Pares David, Chinen Paulo A, Camano Luiz, Moron Antonio F, Torloni Maria R
Fetal Medicine Unit, Obstetrics Department, São Paulo Federal University Medical School, São Paulo, Brazil.
Arch Gynecol Obstet. 2008 Jul;278(1):27-31. doi: 10.1007/s00404-007-0522-2. Epub 2007 Dec 8.
Despite significant advances, perinatal hemolytic disease has not been eradicated and is still associated with significant morbidity and mortality, especially in developing countries. An accurate method for antenatal diagnosis and quantification of fetal anemia is a crucial step prior to the performance of invasive procedures, which are not risk-free. The middle cerebral artery peak systolic velocity (MCA-PSV) is currently the most popular non-invasive diagnostic method used to quantify fetal anemia and determine the exact timing for transfusion The combined use of MCA-PSV and descending thoracic aorta mean velocity (DTA-MV) has not been previously evaluated. Since this strategy has the potential to decrease false positive results it could reduce unnecessary cordocenteses, therefore minimizing fetal risks. This study aimed to evaluate the accuracy of MCA-PSV associated with DTA-MV in the prediction of fetal anemia.
Retrospective analysis of 90 cordocenteses performed on alloimmunized pregnancies in a single hospital MCA-PSV and DTA-MV were performed immediately before cordocentesis. The Dopplervelocimetry findings were compared with fetal hemoglobin concentration. Sensitivity, specificity, positive and negative predictive values and accuracy of MCA-PSV and DTA-MV in the prediction of moderate/severe fetal anemia were calculated.
The individual sensitivity of MCA-PSV and DTA-MV was 100 and 95.7%, specificity was 65 and 100% and accuracy was 92.2 and 96.7%, respectively. The combination of both vessels produced a higher overall accuracy (98.6%).
MCA-PSV is more sensitive and DTA-MV is more specific in the detection of fetal anemia. The highest diagnostic accuracy was obtained by the association of both Doppler evaluations.
尽管取得了重大进展，但围产期溶血病尚未根除，仍然与显著的发病率和死亡率相关，尤其是在发展中国家。在进行并非没有风险的侵入性操作之前，准确的产前诊断和定量胎儿贫血的方法是关键步骤。大脑中动脉收缩期峰值流速（MCA-PSV）是目前用于定量胎儿贫血和确定输血确切时机的最常用非侵入性诊断方法。此前尚未评估MCA-PSV与胸降主动脉平均流速（DTA-MV）的联合使用。由于这种策略有可能降低假阳性结果，它可以减少不必要的脐带穿刺，从而将胎儿风险降至最低。本研究旨在评估MCA-PSV联合DTA-MV预测胎儿贫血的准确性。
对一家医院对同种免疫妊娠进行的90次脐带穿刺进行回顾性分析。在脐带穿刺前立即测量MCA-PSV和DTA-MV。将多普勒测速结果与胎儿血红蛋白浓度进行比较。计算MCA-PSV和DTA-MV预测中度/重度胎儿贫血的敏感性、特异性、阳性和阴性预测值以及准确性。
MCA-PSV和DTA-MV的个体敏感性分别为100%和95.7%，特异性分别为65%和100%，准确性分别为92.2%和96.7%。两种血管联合使用产生了更高的总体准确性（98.6%）。
MCA-PSV在检测胎儿贫血方面更敏感，DTA-MV更具特异性。两种多普勒评估联合使用可获得最高的诊断准确性。
