The performance of cardio‐biparietal ratio measured by 2D ultrasound in predicting fetal hemoglobin Bart disease during midpregnancy: A pilot study

Traisrisilp, Kuntharee; Sirilert, Sirinart; Tongsong, Theera

doi:10.1002/pd.5478

Cited by 4 publications

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References 22 publications

(26 reference statements)

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“…The objective assessment of fetal cardiomegaly has been proposed in various techniques. The CTR and cardio‐biparietal ratio need 2‐step measurements of the cardiac width and transverse thoracic diameter (CTR) or BPD (cardio‐biparietal ratio), 9,16 in which independent factors such as an inappropriate size of the fetal head or thorax can cause an erroneous interpretation of the fetal heart size. The global sphericity index is a 2‐dimensional measurement of the fetal heart size, cardiac width, and cardiac length 8 .…”

Section: Discussionmentioning

confidence: 99%

“…The measurement of fetal heart size as a ultrasound marker of fetal cardiomegaly is a key approach in the prenatal screening of fetal anemia, specifically from hemoglobin (Hb) Bart or homozygous α‐thalassemia 1 disease, which is the most prevalent in Southeast Asia 1,2 . Various measurement techniques have been proposed for objective evaluations of fetal cardiomegaly, such as the cardiac diameter, cardiac length, cardiac area, cardiac circumference, cardiothoracic ratio (CTR), and global sphericity index 3–9 . In our practice, the technique generally used for fetal heart size measurement is the CTR, calculated by dividing the cardiac transverse diameter by the thoracic transverse diameter.…”

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Fetal Heart Diameter as a Predictor of Hemoglobin Bart Disease at Midpregnancy

Nattawongsiri

Tongprasert

Tongsong

2020

J of Ultrasound Medicine

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Objectives To evaluate the efficacy of the fetal heart diameter (HD) in predicting fetal hemoglobin (Hb) Bart disease at midpregnancy. Methods Video clips of fetal chest ultrasound examinations performed on fetuses at risk of Hb Bart disease at 18 to 22 weeks' gestation were randomly retrieved from our video clip database. The clips were replayed for fetal HD measurements, and the measured HDs were converted to z scores based on the z score model as a function of biparietal diameter. An HD z score greater than 2 or an actual HD value above the 95th percentile for gestational age was used as a cutoff in predicting Hb Bart disease. The best cutoff value of HD for identifying affected fetuses during midpregnancy was also evaluated by a receiver operating characteristic curve. Results A total of 90 video clips, including 37 affected and 53 unaffected fetuses, were measured. An HD z score greater than 2 had sensitivity of 94.6% (95% confidence interval [CI], 81.8%–99.3%) and specificity of 84.9% (95% CI, 72.4%–93.3%). An actual HD value above the 95th percentile for gestational age had sensitivity of 100% (95% CI, 90.5%–100%) and specificity of 69.8% (95% CI, 55.7%–81.7%). The best cutoff values of the HD z score and actual HD value were 2.27 (with sensitivity of 94.6% and specificity of 88.7%) and 18.15 mm (with sensitivity of 91.9% and specificity of 77.4%), respectively. Conclusions The fetal HD is highly effective in predicting fetal Hb Bart disease among fetuses at risk at midpregnancy. Both the HD z score and the actual value can be used for noninvasive prenatal screening of fetal cardiomegaly in clinical practice.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Fetal Heart Diameter as a Predictor of Hemoglobin Bart Disease at Midpregnancy

Nattawongsiri

Tongprasert

Tongsong

2020

J of Ultrasound Medicine

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Foetal haemodynamic response to anaemia

et al. 2020

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This study aims to update new knowledge regarding foetal cardiovascular response to anaemia, using foetal haemoglobin Bart's disease as a study model. Original research articles, review articles, and guidelines were narratively reviewed and comprehensively validated. The main foetal cardiovascular changes in response to anaemia are consequences of hypervolaemia and increased cardiac output to meet tissue oxygen requirement. New challenging insights are as follows: (i) the earliest morphological change is an increase in cardiac size and remodelling of the sphericity (an increase in diameter more pronounced than that in long axis) followed by several markers, such as placentomegaly and hepatosplenomegaly. (ii) The earliest functional change is increased peak systolic velocity of the red blood cells because of low viscosity, especially in the middle cerebral artery. (iii) The foetal heart has very high reserve potentials to cope with anaemia: increasing workload without increased central venous pressure and increased myocardial performance without compromising shortening fraction. This hard-working period with good performance lasts long, including most part of the second and third trimester. (iv) At the time cardiomegaly myocardial cellular damage has already occurred, in spite of good cardiac function. (v) Anaemic hydrops foetalis is mainly due to hypervolaemia, hypoalbuminaemia, and high vascular permeability, not heart failure. (vi) Foetal heart failure occurs only when the adaptive mechanism becomes exhausted or long after the development of anaemic hydrops foetalis. Heart failure is a very late result of a longstanding overworked heart. (vii) Ultrasound is highly effective in the detection of foetal response to anaemia. An increase in cardiac size and middle cerebral artery is very helpful in predicting the affected foetuses in pre-hydropic phase. (viii) Theoretically, intrauterine treatment of anaemic hydrops results in satisfactory outcomes as long as cardiac function is normal, but intrauterine intervention should be strongly considered in pre-hydropic phase because myocardial cell damage could have already occurred in this phase or early hydropic phase. Anaemic hydrops foetalis is not primarily caused by heart failure as commonly advocated, but it is rather a consequence of hypervolaemia, hypoalbuminaemia, and high vascular permeability while heart failure is a very late consequence of a longstanding overworked heart. New insights gained from this review may be useful to base clinical practice on which sonographic markers imply significant pathological changes, how ultrasound can be helpful in early detection of anaemic response, when intrauterine transfusion for anaemia due to non-lethal causes should be administered, etc.

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Ultrasound Features of Fetal Anemia Lessons From Hemoglobin Bart Disease

Thammavong

Luewan

Wanapirak

et al. 2020

J of Ultrasound Medicine

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Insights gained from this review are as follows: (1) Ultrasound is highly effective in early detection of fetal hemoglobin (Hb) Bart disease. (2) The most sensitive parameters in predicting Hb Bart anemia appear to be the cardiac diameter–to–thoracic diameter ratio, middle cerebral artery peak systolic velocity, and placental thickness. (3) Several other ultrasound markers are helpful in increasing specificity, such as hepatosplenomegaly. (4) Hydrops fetalis is not a consequence of heart failure but rather of hypervolemia and high vascular permeability of fetuses, whereas heart failure is a very late consequence of a long‐standing overworked heart. (5) Management guidelines for fetuses at risk of Hb Bart disease are proposed.

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The performance of cardio‐biparietal ratio measured by 2D ultrasound in predicting fetal hemoglobin Bart disease during midpregnancy: A pilot study

Cited by 4 publications

References 22 publications

Fetal Heart Diameter as a Predictor of Hemoglobin Bart Disease at Midpregnancy

Fetal Heart Diameter as a Predictor of Hemoglobin Bart Disease at Midpregnancy

Foetal haemodynamic response to anaemia

Ultrasound Features of Fetal Anemia Lessons From Hemoglobin Bart Disease

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