garabédian, Charles

doi:10.1016/j.ejogrb.2018.05.044

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…The MERIDIAN study confirmed the added value of in utero MRI in the diagnosis and management of fetal brain abnormalities . MRI gives increased diagnostic certainty in the evaluation of cases of severe fetal anemia, but is more useful in those cases with acute compromise rather than the more chronic alloimmune anemia …”

Section: Short Term Outcomes Of Fetal Anemiamentioning

confidence: 80%

Red cell alloimmunization: A 2020 update

Castleman

Kilby

2020

Prenatal Diagnosis

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Management of maternal red cell alloimmunization has been revolutionized over the last 60 years. Advances in the prevention, screening, diagnosis, and treatment of alloimmune‐induced fetal anemia make this condition an exemplar for contemporary practice in fetal therapy. Since survival is now an expectation, attention has turned to optimization of long‐term outcomes following an alloimmunized pregnancy. In this review, the current management of red cell alloimmunization is described. Current research and future directions are discussed with particular emphasis on later life outcomes after alloimmune fetal anemia.

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Section: Short Term Outcomes Of Fetal Anemiamentioning

confidence: 80%

Red cell alloimmunization: A 2020 update

Castleman

Kilby

2020

Prenatal Diagnosis

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“…A total of 80 articles describing 240 cases were included 16,17,19–96 . The search of MEDLINE and Embase provided a total of 14 991 records, with three additional records identified by hand searching (Fig.…”

Section: Resultsmentioning

confidence: 99%

Antenatal diagnosis of fetal intraventricular hemorrhage: systematic review and meta‐analysis

Dunbar

Woodward

Leijser

et al. 2020

Develop Med Child Neuro

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AIM To determine how the severity of antenatally diagnosed germinal matrix-intraventricular hemorrhage (GMH-IVH) relates to morbidity and mortality, and to explore potential risk factors. METHOD We conducted a systematic review and individual patient data meta-analysis of antenatally diagnosed fetal GMH-IVH. The primary outcomes were mortality and morbidity. Potential associations with clinical factors during pregnancy were explored. Analysis employed Fisher's exact test and logistic regression. RESULTS We included 240 cases from 80 studies. Presence of venous infarction was associated with mortality (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.4-13.25), motor impairment (OR 103.2, 95% CI 8.6-1238), epilepsy (OR 6.46, 95% CI 2.64-16.06), and developmental delay (OR 8.55, 95% CI 2.12-48.79). Shunt placement was associated with gestational age at GMH-IVH diagnosis and in utero progression. Many cases had uncomplicated pregnancies but possible co-occurring conditions included twin gestation, small for gestational age, and congenital anomalies. INTERPRETATION Severity of fetal GMH-IVH, specifically venous infarction, is associated with overall mortality and morbidity. Risk factors for fetal GMH-IVH are poorly understood and controlled studies are required.

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“…This association between fetal anemia and brain lesions might be related to a combination of different factors present in TAPS: blood decreased oxygen-carrying capacity and lower anemic related viscosity in association to increased blood flow; that may result in heart failure (hyperkinetic heart overload) and increased venous central pressure with reduction of venous return. Moreover, the resulting hydrops can lead to hypovolemic hypotension and hyperdynamic circulation, as well as hypoxia/ischemia can contribute to damage cerebral vessels and brain development in donor twins; the alteration of coagulation may also play a role in this pathological circle [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging of intracranial anomalies in pregnancies complicated by twin anemia-polycythemia sequence

Tricca,

Parazzini,

Doneda

et al. 2024

Neuroradiology

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Purpose To describe fetal brain Magnetic Resonance Imaging (MRI) findings in a large series of monochorionic (MC) pregnancies complicated by Twin Anemia-Polycythemia Sequence (TAPS) prenatally diagnosed, so to characterize the potential intracranial complications associated with this condition, their frequency and potential treatment options. Methods This is a retrospective study of MC twin pregnancies complicated by TAPS and undergone fetal MRI in a single institution from 2006 to 2023. MRI control was performed and post-natal ultrasound (US) or MRI were available. Results 1250 MC pregnancies were evaluated in our institution. 50 pregnancies (4%) were diagnosed with TAPS, 29 underwent a fetal brain MRI. 13/29 pregnancies (44.8%) demonstrated brain findings at MRI in at least a twin. Neuroradiological findings were detected in 14/57 twins (24.6%). We detected four main categories of findings: hemorrhagic lesions, T2-weighted white-matter hyperintensities (WMH), brain edema-swelling and venous congestion. Nineteen findings were present in the anemic and three in the polycythemic twins, with a statistically significant ratio between the two groups (p-value = 0.01). Intrauterine MRI follow-up demonstrated the sequalae of hemorrhagic lesions. A complete regression of brain swelling, veins prominence and T2-WMHs was demonstrated after treatment. Postnatal imaging confirmed prenatal features. Conclusions Our work demonstrates that TAPS-related MRI anomalies consisted in edematous/hemorrhagic lesions that occur mostly in anemic rather than in polycythemic twins. Fetoscopic laser surgery could have a potential decongestant role. Therefore, prenatal MRI may help in counselling and management in TAPS pregnancies, especially for the planning of therapy and the monitoring of its efficacy.

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Contribution of fetal brain MRI in management of severe fetal anemia

Cited by 6 publications

References 21 publications

Red cell alloimmunization: A 2020 update

Red cell alloimmunization: A 2020 update

Antenatal diagnosis of fetal intraventricular hemorrhage: systematic review and meta‐analysis

Magnetic resonance imaging of intracranial anomalies in pregnancies complicated by twin anemia-polycythemia sequence

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