Markov D, Pavlova E, Atanassova D, Diavolov V, Hitrova S, Vakrilova L, Pramatarova T, Slancheva B, Ivanov St
Akush Ginekol (Sofiia). 2015;54(4):67-72.
Rh-isoimmunization is a pathological condition in which the fetal red blood cells of a Rh (+) fetus are destroyed by the isoantibodies of a Rh (-) woman sensitized in a previous event. Despite of the wide spread implementation of anti D-gammaglobolin prophylaxis this is still the most common cause for fetal anemia. Recently, sonographic measurement of the fetal middle cerebral artery peak systolic velocity (MCA-PSV) has been shown to be an accurate non-invasive test to predict low fetal hemoglobin levels. We present a case report of Rh-alloimmunized pregnancy with moderate fetal anemia, followed-up by weekly MCA-PSV measurements.
A 37-year-old Rh (-) negative gravida 3, para 1, without anti-D gammaglobolin prophylaxis in her previous pregnancies, presented at 27+0 weeks of gestation (w.g.) for a routine third trimester scan. Subsequent ultrasound measurements of MCA-PSV confirmed a progressive increase of the peak systolic velocities from 40 to 80 cm/sec, as well as a gradual rise in the anti-D titers. The evidence of developing fetal anemia necessitated elective Caesarean section performed at 35 wg. The neonate was admitted in the intensive care unit and required resuscitation, one exchange blood transfusion and several courses of phototherapy. The patient was discharged two weeks post partum.
There is a strong correlation between the high peak systolic velocities in the middle cerebral artery (MCA-PSV) and the low levels of fetal hemoglobin. The high sensitivity and positive predictive value concerning the development of fetal anemia, as well as its good repeatability, makes this non-invasive test a valuable asset in the management of all pregnancies complicated by severe Rh-alloimmunization.
Rh血型同种免疫是一种病理状态，即Rh（+）胎儿的红细胞被先前致敏的Rh（-）女性的同种抗体破坏。尽管广泛实施了抗D-γ球蛋白预防措施，但这仍是胎儿贫血最常见的原因。最近，超声测量胎儿大脑中动脉收缩期峰值流速（MCA-PSV）已被证明是预测胎儿血红蛋白水平低的一种准确的非侵入性检查。我们报告一例Rh血型同种免疫妊娠合并中度胎儿贫血的病例，并通过每周测量MCA-PSV进行随访。
一名37岁的Rh（-）阴性孕妇，孕3产1，既往妊娠未接受抗D球蛋白预防，在妊娠27+0周时前来进行常规晚期妊娠扫描。随后对MCA-PSV的超声测量证实，收缩期峰值流速从40厘米/秒逐渐增加到80厘米/秒，同时抗D效价也逐渐升高。胎儿贫血进展的证据使得在妊娠35周时进行了择期剖宫产。新生儿被收入重症监护病房，需要复苏、一次换血输血和几个疗程的光疗。患者产后两周出院。
大脑中动脉收缩期峰值流速高（MCA-PSV）与胎儿血红蛋白水平低之间存在密切相关性。该检查对胎儿贫血发生的高敏感性和阳性预测价值，以及良好的可重复性，使其成为管理所有合并严重Rh血型同种免疫妊娠的一项有价值的资产。
