Reassuring Fetal Middle Cerebral Artery Doppler Velocimetry in Alloimmunised Pregnancies: Neonatal Outcomes without Invasive Procedures

Abstract

Objective: To assess the neonatal outcome in red blood cell alloimmunised pregnancies at increased risk of fetal anaemia where invasive testing was avoided based on reassuring middle cerebral artery (MCA) Doppler velocity results. Methods: We included 28 alloimmunised pregnant women at significant risk of fetal or neonatal anaemia who did not have invasive testing because of reassuring MCA Doppler velocimetry. Women requiring invasive testing or intrauterine transfusion were excluded. Outcome measures were admission to neonatal intensive care unit, cord haemoglobin and bilirubin levels and neonatal therapy. Results: Ten neonates (36%) were anaemic at birth while 18 (64%) had normal haemoglobin. Seven neonates (25%) did not require any form of neonatal therapy, 10 (36%) had phototherapy only, 7 (25%) required exchange transfusions and 4 (14%) top-up transfusions. There were no treatment-related complications. Mean cord haemoglobin was 13.9 g/dl (range 7–18.9) and mean bilirubin was 84.1 µmol/l (range 29–192). Conclusion: Avoiding invasive procedures in pregnancies at risk of fetal anaemia by relying on reassuring MCA Doppler velocimetry did not result in life-threatening fetal or neonatal morbidities. The extent of neonatal therapy was acceptable. The routine use of this test can lead to less unnecessary invasive procedures in at-risk fetuses.

Fetal middle cerebral artery Doppler to time intrauterine transfusion in red‐cell alloimmunization: a randomized trial

“…A study from the UK followed 28 women with alloimmunized pregnancies by means of MCA‐PSV. Reported neonatal complication rates were lower than those identified in our trial, with 36% of infants requiring phototherapy for jaundice, 25% an exchange transfusion and 14% a top‐up transfusion.…”

Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery

“…In this report, the critical time for foetal distress had an early onset between 32 and 35 weeks of gestation. In our experience, anaemia, measured by Doppler assessment of foetal middle cerebral artery peak systolic velocity, as described in the literature [11], has proved to be a useful criterion for severity of foetal distress, with a non-invasive technique of measurement. The association with cystic fibrosis has to be considered in prenatal counselling for all the suspected cases of meconium peritonitis, including the simple form.…”

“…Surgery consists of urgent abdominal drainage followed by short-segment bowel resection at the level of persistent intestinal perforation, intestinal temporary diverting methods, and intestinal reversal a few weeks later. Laparotomy results in immediate decompression of the abdomen, improvement of the respiratory pattern, and prevention of future perforation of distended bowel loops [11]. Early postnatal surgery within the first day of life seems to be advisable.…”

“…In light of these suggestions, no other radiological examination, such as CT scans or MRI, were performed in our patients because the prenatal images already contained all of literature's criteria to diagnose the complex form of MP. Some authors report that no obvious perforation is noticed at laparotomy, but it is probably hidden by the presence of generalised adhesions, huge cystic masses, major degree meconium ascites and the weakness of the foetal bowel loops [11,12].…”