Pereira Leonardo, Jenkins Thomas M, Berghella Vincenzo
Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Am J Obstet Gynecol. 2003 Oct;189(4):1002-6. doi: 10.1067/s0002-9378(03)00771-3.
This study was undertaken to compare management of red blood cell alloimmunization by Doppler measurement of middle cerebral artery peak systolic velocity (MCA-PSV) to conventional management with amniocentesis.
A historical cohort of 28 fetuses at risk for anemia caused by red blood cell alloimmunization was followed between 1999 and 2002 at a single institution. The decision to perform percutaneous umbilical cord blood sampling (PUBS) was based on conventional management. MCA-PSV Doppler was measured before amniocentesis or PUBS but not used clinically.
Twenty-eight fetuses were followed up: 4 had severe anemia, 1 had moderate anemia, 3 had mild anemia, and 20 were nonanemic. Conventional management had a sensitivity and positive predictive value for moderate-to-severe anemia of 80% and 44%, with a false-positive rate of 56%. In the same patients, MCA-PSV Doppler had a sensitivity and positive predictive value for moderate-to-severe anemia of 100% and 71%, with a false-positive rate of 28%.
Compared with conventional management, MCA-PSV Doppler may have a better predictive accuracy for moderate-to-severe fetal anemia in red blood cell alloimmunization. Management by MCA-PSV Doppler may eliminate the need for amniocentesis and reduce the number of PUBS performed in red blood cell-alloimmunized pregnancies.
本研究旨在比较通过测量大脑中动脉收缩期峰值流速（MCA-PSV）进行多普勒检查与采用羊膜腔穿刺术的传统方法对红细胞同种免疫的管理效果。
1999年至2002年在一家机构对28例因红细胞同种免疫而有贫血风险的胎儿进行了历史性队列研究。经皮脐血采样（PUBS）的决策基于传统管理方法。在进行羊膜腔穿刺术或PUBS之前测量MCA-PSV多普勒值，但未用于临床。
对28例胎儿进行了随访：4例有严重贫血，1例有中度贫血，3例有轻度贫血，20例无贫血。传统管理方法对中度至重度贫血的敏感性和阳性预测值分别为80%和44%，假阳性率为56%。在同一批患者中，MCA-PSV多普勒检查对中度至重度贫血的敏感性和阳性预测值分别为100%和71%，假阳性率为28%。
与传统管理方法相比，MCA-PSV多普勒检查对红细胞同种免疫导致的中度至重度胎儿贫血可能具有更好的预测准确性。采用MCA-PSV多普勒检查进行管理可能无需进行羊膜腔穿刺术，并减少红细胞同种免疫妊娠中PUBS的实施次数。
