Non-invasive diagnosis and follow-up of fetal anemia

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Fetal anemia is a life-threatening condition caused by different illnesses. The only technique to assess the actual degree of fetal anemia, and thus the need for transfusion, is cordocentesis. However, ultrasound examination may be useful to detect fetal anemia, to follow known at-risk fetuses and to ovoid invasive procedures. We have analyzed data collected from case reports, retrospective and prospective studies about ultrasound detection of a fetal anemia. The detection of a single morphological sign of fetal anemia could help to diagnose fetal anemia, but it is not helpful in predicting the severity of the anemia or in monitoring an isoimmunized fetus, because of the large proportion of false-negative results in the presence of severe anemia. The degree of anemia is not the only determining factor in hemodynamic changes. The absence of fetal hydrops does not mean that the hemoglobin level is above 5 g/dl. Signs of cardiac decompensation and cordiomegaly seem to be immediate pre-hydropic changes. Angle-dependent Doppler measurements seem to be a better tool for avoiding invasive procedures. All cases of severe anemia were correctly diagnosed by means of the deceleration angle of the splenic artery. Fetuses with splenic artery peak systolic velocity below the mean for gestational age were not it risk for any degree of anemia. Therefore, it is a useful means of monitoring the rhesus-isoimmunized fetuses. Middle cerebral artery peak systolic velocity was a good predictor of severe anemia with or without the presence of hydrops fetails. Any of these ultrasound measurements requires a certain degree of training and expertise that may not be available outside of referral centers. The ideal combination of morphologic findings and the choice of fetal vessels for Doppler velocimetry assessment remain to be determined. At present, the ultrasound technique cannot completely replace cordocentesis and amniotic fluid bilirubin measurement. The greatest benefit of these techniques lies in patients with severe disease before 27 weeks of gestation, where amniotic fluid bilirubin levels may not be reliable. It could also help when the cause of fetal hydrops is unknown. Further prospective studies are required to discover an ideal ultrasound protocol for monitoring at-risk fetuses.

Original languageEnglish
Pages (from-to)73-82
Number of pages10
JournalUltrasound Review of Obstetrics and Gynecology
Volume2
Issue number2
Publication statusPublished - 2002

Fingerprint

Anemia
Fetus
Cordocentesis
Hydrops Fetalis
Splenic Artery
Amniotic Fluid
Bilirubin
Edema
Prospective Studies
Deceleration
Rheology
Middle Cerebral Artery
Gestational Age
Hemoglobins
Referral and Consultation
Retrospective Studies
Hemodynamics
Pregnancy

Keywords

  • Anemia
  • Diagnosis
  • Fetus

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Radiology Nuclear Medicine and imaging

Cite this

Non-invasive diagnosis and follow-up of fetal anemia. / Hajdú, J.

In: Ultrasound Review of Obstetrics and Gynecology, Vol. 2, No. 2, 2002, p. 73-82.

Research output: Contribution to journalArticle

@article{3f188659c4954713a4bd17a027f18707,
title = "Non-invasive diagnosis and follow-up of fetal anemia",
abstract = "Fetal anemia is a life-threatening condition caused by different illnesses. The only technique to assess the actual degree of fetal anemia, and thus the need for transfusion, is cordocentesis. However, ultrasound examination may be useful to detect fetal anemia, to follow known at-risk fetuses and to ovoid invasive procedures. We have analyzed data collected from case reports, retrospective and prospective studies about ultrasound detection of a fetal anemia. The detection of a single morphological sign of fetal anemia could help to diagnose fetal anemia, but it is not helpful in predicting the severity of the anemia or in monitoring an isoimmunized fetus, because of the large proportion of false-negative results in the presence of severe anemia. The degree of anemia is not the only determining factor in hemodynamic changes. The absence of fetal hydrops does not mean that the hemoglobin level is above 5 g/dl. Signs of cardiac decompensation and cordiomegaly seem to be immediate pre-hydropic changes. Angle-dependent Doppler measurements seem to be a better tool for avoiding invasive procedures. All cases of severe anemia were correctly diagnosed by means of the deceleration angle of the splenic artery. Fetuses with splenic artery peak systolic velocity below the mean for gestational age were not it risk for any degree of anemia. Therefore, it is a useful means of monitoring the rhesus-isoimmunized fetuses. Middle cerebral artery peak systolic velocity was a good predictor of severe anemia with or without the presence of hydrops fetails. Any of these ultrasound measurements requires a certain degree of training and expertise that may not be available outside of referral centers. The ideal combination of morphologic findings and the choice of fetal vessels for Doppler velocimetry assessment remain to be determined. At present, the ultrasound technique cannot completely replace cordocentesis and amniotic fluid bilirubin measurement. The greatest benefit of these techniques lies in patients with severe disease before 27 weeks of gestation, where amniotic fluid bilirubin levels may not be reliable. It could also help when the cause of fetal hydrops is unknown. Further prospective studies are required to discover an ideal ultrasound protocol for monitoring at-risk fetuses.",
keywords = "Anemia, Diagnosis, Fetus",
author = "J. Hajd{\'u}",
year = "2002",
language = "English",
volume = "2",
pages = "73--82",
journal = "Ultrasound Review of Obstetrics and Gynecology",
issn = "0973-614X",
publisher = "Jaypee Brothers Medical Publishers (P) Ltd",
number = "2",

}

TY - JOUR

T1 - Non-invasive diagnosis and follow-up of fetal anemia

AU - Hajdú, J.

