Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Catalonia, Spain.
Maternal-Fetal Medicine and Therapy Research Center, Evidence-Based Health Care Department, on behalf of the Iberoamerican Research Network in Translational, Molecular and Maternal-Fetal Medicine, Mexico City, Mexico.
Ultrasound Obstet Gynecol. 2019 Dec;54(6):722-731. doi: 10.1002/uog.20273.
To evaluate the performance of fetal middle cerebral artery peak systolic velocity (MCA-PSV) ≥ 1.5 multiples of the median (MoM) for the prediction of moderate-severe anemia, in untransfused and transfused fetuses.
A systematic search was performed to identify relevant observational studies reported in the period 2008-2018 that evaluated the performance of MCA-PSV, using a threshold of 1.5 MoM for the prediction of fetal anemia. Diagnosis of fetal anemia by blood sampling was the reference standard. A hierarchical summary receiver-operating characteristics (hSROC) curve was constructed using random-effects modeling. Subgroup and meta-regression analyses, according to the number of previous intrauterine transfusions, were performed.
Twelve studies and 696 fetuses were included in the meta-analysis. The area under the hSROC curve (AUC) for moderate-severe anemia was 83%. Pooled sensitivity and specificity (95% CI) were 79% (70-86%) and 73% (62-82%), respectively, and positive and negative likelihood ratios were 2.94 (95% CI, 2.13-4.00) and 0.272 (95% CI, 0.188-0.371). When considering only untransfused fetuses, prediction improved, achieving an AUC of 87%, sensitivity of 86% (95% CI, 75-93%) and specificity of 71% (95% CI, 49-87%). A decline in sensitivity for the prediction of moderate-severe anemia by MCA-PSV ≥1.5 MoM was observed (estimate, -5.5% (95% CI, -10.7 to -0.3%), P = 0.039) as the number of previous transfusions increased.
MCA-PSV ≥ 1.5 MoM for the prediction of moderate-severe anemia in untransfused fetuses shows moderate accuracy (86% sensitivity and 71% specificity), which declines with increasing number of intrauterine transfusions. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
评估未输血和输血胎儿中胎儿大脑中动脉收缩期峰值速度（MCA-PSV）≥1.5 个中位数倍数（MoM）预测中重度贫血的性能。
系统检索了 2008 年至 2018 年间发表的评估 MCA-PSV 性能的相关观察性研究，使用 1.5 MoM 作为胎儿贫血预测的阈值。通过采血诊断胎儿贫血作为参考标准。使用随机效应模型构建分层汇总受试者工作特征（hSROC）曲线。根据既往宫内输血次数进行亚组和荟萃回归分析。
共纳入 12 项研究和 696 例胎儿的荟萃分析。hSROC 曲线下面积（AUC）为 83%。汇总的敏感性和特异性（95%CI）分别为 79%（70-86%）和 73%（62-82%），阳性和阴性似然比分别为 2.94（95%CI，2.13-4.00）和 0.272（95%CI，0.188-0.371）。仅考虑未输血胎儿时，预测结果有所改善，AUC 为 87%，敏感性为 86%（95%CI，75-93%），特异性为 71%（95%CI，49-87%）。随着既往输血次数的增加，MCA-PSV≥1.5 MoM 预测中重度贫血的敏感性下降（估计值，-5.5%（95%CI，-10.7 至-0.3%），P=0.039）。
未输血胎儿中 MCA-PSV≥1.5 MoM 预测中重度贫血的准确性中等（敏感性 86%，特异性 71%），随着宫内输血次数的增加而降低。版权所有©2019ISUOG。由 John Wiley & Sons Ltd 出版。
