Have Liley charts outlived their usefulness?

Nicolaides, Kypros H.; Rodeck, CH; Mibashan, R. S.; Kemp, J.R.

doi:10.1016/0002-9378(86)90085-2

Cited by 165 publications

(37 citation statements)

References 14 publications

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“…In addition, if the results of both amniocentesis and fetal blood sampling are normal, the timing of repeat sampling is arbitrarily determined. Finally, the value of amniocentesis has recently been questioned 9 . Umbilical fetal blood sampling, the gold standard for identifying fetuses with severe anaemia, has a risk of acute preterm delivery and an abortion risk of at least 1% per procedure even in experienced hands 10 .…”

Section: Introductionmentioning

confidence: 99%

Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention-to-treat

Zimmermann¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery combined with B-mode ultrasound imaging to predict anaemia in an unselected population of pregnancies complicated by alloimmune antibodies known to cause immunological hydrops. Design Prospective study on an intention-to-treat basis.Setting Multicentre study in five large tertiary referral centres.Population One hundred twenty-five fetuses with maternal alloantibodies known to cause immunological hydrops. Methods If peak systolic velocity and B-mode scan were reassuring the pregnancy was monitored at 7 -14 days interval. If either method showed signs of anaemia, an umbilical fetal blood sampling was performed. When the gestational age was greater than 35 weeks, labour was induced. Main outcome measure Moderate to severe anaemia at delivery.Results Overall sensitivity to detect moderate to severe anaemia below 35 weeks (haemoglobin level below 0.65 multiples of median) was 88%. Specificity was 87%; positive predictive value was 53% and negative predictive value was 98%. The diagnosis of severe anaemia was missed in one fetus; however, the final outcome was good. The method was not useful after 35 weeks. Conclusions Middle cerebral artery peak systolic velocity is a highly sensitive non-invasive means for determining the degree of anaemia present in red blood cell alloimmunised pregnancies. The widespread use of the Doppler method will minimise fetal complications associated with amniocentesis and fetal blood sampling. Non-invasive measurement of middle cerebral artery peak systolic velocities is more convenient and acceptable to alloimmunised pregnancies and may significantly lower health care costs. A Doppler interval of seven days is recommended.

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Section: Introductionmentioning

confidence: 99%

Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention-to-treat

Zimmermann¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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“…Clinical decisions are reached after weighing the risks and benefits of all investigations and procedures and so are dependent largely on the experience and skills of individual clinicians. For example, the use of optic density (OD 450 ) to assess amniotic fluid bilirubin in the midtrimester has been considered to be of limited usefulness by some [8], but not others [9].…”

Section: Introductionmentioning

confidence: 99%

Management of Anti-Rhesus-D Antibodies in Pregnancy: A Review from 1994 to 1998

Cheong

Goodrick²,

Kyle³

et al. 2001

Fetal Diagn Ther

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Objective: To review our management of anti-Rhesus-D antibodies in pregnancy over a 5-year period in order to assess possible changes in the management or prognosis which may have developed with time. Method: Retrospective analysis of prospectively collected data from 31 pregnancies with maternal anti-D levels >4 IU/ml and in which the fetus was Rhesus positive. Results: There were a total of 30 amniocenteses, 8 cordocenteses, and 54 fetal blood transfusions performed. When undertaken as the first procedure, the mean gestational age at amniocentesis was 30 weeks as compared with 25 weeks for fetal blood sampling/transfusion (p < 0.05). The median anti-D level at the first procedure was 24 IU/ml for amniocentesis and 64 IU/ml for fetal blood sampling. Of the 54 blood transfusions, 43 were intravascular, 4 were intraperitoneal, and 7 transfusions were both intravascular and intraperitoneal. Conclusions: Intravascular as opposed to intraperitoneal transfusions were found to be the main method of transfusion in the later years in this study, a finding which was expected with improved sonographic equipment. Apart from this, management and prognosis of anti-D red cell isoimmunisation in pregnancy have remained relatively stable since the 1980s. Amniocentesis was useful in the management of such pregnancies, especially as an initial procedure in the cases with a lower initial anti-D level. In this series 90% of the fetuses requiring blood transfusion, but were without hydrops, survived, whereas this was about 70%, if they had become hydropic (this latter figure was reduced by 2 hydropic deaths before 20 weeks’ gestation in the same very severely affected woman).

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“…If the fetus has no signs of anemia, the patient has repeat ultrasound examination and amniocentesis approximately every second week until term. At hydrops, fetal anemia (<9 g/dl, below 2 SD from mean value), 50,51 or if ∆OD is in zone 3 according to Liley's chart, intrauterine fetal blood transfusion or preterm delivery is considered. At King Faisal Specialist Hospital, intrauterine transfusions have been performed from the 20th week of gestation, and these patients later require additional transfusions with five-to 20-day intervals until a safe delivery can be expedited in the 32nd to 33rd week of gestation.…”

Section: Management Of Isoimmunized Patients At King Faisal Specialismentioning

confidence: 99%

Improved Care for Rh-Isoimmunized Patients in Saudi Arabia

Westgren

1988

Ann Saudi Med

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Although the number of patients with Rh isoimmunization in pregnancy has been decreasing in recent years, this category of patients contributes significantly to the perinatal mortality in Saudi Arabia. Recent advances in obstetric ultrasound and immunology have added new knowledge on how to manage this category of patients, and today almost all Rh-affected fetuses are potentially salvageable. This article presents these advances and discusses the implications they might have on perinatal care in Saudi Arabia.

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Have Liley charts outlived their usefulness?

Cited by 165 publications

References 14 publications

Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention-to-treat

Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention-to-treat

Management of Anti-Rhesus-D Antibodies in Pregnancy: A Review from 1994 to 1998

Improved Care for Rh-Isoimmunized Patients in Saudi Arabia

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