PY - 2002

Y1 - 2002

N2 - Fetal anemia is a life-threatening condition caused by different illnesses. The only technique to assess the actual degree of fetal anemia, and thus the need for transfusion, is cordocentesis. However, ultrasound examination may be useful to detect fetal anemia, to follow known at-risk fetuses and to ovoid invasive procedures. We have analyzed data collected from case reports, retrospective and prospective studies about ultrasound detection of a fetal anemia. The detection of a single morphological sign of fetal anemia could help to diagnose fetal anemia, but it is not helpful in predicting the severity of the anemia or in monitoring an isoimmunized fetus, because of the large proportion of false-negative results in the presence of severe anemia. The degree of anemia is not the only determining factor in hemodynamic changes. The absence of fetal hydrops does not mean that the hemoglobin level is above 5 g/dl. Signs of cardiac decompensation and cordiomegaly seem to be immediate pre-hydropic changes. Angle-dependent Doppler measurements seem to be a better tool for avoiding invasive procedures. All cases of severe anemia were correctly diagnosed by means of the deceleration angle of the splenic artery. Fetuses with splenic artery peak systolic velocity below the mean for gestational age were not it risk for any degree of anemia. Therefore, it is a useful means of monitoring the rhesus-isoimmunized fetuses. Middle cerebral artery peak systolic velocity was a good predictor of severe anemia with or without the presence of hydrops fetails. Any of these ultrasound measurements requires a certain degree of training and expertise that may not be available outside of referral centers. The ideal combination of morphologic findings and the choice of fetal vessels for Doppler velocimetry assessment remain to be determined. At present, the ultrasound technique cannot completely replace cordocentesis and amniotic fluid bilirubin measurement. The greatest benefit of these techniques lies in patients with severe disease before 27 weeks of gestation, where amniotic fluid bilirubin levels may not be reliable. It could also help when the cause of fetal hydrops is unknown. Further prospective studies are required to discover an ideal ultrasound protocol for monitoring at-risk fetuses.

AB - Fetal anemia is a life-threatening condition caused by different illnesses. The only technique to assess the actual degree of fetal anemia, and thus the need for transfusion, is cordocentesis. However, ultrasound examination may be useful to detect fetal anemia, to follow known at-risk fetuses and to ovoid invasive procedures. We have analyzed data collected from case reports, retrospective and prospective studies about ultrasound detection of a fetal anemia. The detection of a single morphological sign of fetal anemia could help to diagnose fetal anemia, but it is not helpful in predicting the severity of the anemia or in monitoring an isoimmunized fetus, because of the large proportion of false-negative results in the presence of severe anemia. The degree of anemia is not the only determining factor in hemodynamic changes. The absence of fetal hydrops does not mean that the hemoglobin level is above 5 g/dl. Signs of cardiac decompensation and cordiomegaly seem to be immediate pre-hydropic changes. Angle-dependent Doppler measurements seem to be a better tool for avoiding invasive procedures. All cases of severe anemia were correctly diagnosed by means of the deceleration angle of the splenic artery. Fetuses with splenic artery peak systolic velocity below the mean for gestational age were not it risk for any degree of anemia. Therefore, it is a useful means of monitoring the rhesus-isoimmunized fetuses. Middle cerebral artery peak systolic velocity was a good predictor of severe anemia with or without the presence of hydrops fetails. Any of these ultrasound measurements requires a certain degree of training and expertise that may not be available outside of referral centers. The ideal combination of morphologic findings and the choice of fetal vessels for Doppler velocimetry assessment remain to be determined. At present, the ultrasound technique cannot completely replace cordocentesis and amniotic fluid bilirubin measurement. The greatest benefit of these techniques lies in patients with severe disease before 27 weeks of gestation, where amniotic fluid bilirubin levels may not be reliable. It could also help when the cause of fetal hydrops is unknown. Further prospective studies are required to discover an ideal ultrasound protocol for monitoring at-risk fetuses.

KW - Anemia

KW - Diagnosis

KW - Fetus

UR - http://www.scopus.com/inward/record.url?scp=0036336395&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036336395&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:0036336395

VL - 2

SP - 73

EP - 82

JO - Ultrasound Review of Obstetrics and Gynecology

JF - Ultrasound Review of Obstetrics and Gynecology

SN - 0973-614X

IS - 2

ER -